Therapy 101: The therapeutic process
One of the most common misconceptions about therapy is that you hire a therapist to give you advice about your problems.
And this makes sense. You go to other medical professionals for advice on your medical care because they’re the experts. They’ve spent a lot of time learning and practicing in their field and, generally speaking, that’s just how most of us learned it typically works. I have an ailment, you tell me how to fix it.
It also makes sense because the word counselor is the term used for academic and licensing purposes in the psychology profession (for example: graduate programs in Counseling Psychology, Licensed Mental Health Counselor, etc.). According to Merriam-Webster, the most common use of the term counselor is "a person who gives advice."
And yet, this is not exactly how the process works. In series two of four, we’ll dive into the sometimes misconceived world of the therapeutic process.
The therapeutic process
Some of the most common questions about therapy include the practicalities of it. If you’re considering starting therapy, you might want to know how long your sessions will be and how often you’ll be going. Therapy is an investment in time and money and you might be wondering how long the entire process will take.
Read on for answers to the more practical questions about the therapeutic process, followed by what to expect in session.
How long will sessions last?
While there is no rigid rule regarding how long therapy sessions should be, there are some typical ranges based on the type of therapy you’re seeking.
Individual therapy
Individual therapy sessions can range from 45-60 minutes long with a 50 minute session being the most common. This timeframe typically allows for in-depth exploration of your concerns, discussion of progress since your last visit, collaborative strategy development, and goal setting.
One thing to note is that your first session, usually referred to as the initial intake session, may be longer than subsequent sessions. If your sessions are normally 50 minutes long, your intake make be the same amount, or may be 90+ minutes.
Couples or family therapy
To effectively address the dynamics and needs of multiple people, couples and family therapy sessions may be longer than individual sessions. The goal here is to allow for sufficient time for everyone to share their perspectives and for the therapist to guide the process toward achieving shared goals. Generally speaking, the larger the family, the longer the session time will likely be.
Group therapy
Group therapy sessions are typically 90-120 minutes in length, allowing ample time for each participant to contribute to the discussion.
Other things to keep in mind:
Your specific needs and goals may influence the session length and may be able to be negotiated with your therapist.
Some therapists may have their own preferred session length, especially those who do not work with insurance.
Insurance companies may have specific guidelines regarding session length for reimbursement, which may affect your therapist’s ability to negotiate session length.
How often will I go to therapy?
As a new client, it’s generally recommended that you be seen on a weekly basis. Being seen weekly creates a steady rhythm to the process, making it easier to establish a rapport with your therapist and maintain a sense of trust.
When it comes to therapeutic progress, consistency plays a pivotal role and weekly therapy sessions offer more frequent and regular engagement with your therapist.
This consistency allows you to delve deeper into your thoughts, emotions, and experiences and with a shorter gap between sessions, you’re better equipped to build on the insights gained from each session, leading to more significant progress over time.
Therapists who see new clients on a bi-weekly or monthly schedule often note that much of their session time consists of re-building comfort and re-building rapport. This means using less of the time to focus on therapeutic work and goals, which tends to slow down the process of change.
After you and your therapist feel that progress has been made, you may begin to talk about reducing session frequency to bi-weekly, monthly, or even drop-in sessions.
Note that this is a general guideline. There are some therapists that only see clients on a bi-weekly basis and some clients with more complex or severe symptoms may benefit from being seen twice a week or more.
If you’re unsure what you need, reach out to a therapist you’re interested in working with and ask them what they’d suggest for your situation.
How long can I expect to be in therapy?
Therapy is an investment of your time and money and it’s completely understandable if you’re wondering how long the process takes. If you’re new to this space and unsure what to expect, you might apply your knowledge and experience from other health professions as an estimate. Let’s run with that.
If you go to the doctor for an infected cut, they’re going to ask you about your symptoms, give you a diagnosis (required for billing insurance), and prescribe medication with instructions on how long to take it. This is helpful because you a) know what’s going on, b) have a remedy to help it, and c) know roughly how long it will take to heal.
You’ve probably also experienced times when you’ve needed to go to the doctor when it wasn’t so cut and dry. Let’s say you’ve had stomach pains on a weekly basis for the past couple months that don’t seem to be resolving. Your doctor will go through a similar process as with the first example, yet the treatment this time is a little trickier because there are many different causes for stomach pain and it might not be obvious what’s going on.
You could receive medication to help the pain, but that only addresses your symptoms and not the root cause. To find that out, you may need to take more of an experimental approach that will take more time and effort.
