Beyond the Six-Session Model

The NHS offers six sessions of CBT. Your Employee Assistance Programme provides eight counselling appointments. Self-help books promise transformation in twelve weeks.

Then there are people who've been in therapy for two years. Five years. Sometimes longer.

Are they just dependent on their therapist? Avoiding real life? Or is something else happening—something deeper and more transformative than brief, focused work can provide?

This guide explores what long-term therapy actually involves, how it differs from short-term approaches, what you might work on over months and years, and whether the significant investment of time and money makes sense.

What Counts as "Long-Term"?

There's no universal definition, but rough categories:

Brief therapy: 6-16 sessions (3-4 months if weekly) Medium-term: 6 months to 1 year Long-term: 1-3 years Extended long-term: 3+ years

Most people thinking about "long-term therapy" mean at least a year of regular sessions, usually weekly or fortnightly.

Context matters: twelve sessions of intensive trauma therapy might feel long-term if you're in crisis. Conversely, someone might see their therapist monthly for years for ongoing support without it feeling intensive.

Why Would Therapy Take Years?

Different Goals Require Different Timescales

Short-term therapy excels at:

Specific, focused problems (recent bereavement, work stress, relationship breakup)
Learning concrete coping skills
Symptom reduction (managing panic attacks, reducing compulsive behaviors)
Crisis stabilization

Long-term therapy addresses:

Deep-rooted patterns formed in childhood
Complex trauma (especially developmental or relational trauma)
Personality-level change (how you fundamentally relate to yourself and others)
Recurrent relationship patterns across multiple partnerships
Chronic, treatment-resistant conditions
Integration of fragmented parts of self
Existential exploration and meaning-making

It's not that long-term therapy is "better"—it's addressing different questions. Quick surgery fixes a broken bone; years of physiotherapy helps you learn to walk again after a spinal injury. Both valid, different purposes.

The Depth vs Speed Trade-Off

Imagine your psyche as a house:

Brief therapy might repaint a room, fix a leak, or install better locks. Important work, tangibly improving your daily life.

Long-term therapy examines the foundations, the structural integrity, the architecture of the entire building. Why was it designed this way? Which walls are load-bearing? What needs to be rebuilt from the ground up?

Foundation work takes time. It's messy. Progress isn't always visible week-to-week. But when you're done, the house stands differently.

What Actually Happens Over Years?

Phase 1: Building the Relationship (Months 1-6)

The early phase focuses on:

Establishing safety and trust
You learning how therapy works
Your therapist understanding your patterns
Beginning to talk about what brought you
Testing whether this person can really hold your difficult feelings

This phase often feels productive. You're finally being heard. Insights arrive. Things shift.

Many people feel significantly better after 3-6 months and consider stopping. For focused issues, this might be perfect timing. But if you're addressing deeper patterns, this is just the foundation.

What you might work on:

Immediate presenting problems
Surface-level symptom management
Building emotional vocabulary
Identifying obvious patterns

Phase 2: The Real Work Emerges (Months 6-18)

Once safety is established, the deeper material appears:

Patterns you didn't initially recognize
Feelings you've been avoiding
Older wounds that underpin current struggles
The ways you relate to your therapist that mirror how you relate to everyone

This phase often includes:

Harder sessions: You might leave feeling worse before you feel better
Resistance: Part of you doesn't want to change (even though you consciously do)
Transference and countertransference: Old patterns playing out in the therapeutic relationship itself
Questioning whether therapy is working: Progress feels slower, less obvious

This is where many people quit, thinking "it's not helping anymore." Actually, it's helping differently—doing the slower, deeper work that doesn't yield quick wins.

