Luke Row is a BACP registered psychodynamic therapist in Croydon, South London, with advanced training at Tavistock Relationships. He works with individuals who've tried managing their symptoms and couples tired of managing each other, people ready to understand what's underneath. Book a session →
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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.
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.
I've sat with people after their eighth session ended. They learned the techniques. They can challenge their thoughts, use their breathing exercises. And they're still stuck, because managing symptoms is different from understanding why you keep generating them.
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.
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 takes time. And that time matters, not as an indulgence but as the condition under which this work becomes possible.
Your psyche has its own timeline. It rarely aligns with service delivery targets.
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.
Short-term work can help with acute problems, specific fears, recent life events. If the foundation is solid and something's temporarily shaken it, brief work can be enough.
But if you've tried everything and still find yourself in the same places? If relationships always seem to go wrong in ways you can't quite explain? If your struggles started before you had words for them?
Then you need space to explore what's underneath. 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.
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.
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.
Therapy where you're not counting down sessions. Where moving backwards is information, not failure. Where someone's more interested in understanding your patterns than eliminating your symptoms.
This exists. Not in eight sessions, but in the longer arc of sustained therapeutic work.
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.
Your struggles took time to develop. They deserve time to be understood.
What I do: Individual Therapy in Croydon
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