The Limits of Short-Term Therapy: Why 8 Sessions Often Isn't Enough

You've probably been there. Six sessions in, just starting to trust your therapist, and they're already talking about "endings" and "consolidating your learning."

The NHS typically offers 6-8 sessions of CBT through Talking Therapies. For some people, for some problems, it works. If you're dealing with a specific phobia or recent stress, those sessions might be exactly what you need.

But if your struggles go deeper - if they're woven through your earliest relationships, your sense of self, the way you've learned to exist in the world - then eight sessions isn't therapy. It's triage.

The arithmetic doesn't work

Your patterns didn't develop in eight weeks. The anxiety that keeps you scanning for danger, the depression that feels like home, the relationships that keep going wrong in exactly the same way - these took years to build. They're held in place by invisible architecture: the beliefs you formed before you could question them, the safety mechanisms that once protected you, the ways of being that made sense when you were seven but are destroying you at thirty-seven.

Eight sessions assumes your problem is recent and your defences are optional. That you can identify your thoughts, challenge them, replace them with better ones. That insight plus technique equals change.

But what if you can't trust the process because trust itself is the problem? What if the thoughts you're meant to challenge are the only thing keeping you upright? What if you need to understand why you built these defences before you can bear to put them down?

The NHS knows this. The therapists delivering CBT know this. But the system is built around throughput, not depth. Around managing waiting lists, not managing complexity. Around what can be measured in eight weeks, not what actually matters.

So you get worksheets about thought patterns when what you need is to understand why those patterns developed. You get breathing exercises when what you need is to understand what you're so afraid of breathing in. You get symptom management when what you need is meaning.

When structure recreates the wound

Here's what's particularly cruel about session limits: they often recreate the exact dynamics that brought you to therapy.

If you struggle with abandonment, being told therapy will end regardless of your progress isn't just disappointing - it's another rejection. The system confirms what you've always suspected: you're not worth the sustained attention it would take to actually help you.

If trust is difficult for you, being processed through a standardised protocol proves that you're not seen as an individual. You're a diagnosis, a set of symptoms, a number on a waiting list. The very thing therapy is meant to address - being reduced rather than recognised - gets reproduced in the structure itself.

The format meant to help ends up reinforcing what hurts. And then, when you struggle to engage or don't improve, the problem is located in you. You're "not ready for therapy" or "unable to engage with the process." The system's limitation becomes your failure.

What actually changes people

Real change happens slowly, in relationship. Not through techniques or homework, but through being seen and understood over time. Through having your defences met with curiosity rather than correction. Through discovering that being known doesn't destroy you.

It happens when someone can hold your contradictions without rushing to resolve them. When you can bring the worst bits and find they don't end the connection. When patterns that once kept you safe can finally be understood and, gradually, updated.

This requires time. Time to trust. Time to test whether this relationship is different. Time to show the parts you've kept hidden and discover they're not as catastrophic as you feared. Time to get it wrong, repair it, and learn that rupture doesn't equal abandonment.

Your psyche has its own timeline. It rarely aligns with service delivery targets.

The evidence question

The research supporting short-term therapy measures what's easy to measure: symptom scores, attendance rates, discharge statistics. Whether you're less anxious on paper. Whether you meet criteria for "recovery."

Not whether you understand yourself better. Not whether your relationships have improved. Not whether you can tolerate feelings you once had to suppress. Not whether you're living a life that feels like yours.

When the NHS says CBT is "evidence-based," they mean it reduces scores on depression questionnaires at eight-week follow-up. They don't mean it helps you understand why you're depressed in the first place. They don't mean it addresses the loneliness, the disconnection, the sense that you're performing a life rather than living one.

The evidence base is built on what the system can deliver, not what people actually need.

Who needs more

Short-term work can help with acute problems, specific fears, or recent life events. A bereavement, a work crisis, a particular anxiety that's getting in the way. If the foundation is solid and something's temporarily shaken it, brief work can be enough.

But if you're dealing with patterns rather than episodes - if you've tried everything and still find yourself in the same places, with the same feelings, making the same mistakes - you need time.

If your struggles started before you had words for them. If relationships always seem to go wrong in ways you can't quite explain. If there's a gap between who you appear to be and who you actually are. If something fundamental feels wrong but you can't articulate what.

Then you need space to explore what's underneath the symptoms you present with. To understand why certain defences developed and what purpose they're still serving. To discover who you are when you're not constantly managing yourself.

You need someone who isn't watching the clock, calculating when to introduce the ending, working towards discharge. You need someone interested in the whole story, not just the current chapter.

What depth work offers

Longer-term therapy - psychodynamic, psychoanalytic, or other depth approaches - starts from a different premise. It assumes your symptoms make sense. That your patterns serve a purpose. That understanding matters as much as managing.

It offers consistency over time. The same person, week after week, getting to know the specific texture of your particular mind. Not processing you through a protocol, but responding to who you actually are. Building a relationship that can hold what previous relationships couldn't.

The work isn't about eliminating symptoms as quickly as possible. It's about understanding why they exist. About making conscious what's been unconscious. About building capacity to feel things you've had to avoid. About discovering that the self you've been hiding might actually be survivable.

This isn't self-indulgent. It's what complex problems actually require. You can't rush someone into trusting you. You can't schedule the emergence of material that's been buried for decades. You can't have meaningful insight on the system's timeline.

If short-term work didn't help

If you've been through NHS therapy and you're still searching, that's not failure. You're not "treatment-resistant." You're not unable to "engage with the process" or "make use of therapy."

You might just need something the system couldn't offer: time, depth, and someone interested in understanding rather than just reducing symptoms.

The gap between what you needed and what you got isn't your fault. The system did what it could within its constraints. Those constraints just weren't built around your actual needs.

What's possible

Imagine therapy where you're not counting down sessions. Where there's no pressure to improve by week six so you can be discharged by week eight. Where moving backwards sometimes is seen as information, not failure. Where your contradictions are welcome.

Imagine working with someone more interested in understanding your patterns than eliminating your symptoms. Who sees your struggles as meaningful rather than just problematic. Who can sit with not knowing long enough for real understanding to emerge.

This exists. Not in eight sessions, but in the longer arc of sustained therapeutic work. In meeting the same person, week after week, until the room itself becomes safe enough to bring what you've never shown anyone.

A different possibility

You deserve more than learning to cope with patterns you don't understand. You deserve to know why certain things keep happening, why some feelings feel impossible, why you keep finding yourself in the same places despite trying so hard to change.

Eight sessions is what the system can offer. It's not necessarily what you need.

If you're ready for something deeper than symptom management - something that honours your complexity rather than rushing to resolve it - that's worth seeking. Even if you have to pay for it. Even if it takes longer than the system wants it to. Even if you don't know exactly what you're looking for yet.

Your struggles took time to develop. They deserve time to be understood.

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If short-term therapy hasn't worked or you know you need something deeper, longer-term psychodynamic therapy might help. I work with people in Croydon and online worldwide (excluding USA and Canada). Email hello@talktoluke.com