Mat Pronger is an Integrative Counsellor/Psychotherapist based in Sheffield, UK.
It’s understandable when thinking about seeing a counsellor, that how long this takes might be in the front of your mind. You might want the thing you’re bringing to therapy ‘dealt with’ immediately, especially if the issue you want to bring is painful, distressing or uncomfortable. You might be concerned about committing lots of time, or the cost of therapy if it takes time.
Like most things related to how we feel, a simple answer isn’t easy, even if it’s what we want. If I had to give a short answer it would be; it depends what you want from counselling. In this blog I want to explain why this is the case, using questions commonly asked of counsellors and psychotherapists.
“How long is a typical course of counselling?”
The answer to this will vary. It will depend on who you ask, where the counselling is and what you want to discuss in counselling.
Within the NHS or IAPT services the guidelines vary depending on what is being brought, and vary. Treatment for severe depression in adults can run from 16-20 sessions spread over 3-4 months, treatment for anxiety disorders can be 7-14 hours of CBT spread over 4 months, treatment for PTSD can run from 8-12 sessions unless the PTSD is complex (dealing with more than one traumatic event), in which case the guidance is ‘beyond 12 sessions’ (all sources: NICE guidelines). As you can see, this is complicated.
In addressing how long a ‘typical’ course of therapy is, we need to think about what you are bringing. The NICE guidelines can give us a rough idea if you only want to look at a diagnosis, and this therapy would need to be focused on the diagnosis.
The reality of therapy and counselling is that sometimes we aren’t bringing a diagnosis. Sometimes we just ‘don’t feel good’ or are troubled by thoughts or memories. There is little guidance about how long it would take to look at these things. In these cases it is a good idea to talk about the length of therapy in your first session, particularly if it is a concern for you. Most private therapists should be able to accommodate your needs, and if they can’t they should be able to tell you this in your first session.
What length of therapy is most effective?
This will all boil down to what you want. If you’re going through a stressful period of time, for example a breakdown in a relationship, a period of stress or difficult change of circumstances, you might just want a little extra support through this period.
Shorter-term therapy can be most useful when you already know what it is you want to look at. This is why NHS therapies require you to have a diagnosis first; the diagnosis identifies what the issue is you want to address. Short-term therapy does require you to be able to identify what it is you want to discuss in therapy, and will require you to participate fully (attend, focus on the issues, work with the therapist). You may also find that the focus means that some things you may want to talk about cannot be fully addressed in therapy. If you specifically want to work short term it can be useful to be clear with your therapist about this from the start.
Shorter therapy is unlikely to be effective for some issues. Drug and alcohol addiction and people who suspect they might have a personality disorder can require treatment that runs longer that a few sessions (Dryden and Feltham: 1993), although new developments such as Dialectical Behaviour Therapy appear to give better results over a shorter time (source: Mind).
If you are approaching a therapist in private practice you may feel that you want longer-term support, especially if you are affected by a broad range of issues, or want to use the therapy to address bigger existential questions about why you act and feel certain ways throughout your life. This often happens if you find a therapist you feel particularly comfortable and safe exploring these issues with. This is not unusual, although it can be hard to find this kind of support outside of private practitioners. Historically psychotherapists have worked in a much more long-term way (MacLeod: 1998), and some people appreciate having more time and space in therapy. There is nothing wrong or unusual about seeing a therapist longer term.
What do I do?
I work in a number of places, both short and long term. If you are approaching me to work in private practice I can work with you either long or short term.
Length of therapy is something we would discuss in a longer first session, also known as an ‘assessment’. In this session we would talk about what you might want from therapy and whether it would be appropriate to work together. I am committed to working within the BACP’s ethical framework, and because of this I wouldn’t make any promises or commit to working in a way I don’t believe is honest and beneficial to you as a client. This means that I will be honest with you if I think the thing you are asking for might not lead to the outcomes that you want (for example a very brief run of therapy to completely recover from a complex issue).
Flexibility is very important to me, and so if for whatever reason you find it difficult to commit to therapy, I would appreciate being able to discuss this with you to see if we can’t work around this.
As with so many issues in therapy, if you are uncertain about something or have a question specific to your situation the important thing to do is to talk to the therapist you are considering working with about it.