How Long Should Therapy Last?
The duration of therapy varies depending on the type of therapy, individual needs, goals, and progress. According to the American Psychiatric Association (APA), therapy duration is flexible and should be determined collaboratively between the therapist and client.[1] However, the APA also reports that between 15 and 20 sessions are often required for half of clients to experience improvement. [2]
When the fathers of psychotherapy started working over 100 years ago, it was normal for clients to be in therapy for many years, often several times each week, in an open-ended arrangement with no clear goals. It was considered necessary.
These practitioners were seeking a significant change in their clients’ basic character yet believed that significant change was unlikely because people were cast according to their personalities to continue to live out a life dominated by their emotions and neuroses.
Therapy was viewed as having an almost “timeless” quality that is always benign and useful. Therapists believed that therapy was the most important aspect of a client’s life.
Around 40 years ago, there came a new generation of therapists who realized that only a few—often only one—sessions were necessary to create change.
With a few well-chosen words, a positive, optimistic view, and a set of attitudes about the change process, they demonstrated that therapy does not have to be timeless to be effective.
Employing a pragmatic approach with minimal intervention, they gave up the idea of a “cure” and, instead, recognized psychological change as an ongoing, inevitable process. Therapy can be a catalyst that the client embeds into their thinking and attitude. These practitioners also acknowledge that some therapeutic approaches—particularly those that require repeated exposure to traumatic events—have the potential to be harmful.
Research repeatedly shows how efficacious brief therapy can be for the whole range of emotional and mental health issues, from depression to addiction and codependency.
Average Therapy Durations for Common Mental Health Disorders
The duration of therapy for common mental health issues varies depending on factors such as:
- The severity of the condition
- Individual progress
- Treatment approach
- The presence of co-occurring conditions
However, research provides some insight into therapy durations for various types of care and mental health illness. Keep in mind that these treatment lengths are simply averages and that the duration of therapy is highly individualized.
As Dr. Brindusa Vanta, MD, says, “From a therapist’s perspective, the duration of therapy depends not only on the condition, its severity, or therapeutic approaches, but also on factors such as the client’s readiness for change, engagement, and the quality of the therapeutic relationship. All these factors impact effectiveness. Flexibility in duration allows for a personalized treatment plan.”
Depression and CBT
Depression is commonly treated with cognitive behavioral therapy (CBT), a form of therapy that analyzes the connection between thoughts, feelings, and behaviors to create positive change.
Based on clinical guidelines and research studies, the average duration of CBT for depression is between 12 to 20 sessions.
A 2023 meta analysis concluded that CBT has moderate to large effects in treating depression compared to usual care and waiting for treatment. These effects remained significant even after 6-12 months. Furthermore, CBT showed similar effectiveness to medication in the short term but was more effective in the long term. Combining CBT with medication was more effective than medication alone in both the short and long term.
Therapy for Anxiety Disorders Anxiety and Panic Disorder
According to a 2018 meta-analysis, about half of patients seeking treatment for anxiety achieve remission status after undergoing CBT. Remission rates vary among anxiety disorders: Post-traumatic stress disorder (PTSD) and generalized anxiety disorder (GAD) show the highest rates (53% and 51%). In comparison, social anxiety disorder (SAD) and obsessive-compulsive disorder (OCD) have the lowest (40% and 38%). The average length of cognitive behavioral therapy (CBT) for various anxiety disorders typically ranges from 12 to 16 sessions.
Co-occurring disorders involve comorbid mental health conditions, such as depression and PTSD or bipolar disorder and substance use disorder. Co-occurring disorders, or dual diagnoses, are more complicated to treat and require an integrated approach.
Research shows that co-occurring conditions may require longer bouts of treatment than a single mental health disorder. People may need 12 to 18 months of therapy to experience symptom reduction and an improvement in functioning.[1]
Factors That Affect the Length of Therapy
Treatment duration varies based on individual needs, the nature of the mental health condition, and the severity of the symptoms. Acute problems usually require fewer sessions than chronic issues. The type of therapy also influences duration. For example, focused CBT is usually shorter than other forms of psychotherapy. It is essential to match the therapy with the individual’s needs.[2]
Some things to consider when agreeing on a treatment duration with a therapist include:[2]
- The longer you are in therapy, the better the treatment outcome.
- Treatment length should be collaborative and discussed with your therapist.
- Treatment length is usually tentative and will be re-evaluated throughout therapy.
- Therapy ends when the client has achieved the goals they agreed upon with the provider.
The Use of Intermittent Therapy
Some therapists opt for the model of long-term psychotherapy. Yet research repeatedly shows how efficacious brief therapy can be for the whole range of emotional and mental health issues, from depression to addiction and codependency.
However, there is now increasing recognition being given to the middle-road approach, called intermittent therapy. In this model, the client comes for an initial few sessions, which may be one, two, six, or 10, and then comes back to the therapist for a “top-up” as and when they require it. This may be fortnightly, monthly, six times a year, or annually. The client decides how frequently to book a session and feels empowered by having control rather than being told how many sessions are required to resolve the issue and create change.
Intermittent therapy is a pragmatic way to manage client and therapist expectations. It is oriented toward improvement rather than cure (although major change happens) and offers a flexible and broad array of methodologies and possibilities for treatment. It is increasingly an attempt to capture and understand the core interpersonal life issues that have led the client to seek help.
[Modern therapists] will talk about the problem as having clearly defined parameters and separate it from the client as rapidly as possible by talking about it in the third person. “What does the depression make you do?”
These modern therapists see themselves as collaborators working with the client and often engage in “psych-Ed” to help the client become better informed about their problem and the way to resolve it. Like brief therapists, an intermittent therapist will focus on a client’s strengths and successes and build a client’s expectation that the issue is resolvable. They will talk about the problem as having clearly defined parameters and separate it from the client as rapidly as possible by talking about it in the third person. “What does the depression make you do?” With positive expectancy and acknowledgment of the client’s successes, a healthy relationship is established in which the client feels encouraged to return if the need arises.
By making themselves available indefinitely but on an “as-and-when” basis, the clients feel nurtured and better understood—the therapy reflects their real-life experience more closely.
Sessions are often longer than the old-school psychotherapists offered, too. In the early days, the “50-minute hour” became established as the norm. This works well for the practitioner who can squeeze a greater number of clients into each day but not so well for the clients who often report that they felt that the session was just getting underway when they were told it was over.
Many of today’s therapists offer a 75-minute session and allow themselves 15 minutes between clients for self-care and refreshment. Both therapist and client feel less rushed, and issues can be explored in greater depth. Also, clients feel that they really have the therapist’s attention. They like that the therapist is more concerned with building their resources to deal with life’s situations and does not talk about pathology.
As Dr. Brindusa Vanta, MD, says, “Intermittent psychotherapy gives clients control over their sessions. It encourages clients to actively participate in the therapeutic process. However, it can lead to gaps in treatment and therefore may affect therapeutic continuity and consistency.”
Sources
- American Psychological Association. (2023). Understanding psychotherapy and how it works. Retrieved from https://www.apa.org/topics/psychotherapy/understanding.
- American Psychological Association. (2017). How Long Will It Take for Treatment to Work? Retrieved from https://www.apa.org/ptsd-guideline/patients-and-families/length-treatment
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