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It is one of the first questions people ask, and probably the hardest to answer. Not because therapists are being evasive, but because the clinically accurate answer is that it depends on a set of variables that are genuinely unknown at the outset: what a person is bringing, how long it has been building, how engaged a client is in the process, how frequently they attend, and what they actually mean when they ask whether something is working.
This guide tries to address that question fully rather than offering a session range that will feel either falsely reassuring or unhelpfully vague.
Why does the question not have a simple answer?
Two people can walk into a therapy room presenting with what looks, on the surface, like the same difficulty. Both would describe themselves as anxious, finding it hard to stay present, struggling in their relationships. Six months in, one has finished their work and is doing well. The other is still going, working through something that turns out to have deeper roots than either of them anticipated at the start.
What makes the difference is rarely willpower or commitment, and not always the specific approach being used. More often it comes down to the history behind the presenting difficulty: how long it has been there, how many parts of life it has shaped, whether the underlying pattern is something recent or has been running quietly for decades. Two people presenting with the same words may be describing very different things.
What tends to affect how long therapy takes?
The complexity and duration of the difficulty is usually the most significant factor, though consistency in attendance and engagement also plays a vital role. Someone who attends regularly, who is able to make space for the reflections between sessions, who is more able to sit with discomfort rather than manage around it, tends to see movement faster than someone who is ambivalent about the process or needs more support to lean into the discomfort. Ambivalence is normal and not incompatible with change. But it does require a slower, more tentative pace.
The therapeutic approach also shapes the timeframe in ways that are worth understanding before starting. Some models are structured and time-limited by design. Cognitive Behavioural Therapy (CBT) has a clear framework and tends to produce measurable change within a contained period for presentations where the pattern is relatively recent and clearly bounded. Schema Therapy works at the level of long-standing relational patterns that have been building since early life, and, due to this complexity, takes longer.
What does ‘working’ actually mean?
People enter therapy with genuinely different ideas about what improvement looks like, and some of those ideas make it harder to notice the progress they are actually making. For some, ‘working’ means symptoms disappearing. The anxiety stops, the low mood lifts, the intrusive thoughts quiet down. For others, it means something more like a changed relationship with those experiences rather than their absence, less controlled by them even if they have not gone entirely.
NHS Talking Therapies data shows that since 2017, half of those completing a recommended course of treatment within NHS mental health services go on to recover fully, with two thirds showing significant improvement. Recovery carries a specific clinical threshold, and many people who fall below it still describe meaningful progress that does not show up in the headline figure. Symptoms can sometimes feel like they are worsening initially, but this does not mean therapy is failing or causing harm. In fact, it can be a sign that important work is being completed.
It is also common for things to feel harder before they feel easier. Examining something that has been successfully avoided for years brings it closer to the surface. Therefore, symptoms sometimes feel like they are worsening initially, but that is not a sign the therapy is failing or causing harm. In fact, this can be a sign that important work is being completed
What do the early sessions tend to look like?
The first few sessions at any reputable clinic are less about active therapeutic work and more about building a clear clinical picture. A psychologist or psychotherapist needs to understand what you are bringing, how you are making sense of it, and what has or has not helped before, before making a recommendation about what to do next. Most people describe these early sessions as useful in their own right. Putting our experiences into words for a skilled listener tends to clarify it in ways that thinking about it privately does not quite manage.
By around the third or fourth session the direction becomes clearer. An expert psychologist or psychotherapist will be explicit about what the work is likely to involve and offer a realistic estimate of how long, based on what they are actually seeing rather than a default number.
How does London Bridge Therapy approach this?
At London Bridge Therapy, the initial assessment is designed to answer this question specifically. By the end of it, you will have likely a recommendation about which therapeutic approach is most appropriate and a realistic sense of the likely timeframe, based on what you have brought rather than a generic estimate. The team spans Clinical Psychologists and Counselling Psychologists, andExpert Integrative Psychotherapists and Couples Therapists, across a range of specialist areas. Both shorter-term and longer-term approaches are available, and the recommendation reflects what the individual actually needs.
If you would like to understand what the process might look like for your specific situation, book an initial consultation. The first conversation is designed to address exactly this kind of question.
