"How long will I need therapy?" is one of the most common questions therapists hear.

The answer depends entirely on what you're working on. If you're learning specific coping skills for panic attacks, you might need 12 sessions. If you're reworking fundamental patterns that have shaped your entire adult life, you might need two years.

Neither is better. They're simply different.

This guide explores long-term therapy: what it involves, who benefits, how it differs from brief work, and whether committing to extended counselling is the right choice for you.

What Is Long-Term Therapy?

Long-term therapy (also called extended or open-ended therapy) typically means working with a therapist for a year or more—sometimes several years.

Typical Timeframes

Short-term: 8-20 sessions (2-6 months)

Medium-term: 6-18 months

Long-term: 1-3+ years

Open-ended: No predetermined endpoint; continues as long as beneficial

Frequency

Weekly: Most common for sustained work

Twice weekly: Intensive approaches (psychoanalytic, deep trauma work)

Fortnightly: Later stages, maintenance, or cost considerations

Long-Term vs. Short-Term Therapy

Short-Term Therapy

Focus: Specific symptoms or problems

Approach: Structured, goal-oriented, time-limited

Depth: Addresses surface layer and immediate coping

Best for: Acute issues, clear problems, symptom reduction

Typical modalities: CBT, solution-focused, brief psychodynamic

Long-Term Therapy

Focus: Underlying patterns, core wounds, personality structure

Approach: Exploratory, relational, process-oriented

Depth: Addresses roots, not just symptoms

Best for: Complex difficulties, personality change, deep growth

Typical modalities: Psychodynamic, humanistic, integrative, psychoanalytic

Key Differences

Aspect	Short-Term	Long-Term
Goal	Symptom relief	Structural change
Timeline	Weeks to months	Months to years
Focus	Present problems	Past, present, future, patterns
Depth	Manageable layer	Core wounds
Therapist role	Active, directive	Facilitative, relational
Cost	Lower total	Higher total
Change	Behavioral	Characterological

Who Benefits from Long-Term Therapy?

You Might Need Extended Work If:

1. Complex Trauma or PTSD

Single-incident trauma can sometimes resolve quickly. Complex trauma from childhood, repeated abuse, or multiple traumatic events typically requires extended work.

2. Personality Difficulties

Deeply ingrained patterns in how you relate, perceive yourself, and experience emotions take time to shift.

3. Chronic Mental Health Issues

Long-standing depression, anxiety, or other conditions often have complex roots requiring sustained attention.

4. Relationship Pattern Problems

If you repeatedly end up in similar dysfunctional relationships, understanding and changing the pattern takes time.

5. Developmental Trauma

Wounds from early attachment, neglect, or emotional unavailability in childhood shape core sense of self—reworking this is long-term work.

6. Multiple Concurrent Issues

Anxiety + depression + relationship difficulties + low self-esteem = complex picture needing extended time.

7. Personal Growth and Self-Actualisation

Beyond fixing problems, some people want deep personal development, which is open-ended.

8. Previous Brief Therapy Didn't Create Lasting Change

If symptoms return after short-term work, longer therapy may be needed to address underlying causes.

What Happens in Long-Term Therapy?

Early Phase (Months 1-6)

Building foundation:

Establishing trust and safety
Sharing your story
Therapist learning your patterns
Initial relief often occurs
Testing the relationship

What it feels like: Hopeful, sometimes intense, possibly exhausting, periods of relief

Middle Phase (Months 6-24)

Deepest work:

Core wounds surface
Resistance intensifies
Transference develops
Old patterns played out with therapist
Grief for what was lost
Integration begins

What it feels like: Harder before easier, frustrating, illuminating, emotionally demanding

Late Phase (Months 18+)

Consolidation:

New patterns becoming natural
Increased self-awareness and capacity
Less dependency on therapist
Preparing for ending (even if not immediate)
Recognizing growth

What it feels like: More spacious, stable, confident, occasionally sad about eventual ending

Benefits of Long-Term Therapy

1. Addressing Root Causes

Short-term work manages symptoms. Long-term work changes why symptoms exist.

Example: Brief CBT can help you challenge anxious thoughts. Long-term therapy can help you understand why your nervous system learned to be hypervigilant and rework that at a foundational level.

2. Characterological Change

Shifting not just behaviors but fundamental patterns in:

How you relate to yourself
How you experience and regulate emotion
How you relate to others
Your core beliefs about yourself and world

3. Reworking Early Relationships

The relationship with your therapist over time becomes reparative:

Experiencing consistent care
Learning secure attachment
Having needs met appropriately
Repairing relational wounds

4. Processing Complex Material

Some experiences are too big, too layered, too defended to process quickly:

Childhood trauma
Grief and loss
Identity development
Shame and self-hatred

These need time, safety, and sustained attention.

5. Integration Happens Naturally

With extended time, insights don't just stay intellectual—they integrate into how you live:

Behavioral change
Emotional capacity
Relational shifts
Identity evolution

6. Resilience Develops

Long-term therapy doesn't just resolve current issues—it builds capacity to handle future challenges independently.

Challenges of Long-Term Therapy

1. Cost

Reality: Extended therapy is expensive

London costs: £70-£100/week = £280-£400/month = £3,360-£4,800/year

Considerations:

Can you afford this sustainably?
Concessions, block discounts, sliding scale?
Is investment worth the benefit?
Can you reduce frequency (fortnightly) if needed?

