When Does Long-Term Therapy Help — And When Does It Keep You Stuck?
Someone posted in an expat Facebook group recently — and it’s worth sitting with.
They described being told by their therapist that they cannot miss their weekly sessions — booked two years in advance — because therapy is “a privilege, not a right.” No defined goals. No exit plan. €150 a week, indefinitely. And the instruction to feel grateful for the access.
It’s an extreme case. But it raises a question the field rarely asks out loud: how long should therapy actually take?
What the research says about therapy duration
The evidence on this is more definitive than most practitioners let on.
For the majority of common presentations — depression, anxiety, adjustment difficulties, relationship stress — the research consistently shows that most therapeutic gains occur within 8 to 16 sessions. A landmark 1986 study by Howard et al. found that roughly 50% of clients showed measurable improvement within 8 to 13 sessions, and 75% by session 26. After that, the rate of improvement slows significantly.
This is known as the dose-effect relationship. More sessions don’t automatically produce more improvement. At a certain point, the curve flattens.
That doesn’t mean long-term therapy is never appropriate. It is — for complex trauma, personality disorders, chronic conditions, and clients who explicitly want ongoing support as part of how they manage their mental health. There are legitimate clinical reasons for extended treatment.
But “I’ve booked you out for two years” is not a clinical reason.
The difference between support and dependency
One of the markers of good therapy is that it works toward its own irrelevance. The goal is not to create a client who needs weekly sessions indefinitely — it’s to build the internal resources, skills, and self-understanding that make the therapist progressively less necessary.
When therapy doesn’t move in that direction, it’s worth asking why.
Sometimes it’s appropriate clinical judgment. Some people genuinely benefit from ongoing, lower-frequency support after an intensive phase. Some choose to continue as a form of self-investment, clear-eyed about what they’re paying for.
But sometimes the structure of long-term therapy serves the practice more than the person in the room. The incentives aren’t hidden — they’re just rarely named.
Questions worth asking your therapist
So what can you do about it? You’re allowed to ask these. A good therapist will welcome them:
- What are we working toward, specifically?
- How will we know when we’ve got there?
- What does ending therapy look like from here?
- If I needed to take a break, what would that mean for my progress?
If those questions are met with deflection, vagueness, or — as in the case above — a reminder that access to therapy is a privilege, that’s information. It may be time to find a therapist who works differently.
What good therapy actually looks like
In good therapy, the client has goals. Good therapy has flexibility. It treats the client as someone moving through something, not someone indefinitely in need of management.
Duration varies — and rightly so. Some people need six sessions. Some need sixty. The number should follow the clinical picture, not the appointment book. This matters especially for couples navigating something difficult together — where the goal is resolution, not indefinite maintenance.
At PsyShrink, sessions are structured around what you’re actually working on. We work with international clients, expat families, and couples navigating real-world complexity — which means we know that life doesn’t run on a fixed weekly schedule, and online or in-person treatment shouldn’t either.
If you’ve been in therapy for a while and you’re not sure what you’re still working toward, that’s a conversation worth having — with your therapist, or with someone new.