What you might work on:

Childhood patterns and their origins
Grieving losses you never fully processed
Exploring difficult family dynamics
Understanding your attachment style
Working through shame, not just managing it
Noticing and changing patterns in the therapeutic relationship

Phase 3: Integration and Consolidation (18 months-3 years)

You've done significant work. Now you're:

Integrating new ways of being into daily life
Testing changes in real relationships
Working through setbacks and regressions
Deepening self-understanding
Preparing for ending (eventually)

Change is more subtle here. You're not having weekly breakthroughs—you're living differently, slowly, almost imperceptibly at first.

What you might notice:

Responding differently in situations that used to trigger you
Relationships improving (or ending, if they were built on unhealthy patterns)
Feeling more authentically yourself
Accessing emotions you previously couldn't
Being less harsh with yourself
Making choices aligned with your values, not just your conditioning

Phase 4: Ending and Moving On

Long-term therapy eventually ends (though some people maintain low-frequency ongoing support indefinitely).

Ending long-term therapy is profound work itself:

Processing loss and separation
Celebrating growth
Internalizing your therapist's supportive voice
Trusting yourself to continue without them

Many people return to therapy years later for shorter stints when new challenges arise. This isn't failure—it's using therapy wisely.

Different Approaches to Long-Term Work

Psychodynamic/Psychoanalytic Therapy

Duration: Often 2-5 years, sometimes longer Frequency: Traditionally 2-4 times weekly (though once weekly is common now) Focus: Unconscious patterns, childhood experiences, transference, dream analysis

Classical psychoanalysis (lying on a couch, therapist out of sight) isn't common anymore, but long-term psychodynamic work remains popular for deep exploration.

Humanistic/Person-Centred Therapy

Duration: Varies widely (months to years) Frequency: Usually weekly Focus: Authentic relating, self-concept, personal growth, the here-and-now relationship

Humanistic therapies don't impose time limits but trust you and your therapist to know when the work is complete.

Schema Therapy

Duration: Typically 1-3 years Frequency: Weekly Focus: Deep-rooted schemas (patterns) formed in childhood, particularly for personality difficulties and chronic problems

More structured than psychodynamic but still long-term, combining cognitive-behavioral and psychodynamic elements.

Relational Therapy

Duration: Often 2-4 years Frequency: Weekly or more Focus: How you relate, using the therapeutic relationship as both mirror and laboratory for change

The relationship itself is the primary healing agent.

Common Themes in Long-Term Work

Working Through, Not Just Talking About

In brief therapy, you might identify a pattern: "I always choose emotionally unavailable partners because my father was distant."

Insight achieved. But you still choose unavailable partners.

Long-term therapy allows you to:

Feel the grief of that childhood loss (not just understand it intellectually)
Notice when you're drawn to unavailability in real-time
Explore the pattern as it shows up with your therapist
Gradually internalize a different experience (being seen, being valued)
Slowly, messily, learn to choose differently

This "working through" takes time. Intellectual insight arrives quickly. Emotional and behavioral integration? That's the years-long part.

Regression and Repetition

Long-term therapy isn't linear progress. You'll revisit the same themes repeatedly, each time from a slightly different angle, with slightly more capacity.

Think of it like climbing a spiral staircase—you keep coming back to the same wall, but you're higher each time.

The Therapist as New Experience

Particularly with relational or psychodynamic work, your therapist provides something you didn't receive earlier:

Consistent, reliable presence
Someone who doesn't retaliate when you're angry
Acceptance of all your feelings
Someone who doesn't need you to be different

Over time, this gets internalized. You learn to treat yourself how your therapist treats you.

This isn't about dependency—it's about repair. You can't rush internalization.

Working with the Therapeutic Relationship

In long-term work, the relationship with your therapist becomes material to explore:

You might feel angry at them (and learn anger doesn't destroy relationships)
You might idealize them (and work through that to realistic regard)
You might test whether they'll abandon you
You might reenact old dynamics

This meta-level work—examining what's happening between you and your therapist—is some of the most powerful therapeutic territory. It only becomes accessible once deep trust exists, which takes time.

Who Benefits Most from Long-Term Therapy?

