Dear Therapist:

I don't know if this is a fair question, and I am sure it varies greatly depending on the situation, but can you please give your opinion as to what the average length of time in therapy should be for someone? In my case specifically I am not referring to trauma or a serious mood disorder rather social and generalized anxiety (though please feel free to address other disorders as well). When I called around, I got very varied answers from different therapists including some who I think it could help make the layman a better consumer if we had a general idea of how long therapy should take. Thank you for your weekly column. I find it very helpful. 

Response:

Every question is fair game. Your question is one that I have been asked on many occasions. As you mentioned, the response can vary greatly depending on the situation. I can discuss some of the factors that can affect the length of a therapeutic relationship.

Some people are looking for short-term therapy to address specific concerns. Others are looking for a long-term therapeutic relationship. This doesn’t necessarily mean that these are what they truly need.

Sometimes a client will see me ostensibly for a few sessions to deal with a specific problem. As this problem is addressed, it becomes clear that there are other issues—either relating to the initial one or not obviously related. Or dealing with the identified problem leads to the recognition of underlying issues that affect other areas of the client’s life.

At other times, I might see a client who clearly wants a friend, or who desperately feels the need for validation. They therefore enter the initial session believing that they require a long-term relationship with someone who will fill this need. It is the therapist’s job to help the client to understand their needs, and help them to address these outside of the therapeutic relationship.

Another example is a client who feels that they have so many problems that they could not possibly be helped in a short period of time. As the therapy process develops, however, they may recognize that all their problems have one or two root causes. Working on these source issues can take significantly less time than anticipated.

Another factor that affects the duration of the therapeutic process is the mode of therapy. There are various basic modalities, and numerous branches of some. Psychoanalytic, cognitive-behavioral, dialectical behavior therapy, existential therapy, gestalt, and humanistic are some of the major therapeutic methods. Some typically take longer than others. Depending on a therapist’s approach, one client might see two therapists who approach the same issue from very different perspectives. Additionally, many therapists are “eclectic,” meaning that they draw from a few or many modalities depending on the client’s issues and needs, using one or more of these methods in each case. The duration of therapy will largely depend on how the case is conceptualized, and the goals of the client and therapist.

Also, recognize that a therapeutic relationship is just that—a relationship. As they say, it takes two to tango. In an optimal situation, the therapist would leave their own emotional (and financial) needs and insecurities at the door, allowing them to focus completely on their client’s needs. Realistically, it is impossible for any human to completely isolate their own needs from that of their client’s. For example, if a client who is searching for validation sees a therapist who has an emotional need to validate others, this can lead to a co-dependent therapeutic relationship, where the therapist is gaining as much—or more—than the client. Indeed, in a situation like this the therapist is likely reinforcing the client’s need for validation, thus intensifying what may be the client’s main underlying problem. The goal is for the therapist to be as aware as possible of any non-altruistic aspects of the therapeutic relationship—and to address them appropriately.

When a potential client asks me how many sessions they will need for a particular problem, I try to help them understand the complexities of the human mind, and the fact that we don’t have a good idea of the actual problems facing the person until a proper assessment is done. However, very often when someone seeks therapy for a relatively minor issue that is not very long-standing, a few sessions can make a large difference.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro College

  Graduate School of Social Work

  author of Self-Esteem: A Primer

  www.ylcsw.com / 516-218-4200

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