Understanding the Process
Longer than you want, shorter than you've been struggling
Most people in psychodynamic therapy work for months to years, not weeks. This isn't inefficiency - it's recognition that deep patterns don't shift quickly.
The NHS offers 6-12 sessions of CBT because that's what's affordable to provide at scale, not because that's how long change takes. For some specific problems - a phobia, a single episode of depression - brief work can help. But for the patterns that keep recurring, the relationship difficulties that won't resolve, the sense of being stuck that persists regardless of circumstances? That takes longer.
I know this isn't what you want to hear. You want a number. Six months. A year. Something you can plan around. But the honest answer is: it depends on what you're working on, how deep you want to go, and what you discover along the way.
The patterns that bring you to therapy weren't built in a weekend. They won't dissolve in one either.
You can't rush the nervous system. The patterns that keep you stuck aren't just thoughts you can swap out - they're wired into your body, your relationships, your automatic responses. They developed over years, often decades, as ways of surviving difficult circumstances. They're not going to let go because you understand them intellectually.
Real change happens in layers. First you start to see the pattern. Then you catch yourself mid-pattern. Then you start to have choice about it. Then the choice becomes more automatic. Then the old pattern loses its charge entirely. Each layer takes time.
And the therapeutic relationship itself takes time to develop. The trust to bring the difficult stuff. The safety to fall apart. The history of repairs after ruptures. You can't manufacture that in session three.
This is why therapy that promises quick results often doesn't stick. You can learn techniques fast. You can have insights fast. But integrating those insights into how you actually live? That's slower work.
How entrenched the patterns are. Something that started in adulthood usually shifts faster than something laid down in early childhood. A specific anxiety responds quicker than a pervasive sense of emptiness.
How often you come. Weekly therapy builds momentum. Less than that and you're essentially starting fresh each time. Twice-weekly accelerates things significantly - not because you're covering more ground, but because the continuity allows deeper work.
What you want from it. Symptom relief is faster than personality change. Getting through a crisis is faster than understanding why you keep creating crises. There's no wrong answer here - but be honest with yourself about what you're actually after.
What else is happening in your life. Major life events, ongoing stress, unstable circumstances - all of these affect the work. Sometimes therapy needs to be about surviving the present before it can be about understanding the past.
Your capacity to tolerate discomfort. The work involves feeling things you've been avoiding. If you can stay with difficult feelings, things move faster. If you need to retreat frequently, that's fine - but it takes longer.
Not by feeling better every session. Sometimes sessions are difficult. Sometimes you leave feeling worse than when you arrived. This isn't failure - it's often the work happening.
You know it's working when you start catching yourself mid-pattern. When you notice what you're doing rather than just doing it. When you have a familiar reaction and think "oh, this again" instead of being swept away by it.
When old triggers lose their charge. The thing your partner does that used to send you into a rage now just irritates you. The situation that used to cause panic now just makes you anxious. The thought that used to spiral for days now passes in hours.
When relationships go differently. Not because you're performing better but because you're actually different in them. When you say what you mean without rehearsing it first. When you can tolerate conflict without collapsing or attacking.
When you need the therapist less. Not in a defensive "I'm fine" way, but genuinely. You've internalised something. You can do for yourself what you used to need them for.
Therapy isn't meant to last forever. The goal is to work yourself out of a job - or rather, for me to work myself out of a job. But knowing when to end is tricky.
Too early, and you've done the excavation but not the rebuilding. You understand your patterns but haven't really changed them. The insights fade, the old ways return, and you're back where you started.
Too late, and therapy becomes more about comfort than growth. You're processing with your therapist what you could be processing alone. You've stopped challenging yourself.
There's a paradox here: you can't become truly independent without first allowing yourself to depend on someone. The capacity to rely on another person - to need them and let them matter - is what eventually lets you carry that support inside yourself. Dependence has become a dirty word, but it's actually the route to genuine autonomy. The goal isn't to need no one. It's to have internalised enough that you can meet your own needs most of the time.
The right time to end is when you've genuinely internalised the work. When you can observe yourself with the same curiosity you've learned in therapy. When you trust yourself to handle what comes up. When ending feels like graduation, not abandonment.
We talk about ending well before it happens. It's a process, not an event - usually over several months. All the patterns that brought you to therapy tend to resurface during the ending, which gives us one last chance to work with them.
I'm a psychodynamic therapist practising in Croydon, South London. I work with individuals and couples, typically weekly, for as long as the work needs.
If you're curious about starting, you can read more about what psychodynamic therapy is or how I work with individuals. The FAQ covers practical questions about sessions and fees.
Or you can just get in touch.