Complex Trauma

Single-incident trauma (one car accident, one assault) often responds to focused, time-limited trauma therapy.

Complex trauma (chronic childhood abuse, neglect, growing up with an alcoholic parent, attachment trauma) affects how you relate to everyone, how you see yourself, how you regulate emotions. Healing this requires sustained, safe relationship over time.

Personality Difficulties

If you've been diagnosed with borderline, avoidant, or other personality patterns—or if you simply notice you keep encountering the same relationship problems regardless of the specific people—long-term therapy is often recommended.

These patterns are deeply embedded. Change is possible but gradual.

Chronic, Treatment-Resistant Depression or Anxiety

If you've tried multiple short-term therapies and medications with limited success, long-term relational work might address underlying causes that brief interventions miss.

Recurrent Relationship Patterns

If you keep:

Choosing partners who replicate painful dynamics
Sabotaging relationships at the same point
Feeling unseen or misunderstood in every relationship

Brief therapy can offer tools, but long-term work addresses the deeper template driving these patterns.

Personal Growth and Self-Understanding

Not everyone in long-term therapy is "ill." Some people simply want profound self-understanding and to live more authentically. This is valid therapeutic work, though unlikely to be NHS-funded.

The Cost Question: Is It Worth It?

Financial Investment

Long-term therapy in London typically costs:

£80/session average
Weekly for 2 years = £8,320
Fortnightly for 2 years = £4,160

This is genuinely expensive. For context:

A year of weekly therapy ≈ one nice holiday + some new clothes
Two years of fortnightly therapy ≈ a used car

Whether it's "worth it" depends on:

Your financial situation
What you're gaining (better relationships? Career progress? Daily peace? Ability to parent differently?)
What untreated mental health is costing you (lost work productivity, broken relationships, physical health)

Research suggests therapy has strong ROI—every £1 spent produces roughly £5 in societal benefit through improved functioning. But you're not a statistic—you're deciding if this makes sense for your specific life and budget.

Strategies to Make It More Affordable

Reduce frequency: Fortnightly instead of weekly halves the cost
Use trainee therapists: Often £20-£40/session, can provide excellent long-term work
Low-cost organizations: Some charities offer long-term sliding-scale therapy
Block booking discounts: Many therapists offer reduced rates for pre-paid blocks
Mix modalities: Do intensive work with a private therapist, supplement with NHS or groups

Time Investment

Beyond money, long-term therapy requires:

50-60 minutes weekly (including travel if in-person) = 50+ hours per year
Emotional energy between sessions
Commitment even when you don't feel like going

For busy people, this isn't trivial. But compare to hours spent ruminating, managing anxiety, or dealing with relationship fallout—therapy might actually save time overall.

Potential Drawbacks and Criticisms

Dependency Concerns

Critics argue long-term therapy creates unhealthy dependence on the therapist.

Valid concern. Some signs of problematic dependency:

You can't make decisions without your therapist's input
Your life revolves around therapy sessions
You avoid ending despite feeling the work is done
Your therapist discourages you from reducing frequency or ending

Healthy long-term work:

Gradually increases your autonomy
You become less dependent over time
Ending is openly discussed when appropriate
You're encouraged to trust your own judgment

Opportunity Cost

Time and money in long-term therapy is time and money not spent elsewhere. Could you achieve similar growth through:

Meaningful relationships?
Creative pursuits?
Spiritual practice?
Education?

Maybe. Therapy isn't the only path to growth. But for some patterns, particularly those involving early trauma or attachment, other routes often aren't sufficient. You need a skilled, boundaried relationship specifically designed for repair.

The "Therapy as Lifestyle" Trap

In some social circles (particularly in cities, among certain professional classes), therapy becomes identity and social currency. People compete over whose trauma is most interesting or therapist most insightful.

This culturally reduces therapy to fashionable consumption rather than genuine healing work.

If you find yourself more interested in talking about therapy than actually changing, that's worth examining.

