When it comes to psychotherapy, the Good Faith Estimate (GFE) has much less to do with some hidden surprise cost you might discover when you wake up in your hospital bed than with how long you will engage with the service.
For a person entering psychotherapy, it’s a very reasonable question to ask: “In the end, how long is all this really going to last? Am I going to be seeing you for a month, six months, a year? What am I actually getting myself into here?”
What am I actually getting myself into here?
These are great questions.
I don’t think that most people, when they initiate psychotherapy sessions, give such questions a lot of thought, because often enough they’re in a lot of pain. And maybe they shouldn’t be so concerned with such questions, if it means they wouldn’t get the help they need.
At the same time it might be helpful to understand more clearly some of the common length of times of service. Following is how I have seen people use psychotherapy, and why.
| Number of Sessions | Total Cost | Form |
|---|---|---|
| 1 – 4 | $125 – $500 | Very brief |
| 5 – 12 | $625 – $1500 | Brief (2 – 4 months) |
| 13 – 24 | $1625 – $3000 | Short term (3 – 6 months) |
| 25+ | $3125 – $6250 yearly | Long term |
Very brief
Laser-focus counseling might happen if you have a very particular issue or trauma to resolve and you wish to work with a professional on it. There may be sessions involving the Flash Technique, or you might make a decision or take action or let something go in such a way that you can move on, problem solved. Or you can have an unexpected, fast breakthrough and both you and I agree that it’s appropriate to end services.
This might also happen if you don’t connect with the therapist, or for whatever reason don’t feel that you wish to continue. Generally speaking, it is in your hands. The therapist might also end the process if he feels he cannot meet the client’s needs; in this case, he is ethically required to refer the client out.
Less than four sessions is uncommon, but happens, and sometimes, very successfully.
Brief
This is short-term, solution-focused psychotherapy. In some cases it might feel a little bit tight, in others just right. We are there together to go after something very specific and we stay on track. This could be for example, an initial guidance through Pain Reprocessing Therapy so that you have a full introduction to and experience of the method. In this time you can change your understanding and experience of pain as we work together through those months. And this could very well suffice.
Or if you suffer from anxiety or panic this would be enough time for you to have had space to really talk through what’s been going on with you; for you to be presented with and have the time to think & feel through different ways of understanding yourself and your experience; for us to try a number of interventions; and for you to have had time to develop new habits.
Short term
This is “longer” short-term psychotherapy, often no longer as solution-focused and sometimes, more interested in insight. From what I’ve seen, this is a common amount of time for people to spend in psychotherapy. It’s roughly a six-month period of consistent weekly work together, or it might be spread out over a year or even a little longer.
It’s supportive of deeper changes that you want to make in your life—but it is also not necessarily better or more productive than a shorter number of sessions. It depends on you and your speed of change and need or wish for support.
If you have the means, then setting an expectation of 3 – 6 months for yourself might be beneficial, because it might allow you to navigate both the tension of being pushed to “get better fast” and anxiety about a long process. Your actual needs will clarify over the first few sessions, and again, it is up to you.
Long Term
In general, there is a large group of clients within the field who fall into this group … but how long is long? As it was originally understood by Freud and others, true long-term psychotherapy can go on for many years. The therapeutic treatment of psychoanalysis was intensive, involving 3 to 5 weekly sessions and 3 to 7 years. This is roughly the time it takes to undergo a major maturational change. But for the vast majority of therapy seekers today, those days are long gone, and—most might think—good riddance.
However, many people do “longish”-term therapy, seeing a therapist every week for a few months and then continuing as needed over several years.
From a cynical point of view, one might think that this is the type of client that a psychotherapist wants to see, a long-term customer. But actually, that’s not really the case. Psychotherapists are people too and they enjoy variety and seeing new clients. And they also appreciate seeing positive development and true healing, “graduation” from therapy—but with an important caveat.
Necessary Support
Regardless of social class, some people require a professional caregiver of one sort or another to be a part of their life. If they do not have ongoing support from a psychotherapist or other professional helper, they will not be able to attain and hold on to a job and their relationships with friends and family will be untenable. Instead of functioning they may be in jail or on the street or worse.
Having worked for multiple agencies that served clients who were poor, had little education and often faced enormous environmental and life stresses as well, it’s quite clear to me that some people require long-term help, without a prescribed limit, and with no expectation whatsoever of “getting better”. Indeed, anyone can go through a period of several years in which they need some ongoing weekly presence just in order to keep things together.
Short-term psychotherapy can be excellent if you fall into a hole and you need help getting out of the hole. But what if you’re living in a hole? What if you need someone who is willing to climb down there and sit with you in a friendly way every week while you figure out how to make a ladder or dig a tunnel or even imagine what it’s like up there in the sunlight?
Developmental Change & Life Adjustment
A second point is that people go through periods of developmental change and sometimes have terrible difficulty managing those transitions. We may not have a person in our life who can be there to help us, and often it’s not because they don’t want to, but simply because they don’t have the skill.
Speaking personally, I first went to psychotherapy when I was 19 years old and was suffering from terrifying panic attacks. Always a good student, I was suddenly facing failure because I was having attacks everywhere including in class and I had no idea how to calm my nervous system. I hardly knew I had a nervous system until it quite rudely awakened me to the fact! But I needed to figure out how to manage the sorts of feelings and energies that can flow through a body.
So I entered psychotherapy on a weekly basis and I was in it for over a year. During that year my grades turned around and I finished well, getting a degree in Physics, and then I went on to Graduate School in Counseling Psychology because I had become so fascinated with what I was finding out about the mind. So for a person like me, who was on a sort of journey of self-discovery, a year or more of psychotherapy made perfect sense. And luckily, I had the health insurance to pay for it. (A good investment by the insurance industry that has been paid back many-fold.)
Life Enhancement
Finally, another group of long-term psychotherapy clients are people of means. I have a wealthy friend who once joked that a psychotherapist he and his former wife saw helped keep their relationship from dissolving for many years until they finally quit psychotherapy … and then immediately got divorced.
It’s funny—sort of—but is the moral of the story that they should have just gotten a divorce right at the outset? It’s hard to say, isn’t it? Life is complex. But it implies both that psychotherapy can help one adjust to things that are difficult to adjust to … but also, it can, especially in long-term therapy, become a way of resisting change as well. This is a deep subject, the uses and misuses of psychotherapy.
Regardless, the fact is that if a person has the means, then they can view psychotherapists or coaches as aids in personal growth that they elect to pay for out of pocket. They find that the service makes their work better, their relationships better, and it presents them with a developmental path that otherwise might be lost in a overly-busy life.
From my point of view, all of these are reasonable and usually unproblematic reasons to do long-term psychotherapy. The question in each case is whether it is a good fit between client and counselor and one in which beneficial development is indeed occurring. That question, as my friend pointed out, is always an important one to return to.
The question now is, what type of client are you? Which of these situations sounds like you? I can’t really answer that. Although of course, if and when we meet, I would be happy to discuss the matter and I’d bet we can discern an answer.
My offer to you is to work together on a productive series of psychotherapy sessions, such that we both feel that your goals are being met. One thing my coaching training has highlighted for me, is the importance of discovering at the outset just what it is that you really wish from the encounter, and keeping that in our sights.
Why exactly do you seek counseling? Understanding that clearly already brings us close to meeting that need and tells us something about how much time it will take.