How long does counseling or therapy take?

Several things affect how long, or how many appointments clients require. You have probably hear of some individuals who have been going to therapy continuously, every week or so, for several years. This is a fairly with an approach like long-term psychoanalysis. However, most therapists have learned to use briefer forms of therapy. This is due in part, to the fact that insurance companies like to limit the number of sessions they are willling to pay for. However, it is very clear based on a large number of quality research studies that the rate of improvement in counseling often starts to decrease after about five to six appointments.

A second factor involved in determining the duration of therapy is the severity of your condition, and the number of problems you face. Relatedly, whether or not a particular diagnosis tends to be chronic is most strongly associated with long-term therapy. So, for example, bereavement episodes tend to be shorter term in duration than a condition like true bipolar disorder, which is often a life-long condition. Also, some problems such as addictions (alcohol, pathological gambling), tend to involve a great many relapses along one’s way toward recovery. Furthermore, in many cases, when one’s life situation suddenly changes for the better, e.g., a client secures a better job after being fired, his or her behavioral health can improve significantly. Situational or life circumstances can cause counseling to become shorter or longer in duration.

Unfortunately, a third factor that promotes longer-than-necessary therapy is some counselors’ motivation to keep clients in therapy as long as possible, as their financial livelihood depends on it. I am not sure how often this happens but of course, it is not an ethical use of clients’ time or their financial resources. I clearly found this overuse of to be the case quite often when working in a primary care clinic, where the expectation was to see as many patients as possible, for the least amount of time necessary to provide the most benefit. We could not see all of the patients that needed help and so we referred many to therapists in the community spent far longer in counseling that the ones we saw in the primary care clinic, with about 25% of them using up all of the appointments allowed by the insurance company for the year.

A fourth factor that leads to longer-than-needed therapy has to do with the use of inefficient approaches to helping. Having had the opportunity to review over 1000 full medical records of social security disability patients in the past 15 years, I have found that the vast majority of therapists (over 90%) never provide evidence that they are actually applying the empirically-supported form of therapy they claimed to be using. If they did, the duration of therapy is very likely to be shorter and improvement, greater. For example, while a therapist claimed to use “Cognitive-Behavioral Therapy (CBT)”, yet their case notes nearly always read like a running diary of the life events experienced by the client since the last appointment. Nothing was ever mentioned about the outcome of CBT procedures, whether symptoms were improving since the last appointment, whether the client had completed a “homework” assignment, etc. Apparently, CBT is not actually occurring in the sessions, which was almost certainly inefficient and needlessly extended the duration of therapy.

In summary, the factors mentioned above all contribute to the duration of therapy. Here are some rough guidelines for you: 1) After completing an initial appointment with your therapist, you should ask how long therapy for a problem such as yours normally takes. 2) Your therapist should be able to outline what sorts of things you will be doing in future appointments to promote improvement. They should be able to outline goals. Relatedly, I believe clients should never leave any appointment without having something specific to be working on they feel motivated to do. (What will you be doing, when, for how long, etc……). 3) You should leave the first appointment or two with a sense of hopefulness, sensing that on the right track toward resolving your problem. 4) You may want to check with your insurance company to see how many appointments they will initially authorize. 5) If your counseling is occurring in conjunction with taking medication for your conditions, your therapist should ask you to sign a release form so he/she can touch base with your medication provider. Collaborating with your medication provider will make your therapy more effective, and vice/versa.

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