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Why Does Therapy Take So Long? Psychologists Explain What’s Normal.

Patients looking for immediate relief are unlikely to find it. That sucks, but there's some good news as well.

There are almost as many types of talk therapy as there are problems to get help with, but, much to the chagrin of their patients, the vast majority of therapists seem to agree on one thing: Progress takes time. Lots of time. For those engaged in therapy and even for those committed to it over the long term, this can be profoundly frustrating and also profoundly expensive. This leads to attrition. It shouldn’t. The problem isn’t ultimately that psychotherapy takes time, it’s that people approach the process looking for relief rather than understanding the hard work ahead. How long it takes to get something out of therapy has everything to do with the patient.

“Some clients do not want to do the work, which can be painful sometimes, and prefer to take medication to relieve depression or anxiety versus processing a chaotic childhood or unresolved traumas that may be the underpinnings of those conditions,” psychologist Dr. Nancy Irwin explains.  “Focusing on the speed of getting better can actually elongate the process of psychological health.”

Process is the key word. Talk therapy was introduced by Sigmund Freud in the 19th century has since been modified and shaped by the work of scholars like Alfred Adler and Carl Jung, who mostly focused on cognitive-behavioral approaches, which have been collectively referred to as Cognitive Behavioral Therapy since the 1970s. In contrast to traditional Freudian therapy, CBT is focused on immediate problem solving and behavior modification. Psychoanalytics aren’t really the point. This means both that CBT can yield some effective results and that there’s not really a moment of resolution, just a long-term commitment to introspection. CBT therapy typically takes a minimum of 20 one-on-one sessions to show results and that’s the best case scenario. Issues like procrastination and anxiety can be resolved relatively quickly, but that’s the easier stuff.

More traumatic issues are often the focus of Freudian therapy, which is more of a process of excavation. It can take years and years and results are less likely to be understandable in terms of behavior. In difficult cases involving past trauma, it’s crucial for therapists to build up trust and develop support systems and healthy coping skills first. Therapists have to do this before addressing painful pasts or else individuals may not always be able to deal with what’s dug up.

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“If they are intoxicated or suicidal, they are not ready for one-on-one therapy yet. They must be stabilized,” Irwin warns. In these extreme instances, group therapy can a better fit because it helps people build up a support network and feel less isolated, and this can take up to 25 group therapy sessions.

No matter what type of talk therapy or personal problem, the reason people get so impatient with the process is a relatively universal one —  because they desperately want to feel better. Therapy takes so long to show results because it took a lifetime to settle into these patterns that no longer work. A therapist can help people dismantle maladaptive behaviors and beliefs and build new up ones faster than people can on their own, but it’s still an investment of time.

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“Therapy that tracks your early attachment to caregivers, explores relationship history, processes traumas, and sets realistic life goals that are meaningful to the client, takes some time just like dating or building a business or getting an education,” Irwin says. “I’m committed to helping them get out of pain as quickly as possible, but not by sacrificing quality.”

This is basically the stance of therapists: They’d like to work faster, but that’s not the nature of the work.

That said, there’s some reason to believe this could change thanks to new technologies and methods. Eye Movement Desensitization and Reprocessing is a therapeutic method used by therapists like Irwin to efficiently and effectively treat traumatic memories. EMDR is designed to heal psychological trauma forcing patients to recall painful events and the feelings that followed while the brain’s information processing center is activated through therapist-directed rapid eye movements. Scientists suspect they’re learning how to train the brain and body to become less activated by the traumatic memories. Sessions take about 90 minutes and a growing body of research suggests progress can be made in just five or six sessions.  

“One of the best ways I have found to tackle those layers and heal the wound effectively is through the process of EMDR,” clinical psychologist Kim Anderson says. “It is an empirically validated treatment for both big trauma and little trauma, allowing us to identify the root cause of our wound, clear it out, and close it up. The approach allows the therapist to bring substantial improvement in short periods of time.”

For now, EMDR isn’t a behavioral solution so most patients will still be stuck in CBT. But the creation of this new program augurs well for a future in which therapy is a bit more efficient. That future simply hasn’t arrived yet.