2. Time Commitment

Reality: Weekly sessions for years is significant time

Considerations:

Fitting appointments into schedule long-term
Prioritizing therapy during busy periods
Managing when life circumstances change

3. Emotional Intensity

Reality: Deep work is hard

Challenges:

Sessions may be emotionally draining
Difficult material surfaces
Old wounds reopen before healing
Periods of feeling worse before better

4. Dependency Concerns

Reality: You develop significant attachment to therapist

Balance:

Healthy dependency supports growth
Therapist helps you become more independent over time
Ending will involve grief—but that's part of the work

5. Questioning Whether It's Working

Reality: Progress is slow and non-linear

Challenges:

Months may pass without obvious change
Difficult to "measure" growth
Wondering if you're stuck vs. doing important slow work

6. Life Changes May Interrupt

Reality: Jobs, moves, relationships, finances change over years

Flexibility:

May need to switch therapists
May need breaks
May need to shift to less frequent sessions

How to Know If You're Making Progress

In long-term work, progress is subtle:

Signs of Growth

Relationships: Patterns shifting, communication improving, choosing healthier partners
Self-awareness: Catching patterns as they happen, understanding triggers
Emotional capacity: Tolerating difficult feelings without collapsing or avoiding
Self-compassion: Treating yourself more kindly
Agency: Recognizing choices, taking responsibility
Authenticity: Living more congruently with values
Resilience: Bouncing back from setbacks faster
Creativity: More alive, engaged, curious about life

What Progress Isn't

Constant happiness
Elimination of all problems
Perfect relationships
Never struggling
Being "fixed"

Reality: Long-term therapy creates capacity to live fully—including difficult parts—not perfection.

When to End Long-Term Therapy

Signs You Might Be Ready

Significant issues resolved or manageable
Relationship patterns healthier
Self-awareness and emotional capacity developed
Living more authentically
Internalized therapist's perspectives
Feeling capable of handling challenges independently
Sense of completion (not perfection)

How Ending Happens

Planned endings (ideal):

Discussed weeks or months in advance
Time to process ending itself
Review of journey
Preparation for continuing alone

Gradual transition:

Reducing frequency (weekly → fortnightly → monthly)
Easing separation
Testing independence whilst maintaining connection

"Open Door" Policy

Most therapists welcome clients returning:

After a break
For specific issues
During life transitions
For periodic "check-ins"

Ending doesn't mean never returning.

Cost Management Strategies

Making Long-Term Therapy Affordable

1. Negotiate concessions: Ask about reduced rates

2. Block bookings: Prepaying multiple sessions sometimes reduces cost

3. Reduce frequency: Fortnightly instead of weekly (later in therapy)

4. Training clinics: Lower cost with trainee therapists under supervision

5. Employee benefits: Some employers offer EAP with extended sessions

6. Budget creatively: What can you reduce elsewhere to prioritize therapy?

Is It Worth It?

Consider:

Quality of life: What's it worth to resolve chronic suffering?
Prevented costs: Relationship breakdowns, job losses, health problems therapy might prevent
Long-term investment: Cost per year vs. decades of improved wellbeing

Finding a Therapist for Long-Term Work

Look For

Training in depth approaches:

Psychodynamic
Humanistic/integrative
Psychoanalytic
Jungian

Experience with extended work: Ask: "Do you work with people long-term?"

Relational focus: Therapists valuing therapeutic relationship

Flexibility: Willing to commit but adapt as needed

Questions to Ask

"Do you typically work with people short-term or long-term?"

"What's your longest therapeutic relationship?"

"How do you know when someone's ready to end?"

"Are you comfortable with open-ended work?"

"What happens if I need a break but want to return?"

Long-Term Therapy Approaches

Psychodynamic Therapy

Focus on unconscious patterns, past influencing present, therapeutic relationship

Timeline: Usually 1-3+ years

Humanistic/Integrative Therapy

Focus on growth, authenticity, relational healing, tailored approach

Timeline: Flexible, often 1-2+ years

Psychoanalysis

Most intensive—deep unconscious work, usually multiple sessions weekly

Timeline: 3-5+ years

Person-Centred Therapy

Non-directive, relationship-focused, client-led

Timeline: Open-ended, continues as long as beneficial

Common Concerns

"Will I become dependent on my therapist?"

Healthy dependency during therapy is normal. Good therapists help you internalize support and become increasingly independent.

"How will I know when I'm done?"

You'll feel it: a sense of completion, confidence, readiness. Your therapist will also recognize signs and discuss ending.

"What if I can't afford it long-term?"

Discuss with therapist. Options include reducing frequency, taking breaks, finding lower-cost options, or doing what you can afford and pausing when needed.

"Is wanting long-term therapy self-indulgent?"

No. Deep psychological work is legitimate investment in yourself and everyone you interact with.

"Will therapy become my whole identity?"

Good therapy expands your life, not replaces it. If therapy becomes your only focus, discuss this with your therapist.

Final Thoughts

Long-term therapy isn't for everyone. Some people don't need it. Some can't afford it. Some prefer shorter, focused work.

But for those dealing with complex trauma, deep-seated patterns, or seeking fundamental change rather than symptom management, extended therapy offers something brief work can't: time for real, structural transformation.

The commitment is significant—financial, temporal, emotional. But for many, it's the most valuable investment they've ever made.

Not because therapy solves all problems or makes life perfect. But because it develops capacity to live fully, relate authentically, and navigate challenges with resilience and self-compassion.

If you're in South West London and considering long-term therapy, I offer open-ended, integrative counselling combining person-centred, Gestalt, and TA approaches. I provide free 15-minute consultations to discuss whether extended work might support what you're navigating.

Sometimes quick fixes work. Sometimes you need time to go deep. Both are valid. The question is: what do you need?

Long-Term Therapy: What to Expect from Extended Counselling