Understanding the Process

How long does therapy take?

Longer than you want, shorter than you've been struggling

The honest answer

Many people in psychodynamic therapy work for months to years, not weeks. This isn't inefficiency - it's recognition that deep patterns often don't shift quickly.

The NHS offers 6-12 sessions of CBT because that's what's affordable to provide at scale, not because every person's change fits that frame. 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 keep repeating, the sense of being stuck that persists regardless of circumstances? That often 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.

Why it takes time

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 rarely let go simply because you understand them intellectually.

Change often 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 may become more automatic. Then the old pattern may lose some of its charge. 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 quick promises can be misleading. You can learn techniques fast. You can have insights fast. But integrating those insights into how you actually live? That's slower work.

What affects the length

How entrenched the patterns are. Something that started in adulthood may shift faster than something laid down in early childhood. A specific anxiety may respond more quickly than a pervasive sense of emptiness.

How often you come. Weekly therapy builds momentum. Less than that can feel like starting fresh each time. Twice-weekly work can deepen the continuity - not because you're covering more ground, but because the space is held more closely.

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, the work may move more freely. If you need to retreat frequently, that's fine - but it may take longer.

How you know it's working

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 may notice it 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 feel less charged. 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 feels like anxiety you can recognise. The thought that used to spiral for days now passes sooner.

When relationships begin to go differently. Not because you're performing better but because you have more room inside them. When you say what you mean with less rehearsal. When you can tolerate more 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 sometimes do for yourself what you used to need them for.

When to end

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.

Common questions

Practical questions about therapy duration and frequency.

How often should I come to therapy?

Weekly is standard for psychodynamic work. It creates enough continuity that patterns can emerge and be worked with. You remember what happened last session. The relationship builds momentum. Twice-weekly can be useful for intensive work - it's not just double the sessions, it's a qualitatively different experience. The continuity may allow things to emerge that weekly work doesn't always reach. It's what many training therapists do for their own therapy, for good reason.

What if I can't afford long-term therapy?

This is a real constraint and I won't pretend otherwise. Therapy is expensive, and the people who most need it often can't afford it. Some options: Some therapists offer sliding scales or reduced-fee slots. Training organisations often provide low-cost therapy with trainees (who are supervised and often excellent). Employee assistance programmes sometimes cover short-term work. NHS talking therapies exist, though waiting lists are long. But also: even limited therapy can be useful. A few months of weekly work won't transform everything, but it may shift something. You might return later when circumstances change. Brief work can still matter.

Can I take breaks from therapy?

Yes, though it depends on why. Sometimes a break is genuinely needed - financial pressure, life circumstances, needing to integrate what you've learned. This can be healthy. We'd plan it together, discuss what it means, and leave the door open for return. Sometimes wanting a break is avoidance in disguise. Things are getting difficult, something's emerging that you don't want to face, so you find a reason to stop. This is worth examining before acting on. The difference usually shows in the timing. If you want to stop right when something important is surfacing, that's worth questioning. If you've reached a natural plateau and need space to consolidate, that's different.

Is longer therapy always better?

No. Longer isn't automatically deeper. Some people stay in therapy too long - it becomes a comfortable routine rather than active work. They process their week, feel heard, but nothing really changes. This can be collusion between therapist and client to avoid the difficult stuff. Good long-term therapy should feel different at year three than year one. If you're having the same conversations, exploring the same themes without movement, something's wrong. The question isn't how long but how deep. Some people do meaningful work in a year. Others spend five years circling the surface. Length matters less than what you're actually doing with the time.

How do I know when to stop?

When the things that brought you to therapy have less grip on your life. Not that they're completely gone - some patterns never disappear entirely - but they don't run things in the same way. When you've internalised the observing capacity. You can notice your patterns, question your reactions, be curious about yourself without needing someone else to do it for you. When ending feels sad but right. Not like abandonment, not like escape, but like graduation. You'll miss it, and you're ready. We might not always feel the same way about when to finish. We can talk that through, including what ending brings up and any practical reasons you need to stop. You don’t have to agree with my view for your reasons to matter. We’ll discuss how to end within the notice arrangement we’ve agreed. Endings are part of the work, not separate from it.

Working with me

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.

Get in touch