When to Continue vs When to Stop

Signs Long-Term Might Be Right

You've tried brief therapy multiple times with temporary improvement followed by regression
The issues you're addressing are complex and interconnected
You have capacity (financial, temporal, emotional) for sustained work
You trust your therapist and feel the relationship is healing
Changes are happening, even if slow
You're addressing root causes, not just managing symptoms

Signs It Might Be Time to End

You're attending out of habit, not because sessions feel useful
You've addressed your original goals and no new substantial work emerges
Financial or time burden significantly outweighs benefit
You're avoiding life by staying in therapy
You and your therapist agree you've consolidated your gains
You want to try living without therapy for a while (you can always return)

Ending isn't failure. Successfully completed long-term therapy often feels quiet—not a dramatic finale, but a sense of "I think I'm ready."

Alternatives and Complementary Approaches

Long-term individual therapy isn't the only option:

Lower-frequency maintenance: Monthly sessions indefinitely might cost less overall than weekly for two years

Intensive short-term dynamic psychotherapy (ISTDP): Aims to accelerate the work typically done over years into months

Group therapy: Long-term groups can provide relational healing at lower cost

Therapy "seasons": Intensive work for 6-12 months, break, return when needed

Hybrid models: Combine therapy with peer support, meditation retreats, body work, etc.

What Research Shows

Outcome research on long-term therapy shows:

Significant symptom reduction and improved functioning
Gains that increase over time (unlike some brief therapies where gains diminish)
Particular effectiveness for complex conditions and personality difficulties
High client satisfaction
Cost-effectiveness over lifetime when accounting for improved work functioning and reduced healthcare use

That said, research also shows:

Most therapeutic gain happens in first 10-20 sessions for many conditions
Diminishing returns can occur if therapy becomes unfocused
Therapist skill and the relationship quality matter more than duration

Making the Decision

Consider long-term therapy if you're seeking deep change and have:

✓ Financial capacity (even with reduced fees or lower frequency)
✓ Issues suited to depth work (complex trauma, chronic patterns, relational difficulties)
✓ Willingness to commit to the process even when it feels slow
✓ A therapist you trust and feel safe with
✓ Realistic expectations (gradual change, not constant breakthroughs)

Don't pursue it if:

✗ Financial strain will create more stress than therapy relieves
✗ You're primarily seeking practical coping skills (brief CBT might be better)
✗ You don't genuinely connect with your therapist
✗ The commitment feels oppressive rather than supportive

A Personal Perspective

As an integrative therapist, I work with clients across the spectrum—some for six sessions, others for years.

The people who've worked with me long-term (1-3 years) typically:

Arrived with complex histories and deeply entrenched patterns
Made moderate progress initially, then hit deeper layers
Used the safety of our ongoing relationship to risk being more vulnerable
Changed gradually in ways they (and their loved ones) noticed in daily life
Eventually felt ready to end, trusting they'd internalized enough to continue growing independently

It's not better than brief work—it's different work, for different purposes.

Final Thoughts

Long-term therapy isn't for everyone. It's expensive, time-consuming, and sometimes frustrating in its slowness.

But for people addressing deep, complex patterns—particularly those rooted in childhood experiences or ongoing relational difficulties—it can be genuinely life-changing in ways brief interventions simply can't match.

The question isn't "should everyone do long-term therapy?" It's "do I have the kind of difficulties, the resources, and the readiness for this particular kind of work?"

Only you can answer that. But now you know what you'd be saying yes to.

About the Author: The Kicks Therapy content team provides honest, practical information about therapy options. Our practice offers both focused short-term work and longer-term integrative therapy, tailoring duration and approach to your specific needs.

Wondering if long-term therapy might benefit you? Book a consultation to discuss your situation. We'll explore together whether deeper work makes sense or whether a focused, time-limited approach would serve you better. Sessions in Fulham or online, £80 with block discounts available.

Long-Term Therapy: What to Expect and Is It Worth It?