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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.

Addressing Shame in Body Dysmorphic Disorder: A Promising New Approach

December 27, 2024 by Portland Psychotherapy Team

Body Dysmorphic Disorder (BDD) is a severe mental health condition characterized by an obsessive focus on perceived flaws in one’s appearance, often leading to significant distress and impairment in daily functioning. While Cognitive Behavioral Therapy (CBT) has been the gold standard treatment for BDD, many individuals do not respond adequately to this approach. Recent research suggests that shame plays a critical role in the development and maintenance of BDD symptoms. Therefore, targeting shame directly may enhance treatment outcomes for those suffering from this debilitating disorder.

In a pioneering study published in Behavior Modification, a team of researchers including Jason Luoma PhD, from Portland Psychotherapy, developed and tested an innovative therapeutic approach that combines Acceptance and Commitment Therapy (ACT) with compassion-focused approaches to address shame in individuals with BDD. This approach, called ACT with Compassion (ACTwC), is designed to reduce shame and self-criticism while increasing psychological flexibility and self-compassion.

The Role of Shame in BDD

Shame is a powerful emotion that involves seeing oneself as fundamentally flawed and unworthy. In BDD, this emotion is often tied to the perceived defects in one’s appearance, driving behaviors such as excessive mirror checking, comparing oneself to others, and social avoidance. These behaviors not only reinforce the negative self-view but also contribute to the persistence and severity of BDD symptoms. Research has consistently shown that higher levels of shame are associated with worse outcomes in BDD, including greater symptom severity, lower quality of life, and higher rates of depression.

Despite the clear link between shame and BDD, traditional CBT does not specifically target shame, focusing instead on changing maladaptive thoughts and behaviors. The researchers recognized this gap and sought to create a treatment that would directly address the underlying shame fueling BDD symptoms.

The ACT with Compassion Approach

ACT with Compassion (ACTwC) integrates the principles of ACT, which encourages individuals to accept difficult emotions and commit to actions aligned with their values, with compassion-focused elements. The treatment protocol developed by the team involves 12 individual therapy sessions, each about 60 minutes long, delivered over weeks.

The intervention includes psychoeducation about BDD and shame, mindfulness training, and experiential exercises designed to foster self-compassion and psychological flexibility. Patients are encouraged to confront and accept their feelings of shame rather than avoiding them, and to develop a kinder, more compassionate relationship with themselves.

Promising Results from the Pilot Study

The pilot study conducted by the researchers involved five participants diagnosed with BDD. The results were encouraging: four of the five participants showed significant reductions in BDD behaviors and self-criticism by the end of the treatment. Moreover, three participants reported decreases in body-related shame, and these improvements were maintained at a six-month follow-up.

In addition to reductions in shame and self-criticism, participants experienced significant improvements in overall BDD symptoms, depressive symptoms, and quality of life. The treatment was well received, with participants rating it as highly credible and expressing satisfaction with the therapy.

Implications for Future Treatment

The findings from this study suggest that ACT with Compassion could be a promising new approach to treating BDD, particularly for individuals who struggle with intense shame and self-criticism. By directly targeting these underlying emotional drivers, this approach may offer a more effective treatment option for those who have not responded to traditional CBT.

As with any new therapeutic approach, further research is needed to confirm these findings and to refine the treatment protocol. Larger, randomized controlled trials will be necessary to establish the efficacy of ACTwC compared to other treatments. However, the initial results are promising and suggest that this approach could help improve the lives of individuals suffering from BDD.

You can find an open access version of this article here.

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 Insights into Psychologists’ Views on Psychedelic Therapy

October 27, 2023October 3, 2023 by Portland Psychotherapy Team

As interest grows among both clinicians and the public, psychedelic knowledge and reduced stigma within the psychology field will be critical to ensuring these treatments are implemented ethically, safely, and accessibly. Outreach, education, and interdisciplinary collaboration remain key priorities moving forward.

A recent survey-study involving researchers at Portland Psychotherapy provides intriguing insights into psychologists’ attitudes toward the emerging use of psychedelics like psilocybin and MDMA in psychotherapy. The study, published in the Journal of Psychoactive Drugs, found psychologists hold cautiously optimistic views about the promise of psychedelic-assisted therapy but also harbor concerns about safety risks.

