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How Long Does Therapy Take? The Answer Might Surprise You

January 6, 2025 by Jason Feinberg, PhD

“How long until I feel better?” It’s often the first question people ask when considering therapy. And it’s a crucial one – after all, you’re investing your time, energy, and money into improving your mental health. Let me share some encouraging news about what you can expect.

In my practice, I work with adults struggling with:

Anxiety disorders
Obsessive-compulsive disorder (OCD)
Depression
Posttraumatic stress disorder (PTSD)

Here’s what might surprise you: most of my clients complete their treatment in just 8-20 sessions. That means meaningful change typically happens within 2-5 months – much faster than many people expect. This timeline is consistent with the typical treatment length reported in several large research studies of various types of psychological treatments¹^,².

What Makes Treatment Effective?

Matching the Right Treatment to Your Needs

Think of it like choosing the right tool for a specific job. Early on, we’ll work together to identify your specific challenges and select proven treatments designed for those exact issues. For instance, my clients with PTSD often benefit from a focused, 5-session program called Written Exposure Therapy³.

The Power of Practice

Just like learning any new skill, progress happens both in and outside our sessions. Each week, you’ll have practical exercises to try at home. These aren’t just busy work – they’re carefully chosen activities that help you build stronger coping skills. For my clients with OCD, for example, these between-session practices are often where the biggest breakthroughs happen. When implementing Exposure and Response Prevention for OCD, practicing with typically avoided situations and triggers is the primary intervention that leads to treatment progress⁴.

Taking that first step toward therapy can feel like a big leap. But here’s the encouraging reality: positive changes often begin sooner than you might think. Even better, research shows that the progress you make in therapy tends to stick with you long after our sessions end⁵. You’re not just investing in feeling better now – you’re building skills and resilience that will serve you for years to come.

1. Carpenter, J. K., Andrews, L. A., Witcraft, S. M., Powers, M. B., Smits, J. A., & Hofmann, S. G. (2018). Cognitive behavioral therapy for anxiety and related disorders: A meta‐analysis of randomized placebo‐controlled trials. Depression and anxiety, 35(6), 502-514.

2. Robinson, L., Delgadillo, J., & Kellett, S. (2019). The dose-response effect in routinely delivered psychological therapies: A systematic review. Psychotherapy Research, 30(1), 79–96.

3. Sloan, D. M., Marx, B. P., Acierno, R., Messina, M., Muzzy, W., Gallagher, M. W., … & Sloan, C. (2023). Written exposure therapy vs prolonged exposure therapy in the treatment of posttraumatic stress disorder: A randomized clinical trial. JAMA psychiatry, 80(11), 1093-1100.

4. Wheaton, M.G., Chen, S. Homework Completion in Treating Obsessive–Compulsive Disorder with Exposure and Ritual Prevention: A Review of the Empirical Literature. Cogn Ther Res 45, 236–249 (2021). 

5. von Brachel, R., Hirschfeld, G., Berner, A., Willutzki, U., Teismann, T., Cwik, J. C., … & Margraf, J. (2019). Long-term effectiveness of cognitive behavioral therapy in routine outpatient care: a 5-to 20-year follow-up study. Psychotherapy and psychosomatics, 88(4), 225-235.

There’s no Shame in Having OCD – Addressing Shame in OCD Treatment

November 15, 2023 by Jason Feinberg, PhD

Shame is all too common among people with obsessive-compulsive disorder (OCD). Almost every person who I have worked with has expressed feeling ashamed and embarrassed about the content of their intrusive thoughts or the nature of the compulsions they engage in to combat them. This has been true for my clients whether they have been struggling with obsessions about contamination, self-harm, relationships, or something else. A common question I hear is “Why can’t I do X, Y, or Z like a ‘normal person’?” Along with such questions usually comes a barrage of self-critical thoughts like, “I’m such a weirdo” or “I’m so weak for repeatedly giving in to my intrusive thoughts.” In addition, it certainly doesn’t help to hear friends, family, and strangers – even if unintentionally – belittle your struggle when they talk about “being so OCD” as if this were a punchline.

Hopefully you are already well aware that highly effective, evidence-based treatments for OCD exist (e.g., Exposure and Response Prevention, Cognitive Behavioral Therapy, Acceptance and Commitment Therapy)and are provided by our expert clinicians in the Portland Psychotherapy Anxiety Clinic. A lesser known component of these treatments is that they often involve an explicit focus on developing skills to more effectively respond to shame and self-criticism. Below are two examples of how evidence-based OCD treatments might address shame and self-criticism related to OCD, including links to helpful resources.

