One of the most common questions people ask before starting therapy is also one of the hardest to answer precisely: how long will this take?
The honest answer is: it depends. But "it depends" without context is not especially useful. Here is what the research actually shows — and what to realistically expect.
Short-term versus long-term: the basic distinction
Most evidence-based therapies are designed as short-to-medium-term treatments. CBT for anxiety or depression is typically structured as 12–20 sessions. EMDR for single-incident trauma can produce significant change in 8–12 sessions. Structured DBT programs run 24 weeks. These are not arbitrary numbers — they represent the duration over which most clinical trials have found meaningful and lasting symptom change.
This does not mean therapy automatically stops at session 20. It means that most people with these conditions, meeting weekly, should see significant improvement within that window. If meaningful progress hasn't occurred, it's a signal to re-evaluate the approach — not simply continue indefinitely.
What conditions typically require longer work?
Some presentations genuinely benefit from longer-term therapy:
Complex trauma (C-PTSD) develops from prolonged or repeated traumatic experience, often in childhood, and affects core patterns of self-perception, relationships, and emotional regulation. It takes longer not because therapy is failing but because the change being made runs deeper than symptom relief.
Personality patterns — particularly the patterns associated with borderline, avoidant, or dependent personality styles — are not discrete symptoms but pervasive ways of relating to self and others. Treatments like DBT and schema therapy are designed for longer engagement.
Long-standing, recurrent depression that has been present for years or decades, and is woven into someone's sense of themselves and their history, typically requires more than symptom-focused work.
Co-occurring conditions — anxiety plus ADHD, depression plus substance use, trauma plus an eating disorder — almost always extend treatment duration because the conditions interact and each needs to be addressed.
What frequency of sessions matters
Weekly sessions are the standard for active treatment. The session-to-session continuity matters: skills learned in session need to be practiced and refined before the next appointment, and material explored in session needs time to integrate. Every-other-week therapy slows this process measurably.
If you cannot attend weekly, every-other-week therapy is better than nothing — but discuss this openly with your therapist and adjust goals accordingly.
Signs therapy is working
Progress in therapy does not always feel like linear improvement. Some sessions will feel harder than others — particularly when you're working through difficult material. But over the arc of months, you should be able to identify:
- The specific concerns that brought you in feel less overwhelming
- You have skills you're actually using in your daily life
- The story you tell about your difficulties is changing — more nuanced, less shame-laden, more compassionate toward yourself
- Your relationships are slightly different — less reactive, more intentional
- Your therapist and you have a shared language for your experience
If none of these feel true after 10–12 sessions, raise it directly: I don't think I'm making progress. What's your read on that?
When therapy and medication together is faster
For moderate-to-severe anxiety or depression, the research is fairly consistent: therapy combined with medication produces faster response and better long-term outcomes than either alone. This does not mean everyone needs medication — but if you've been in therapy for 12+ sessions without meaningful symptom change, a psychiatric evaluation is worth considering.
MMHC offers integrated therapy and psychiatry at the same locations. When your therapist and prescriber can communicate directly, coordination is straightforward.
Getting started
If you're in Minnesota and considering therapy, our therapists across 11 Twin Cities locations are accepting new patients. A first appointment is typically available within one to two weeks. Most major insurance plans are accepted.