Similarly, there are some people who come to counseling with issues that are more cut and dry. Maybe they have one small thing they want to work on, like managing stress at work. This might take as little as a couple months to treat because it’s largely targeting symptom reduction.
Others come in with psychological wounds that are more complex and benefit from exploration of the root cause and time for repair and healing in addition to symptom reduction. Just as for the issue of stomach pains above, it might take a number of different remedies to heal your unique concern.
Also keep in mind that the modality your therapist uses may also impact how long you’re in therapy. Cognitive Behavioral Therapy (CBT) or Solutions Focused Brief Therapy (SFBT) are examples of more short-term therapies that focus on specific problems, while psychodynamic therapy is a good example of a long-term therapy that takes the time to explore deeper patterns.
How you and your therapist work together is also important. If you find a good connection and feel comfortable, you're more likely to make progress. Your commitment to the process, like attending sessions and doing any "homework," is also key.
The following are questions you can ask yourself to determine how long you might need in therapy:
How long has this problem been occurring?
How ingrained are my habits related to this problem?
Has this problem ever had flair-ups after periods of feeling better?
At the start, you and your therapist will likely talk about your goals and create a plan. This plan might include a rough idea of how long therapy could last, but it's flexible. Things change, and your needs might too.
The most important thing to remember is that therapy is unique to you. There's no right or wrong timeline. It's about finding what works for you. Don't be afraid to talk to your therapist about your progress and how you're feeling. Open communication will help you get the most out of your experience, for as long as you need it.
What can I expect in sessions?
So what actually happens in the therapy room? If you’ve never been to therapy, you may be relying on what you’ve seen in popular media to get an idea of what goes on. Common stereotypes of a therapist displaying token empathy and asking things like “And how does that make you feel?” fuel a lot of assumptions.
Others might picture a wise figure dispensing sage advice. While it's tempting to think a therapist holds all the answers, the reality of therapy is far more nuanced and ultimately, more empowering.
Therapy isn't about getting a to-do list for happiness. Instead, it's a collaborative journey of self-discovery and growth. Think of your therapist as a guide, not a guru. In fact, one of the main aims of therapy is to empower you to discover your own solutions. Here’s why:
You are the expert on your own life. No one else can truly understand your experiences and feelings as deeply as you do.
Advice can offer temporary relief, but true and lasting change comes from within. Your therapist will help you develop the skills needed to navigate challenges on your own terms.
Simply telling someone what to do doesn't address the underlying issues that contribute to their concerns. Therapy delves into the "why" behind your thoughts, feelings, and behaviors, fostering deeper understanding and healing.
Therapy equips you with skills for coping, problem-solving, and emotional regulation. This empowers you to become more self-reliant and resilient, rather than dependent on external advice.
What has worked for your therapist or for other clients might not work for you. Therapy is tailored to your unique needs and circumstances, helping you discover solutions that are right for you.
All that said, what your therapy will look like his highly dependent on many different factors such as what type of therapy you’re in, what modality your therapist uses, and what your concerns are.
What we can say is that the beginning of therapy (first 1-4 sessions) often involves sharing your history, determining goodness of fit between yourself and your therapist, discussing your goals and treatment plan, and building trust and rapport.
Subsequent sessions move towards deeper therapeutic exploration in service of your goals. This might include things like working toward gaining insights, learning skills, and processing emotions. The topics you discuss with your therapist depend on your preferences, goals, and progress. You might delve into past experiences or address current concerns.
Therapy is a dynamic process that can be emotionally taxing, but can also be incredibly rewarding. It's a good idea to plan your sessions at a time of day when you can take some downtime after sessions.
What happens when I've met my goals?
Reaching your treatment goals is a significant milestone that deserves some acknowledgement and celebration. At this point, therapy often shifts from intensive work to a more maintenance-focused approach.
You and your therapist might discuss reducing session frequency, moving from weekly to bi-weekly or monthly. This allows you to practice your new skills independently, while still having a safety net. Sessions will focus on reviewing your progress, addressing any emerging concerns, and reinforcing your skills.
When you feel confident in your ability to manage challenges and maintain your well-being on your own, congratulations, you’ve reached the end of your therapeutic journey. Your therapist will very likely welcome you back for one-off sessions in the case of future flare-ups.
Ultimately, the therapeutic process is about empowering you to become your own best resource. It's about building the skills and confidence to create a life that's meaningful and fulfilling for you. Stay tuned for our next Therapy 101 series all about navigating the cost of therapy.
