Short-Term vs Long-Term Therapy: Which Do You Need?

"How long will I need therapy?"

It's one of the first questions people ask. And it makes sense—you want to know what you're committing to, financially and emotionally. Will this be six sessions or six years?

The honest answer: it depends.

Not the most helpful response, I know. But therapy duration genuinely varies based on what you're working on, your goals, your history, and how quickly change happens for you.

That said, there are meaningful differences between short-term and long-term therapy—not just in duration, but in what they can achieve and who they suit best.

This article explores both approaches, what each offers, and how to decide which you need.

Defining the Terms

Short-Term Therapy

Duration: 6-20 sessions (roughly 2-6 months)

Structure:

• Time-limited from the start
• Focused on specific goals
• Often directive and solution-oriented
• Clear beginning, middle, end

Common approaches:

• CBT (Cognitive Behavioural Therapy)
• Solution-Focused Brief Therapy
• Time-limited psychodynamic therapy
• Structured trauma protocols (like brief EMDR)

Long-Term Therapy

Duration: 6 months to several years

Structure:

• Open-ended (no predetermined end date)
• Exploratory and process-oriented
• Focuses on deep patterns and relationship
• Ends when work feels complete

Common approaches:

• Person-centred therapy
• Psychodynamic/psychoanalytic therapy
• Long-term integrative therapy
• Attachment-based therapy

The Grey Zone: Medium-Term Therapy

Many people fall somewhere in between:

• 3-6 months (12-24 sessions)
• Addresses more than immediate crisis
• Allows some deeper work
• Provides flexibility

This is actually the most common duration in private practice.

Short-Term Therapy: When It Works Well

Best For:

1. Specific, Concrete Problems

Short-term therapy excels when you have a clear, targeted issue:

• Managing panic attacks
• Overcoming a specific phobia
• Preparing for a known challenge (presentation, exam, medical procedure)
• Developing coping strategies for a particular stressor

2. Recent Life Events

When difficulty stems from a specific recent event:

• Redundancy
• Break-up
• Bereavement (uncomplicated grief)
• Moving to new city

You need support processing the event and adapting, not deep exploration of lifelong patterns.

3. Skill-Building

Learning specific tools:

• Assertiveness
• Anxiety management
• Sleep hygiene
• Conflict resolution

4. Decision-Making

When you need clarity about a specific decision:

• Should I leave this job?
• Is this relationship right for me?
• How do I handle this family conflict?

5. Crisis Stabilisation

Immediate support to:

• Manage acute distress
• Develop safety plan
• Access resources
• Stabilise before deeper work (if needed)

What Short-Term Therapy Provides

Immediate relief: You'll likely notice symptom reduction relatively quickly—within 6-8 sessions for many issues.

Focused attention: Clear goals mean therapy stays on track. Less wandering, more direction.

Practical tools: Techniques and strategies you can use immediately.

Predictable commitment: Knowing it's 12 sessions makes it easier to commit financially and emotionally.

Sense of achievement: Completing a time-limited therapy can feel empowering.

Limitations

Surface-level: Short-term therapy addresses presenting problems but may not explore underlying patterns.

Symptom-focused: It might reduce anxiety without addressing why you're anxious in the first place.

Requires clear goals: If you're not sure what you want or need exploratory space, time limits feel constraining.

Doesn't suit complex issues: Trauma, personality difficulties, deep relationship patterns need longer.

Long-Term Therapy: When It's Necessary

Best For:

1. Complex Trauma

Childhood abuse, neglect, or multiple traumatic experiences require:

• Time to build safety and trust
• Gradual processing
• Healing attachment wounds
• Rebuilding sense of self

This can't be rushed.

2. Personality Patterns

Deep-rooted ways of seeing yourself and relating to others:

• Chronic low self-esteem
• Attachment difficulties
• Relationship patterns (choosing unavailable partners, sabotaging intimacy)
• Identity issues

These patterns formed over years—they take time to shift.

3. Chronic Mental Health Difficulties

Long-standing depression, anxiety, or other conditions:

• Woven into your identity and life
• Multiple contributing factors
• Require fundamental shifts, not just symptom management

4. Developmental Work

If you're working on:

• Who am I?
• What do I want?
• How do I relate authentically?
• What gives my life meaning?

These existential questions unfold over time.

5. Relationship as Healing

Sometimes the therapeutic relationship itself is the healing agent.

If you've never experienced:

• Being truly heard
• Unconditional acceptance
• Consistent, reliable presence

The relationship takes time to build and becomes the vehicle for change.

What Long-Term Therapy Provides

Deep exploration: Space to understand yourself at fundamental levels—not just fixing symptoms, but discovering who you are beneath them.

Healing attachment wounds: Building a secure relationship with your therapist over time can genuinely shift internal working models of relationships.

Pattern recognition: Patterns take time to emerge and observe. In long-term work, you see the same issues arise in different contexts—illuminating.

Integration: Changes integrate more fully when they happen slowly and are supported over time.

Safety for difficult work: Some things can only be explored when deep trust exists. That takes time.