ADDRESSING SHAME VIA ENHANCING SELF-COMPASSION

People, including individuals with OCD, are often naturally skillful at acting compassionately towards others. However, it can be much harder to turn that compassion inwards. Therapeutic approaches to enhancing self-compassion include learning about self-compassion, understanding how it operates in your own life, and developing a consistent self-compassion routine via practicing self-compassion-focused exercises. To learn more about self-compassion and to see example exercises, use the following links:

ADDRESSING SHAME VIA COMBATING OCD STIGMA & MISINFORMATION

The reality is that most people’s understanding of OCD is limited to media caricatures they have seen of people who are highly perfectionistic and/or extremely focused on cleanliness. One of the most common initial tasks of OCD treatment is to dispel common myths about OCD and provide more factual information. Whenever possible, I like to incorporate individuals’ main support systems in this “de-mystifying OCD” process. It becomes easier to feel less ashamed about OCD when you and the people around you understand OCD and feel like you’re on the same team in treating it. For folks who encounter OCD-related stigma especially frequently, treatment may also involve learning and rehearsing ways to practice self-advocacy. Lastly, people often find it helpful to develop a sense of community in order to feel less isolated and alone in their struggles with OCD. To learn more about OCD and to see example exercises and resources, use the following links:

https://iocdf.org/about-ocd/

https://iocdf.org/realocd/

https://iocdf.org/programs/conferences/

New Research Sheds Light on How Self-Criticism Damages Social Relationships

November 15, 2023October 3, 2023 by Portland Psychotherapy Team

The findings suggest some behaviors that may partially explain why highly self-critical people often experience poorer quality relationships and social isolation. Out of a desire to avoid rejection, self-critical individuals may mute their emotional expressions and conceal thoughts and feelings. Unfortunately, this emotional guardedness can distance others and undermine relationship intimacy and closeness.

A team of researchers from Portland Psychotherapy recently published an intriguing study that sheds light on how self-criticism can damage social relationships. Self-criticism, defined as the tendency to negatively and harshly evaluate oneself, has been linked to poorer interpersonal functioning and social isolation. However, the specific mechanisms underlying this association have been unclear. In this new study, published in Current Psychology, the research team identified some likely interpersonal behaviors through which self-criticism exacerbates social disconnection.

The researchers, Jason B. Luoma, PhD and Christina Chwyl surveyed over 300 participants from the community. They measured self-criticism along with three interpersonal variables – expressive suppression, expression of positive emotions, and self-concealment. Expressive suppression involves inhibiting the outward display of emotions. Self-concealment refers to the tendency to hide personal information perceived as negative or distressing.

The results showed that higher self-criticism was associated with greater expressive suppression, less expression of positive emotions, and more self-concealment. These relationships held even after accounting for the roles of depressive symptoms and emotional intensity. Among these variables, reduced positive emotional expression had the strongest link to lower feelings of social belonging among self-critical participants.

The findings suggest some behaviors that may partially explain why highly self-critical people often experience poorer quality relationships and social isolation. Out of a desire to avoid rejection, self-critical individuals may mute their emotional expressions and conceal thoughts and feelings. Unfortunately, this emotional guardedness can distance others and undermine relationship intimacy and closeness.

Suppressing positive emotions, in particular, may deprive self-critical people of opportunities for social connection. Expressing positive emotions promotes relationship development and maintenance. Failing to outwardly share happiness, excitement, and affection could impair self-critical individuals’ ability to form close bonds. This intriguing study thus highlights the importance of fostering positive emotional expression for self-critical people’s social wellbeing.

As the researchers note, their cross-sectional design precludes firm causal conclusions. Experimental and longitudinal research is needed to further test the study’s model. However, these results move our understanding forward by pinpointing specific interpersonal pathways that may fuel the isolating effects of self-criticism.

The findings suggest that psychotherapies which help clients express emotions openly, authentically share about themselves, and connect with positive emotions could aid self-critical individuals in building fulfilling social relationships. By targeting key interpersonal behaviors, clinicians may be able to alleviate self-critical people’s loneliness and foster a greater sense of belonging. Remediating deficits in positive emotional expression seems particularly promising based on this study. Overall, these insights enhance our grasp of how self-criticism operates interpersonally and point toward avenues for reducing its detrimental social impacts.

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