Limitations

Cost: Long-term therapy is expensive. At £100/session weekly, that's £400/month, £4,800/year.

Time commitment: Attending weekly for months or years requires dedication.

Dependency risk: Some people become overly dependent on their therapist, using therapy as substitute for life rather than support for living.

No clear endpoint: Not knowing when you'll finish can feel unsettling.

How to Decide What You Need

Ask Yourself:

What am I hoping to achieve?

• Specific symptom relief = short-term might work
• Deep self-understanding = likely needs longer

How long have I struggled with this?

• Recent problem = shorter therapy often sufficient
• Lifelong patterns = longer work needed

Have I tried therapy before?

• If short-term helped but didn't last, you might need deeper work
• If you've never tried therapy, start short-term and reassess

What's my situation?

• If you have specific stressor with clear end (job search, divorce process), time-limited makes sense
• If you're dealing with existential questions or identity, open-ended suits better

What can I afford? Be realistic. Six months of therapy you can afford beats two years you can't sustain.

The Starting Point Question

Don't know whether you need short or long-term? Start with:

• 8-12 sessions with review at end
• Assess: Has it helped? Is there more to do? Do I want to continue?

This gives you information without lifetime commitment.

The Hybrid Approach

You don't have to choose one forever. Many people do:

Sequential:

• Short-term therapy for immediate crisis
• Return later for longer-term work when ready

Phased:

• Intensive period (weekly for 3-6 months)
• Taper to fortnightly or monthly
• "Maintenance" sessions as needed

Intermittent:

• Therapy for a few months
• Break
• Return when new issues arise

This is actually how many people use therapy throughout their lives.

What Research Says

Effectiveness:

• Short-term therapy (especially CBT) shows strong results for specific disorders (anxiety, depression)
• Long-term therapy shows benefits for personality difficulties, complex trauma, and general wellbeing
• For many issues, both work—choice depends on goals and preferences

Dose-effect:

• Most improvement happens in first 8-12 sessions
• But deeper, lasting change often requires longer
• Some research suggests 50+ sessions for complex issues

Therapeutic relationship: The strength of the relationship predicts outcomes more than duration. A strong connection in short-term therapy can be more effective than weak connection over years.

Making It Work Financially

For Short-Term Therapy:

Block book: Many therapists offer discounts for booking 6-12 sessions upfront.

Use EAP: Employee Assistance Programmes often provide 6-8 sessions free.

Ask for time-limited contract: "Can we work together for 10 sessions focusing on [specific issue]?"

For Long-Term Therapy:

Reduce frequency: Weekly is ideal, but fortnightly is half the cost and still beneficial.

Look for sliding scale: Some therapists offer reduced rates for long-term clients.

Mix formats: Alternate between in-person and online (some therapists charge less for online).

Review regularly: Every 3-6 months, assess: Is this still helpful? Can I afford to continue?

Knowing When to End

Signs Short-Term Therapy Has Achieved Its Goal:

• Specific symptoms significantly reduced
• You've developed tools and skills
• Clarity achieved about decision
• Crisis stabilised
• Agreed-upon goals met

Signs Long-Term Therapy Might Be Complete:

• Deep patterns have shifted
• You relate to yourself and others differently
• Symptoms significantly reduced or resolved
• Therapy feels less necessary—you're using skills independently
• The work feels finished (even if not perfect)

When to Extend:

Short-term becomes longer if:

• Initial issues improved but deeper patterns emerged
• You realise you want more than symptom relief
• Therapeutic relationship feels valuable and you want to continue

Long-term extends further when:

• New material emerges
• Life circumstances change
• You want ongoing support during transitions

Common Concerns

"Will my therapist push me to continue longer than I need?"

Ethical therapists don't create dependency. If you feel pressured, that's a red flag.

Good therapists:

• Regularly review progress
• Support your autonomy
• Acknowledge when work feels complete

"Can I stop before the agreed-upon time?"

Yes. Therapy is voluntary. However:

• Discuss with your therapist rather than just not showing up
• Ending well (even if earlier than planned) is valuable
• You can always return

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

Options:

• Reduce frequency (fortnightly)
• Find low-cost services (wait times apply)
• Intensive short period, then break, then return
• Use NHS IAPT for symptom-focused short-term work

Final Thoughts

There's no universal right answer to "how long should therapy last?"

Some people do meaningful work in eight sessions. Others need eight months. Some return to therapy multiple times across their lives, each time for a different need.

What matters is:

• Matching approach to your goals
• Finding what you can sustain
• Feeling progress (even if slow)
• Ending when work feels complete (for now)

Therapy isn't like medication with fixed dosage and duration. It's more like education—some people need GCSEs, others need PhDs. Both are valuable. Neither is wrong.

Start where you are. Reassess as you go. Trust yourself to know what you need.

If you're in London and unsure whether you need short or long-term work, I offer a free initial consultation to discuss your goals and what might suit you best. I work with both time-limited focused therapy and open-ended exploratory work, depending on what you need.

You can reach me at 07887 376 839 or via the contact form on this website.