Led by Jason Luoma, PhD and Brian Pilecki, PhD of Portland Psychotherapy, the survey queried 366 licensed psychologists in the U.S. Using vignettes of client scenarios, the researchers examined psychologists’ openness to exploring psychedelic experiences therapeutically compared to alternative interventions like meditation retreats.

Overall, most psychologists indicated receptiveness to discussing psychedelic experiences compassionately in therapy to foster learning. However, around 75% said they would likely warn clients about potential risks of psychedelic use, whereas only 25% would issue cautions around spiritual retreats. Many also expressed the need to consult colleagues due to limited knowledge of psychedelics.

In ratings of treatment acceptability, psychologists viewed psychedelic-assisted therapy much less favorably than conventional medication-assisted treatment for opioid use disorder. They also saw greater risks and lower confidence in effectiveness with psychedelics compared to established interventions.

Additionally, participants rated psychedelics as equivalently safe to alcohol and far riskier than cannabis. In truth, research shows psychedelics like psilocybin have very low rates of harm, in contrast to the extensive public health burden of alcohol. This highlights an urgent need to educate psychologists on the actual safety profiles and therapeutic mechanisms of psychedelics.

On a positive note, most participants believed controlled psychedelic use in research is safe and merits continued scientific investigation. Over 80% felt research on psychedelics should continue to be researched. Still, less than half agreed psychedelics show promise for mental illness, signaling cautious optimism.

In interpreting their findings, the Portland Psychotherapy researchers emphasized the influential role psychologists have in healthcare settings and policy. As interest grows among both clinicians and the public, psychedelic knowledge and reduced stigma within the psychology field will be critical to ensuring these treatments are implemented ethically, safely, and accessibly. Outreach, education, and interdisciplinary collaboration remain key priorities moving forward.

Though this initial survey faced limitations like possible sampling bias, it provides a springboard to track evolving psychedelic perceptions among mental health professionals. Replication with psychologists and other providers will paint a clearer picture of where additional training and open dialogue are needed to overcome enduring misconceptions. As Luoma summarizes, “We must continue the complex process of safely integrating psychedelics into science and society.”

Mitigating Risks in Psychedelic Integration Therapy: Practical Considerations

October 3, 2023 by Portland Psychotherapy Team

Psychedelic HRIT is an emerging clinical area that requires careful consideration of risks associated with this type of therapy. Although it can be a powerful tool for mental health treatment, clinicians must be aware of the potential for licensing board sanctions, criminal prosecution, malpractice litigation, and professional reputation damage.

Psychedelic therapy has gained increasing attention as a potential treatment for a range of mental health conditions, from depression to PTSD. Along with this comes the need for harm reduction and integration therapy (HRIT) to help individuals navigate their psychedelic experiences safely and effectively. However, there are risks associated with conducting this type of therapy, particularly in regions where it is still illegal. In this blog post, we will outline some of the most common types of risk associated with psychedelic HRIT and suggest steps clinicians can take to mitigate these risks.

One of the most significant areas of risk for clinicians offering psychedelic HRIT are licensing boards. Although clinicians may not be engaging in any illegal behavior, licensing boards have a broader mandate to assess professional conduct and determine if a clinician is acting outside the boundaries of acceptable practice. Licensing boards may receive complaints from clients, other clinicians, or members of the public, particularly in areas where psychedelic therapy is stigmatized. A client’s family or another provider may discover that a therapist is offering HRIT and perceive that the therapist has encouraged the client to use illegal substances, which could trigger a complaint. In addition, licensing boards may consider it a violation to engage in intention setting or other strategies aimed at maximizing benefit as they may be perceived as encouraging clients to engage in illegal activities.

Another area of risk is criminal prosecution. If a therapist wants to do the maximum to avoid risk, they should avoid facilitating access to prohibited substances in any way and refrain from providing a space in which psychedelics could be used. Referring clients to underground guides or assisting them in the attainment of prohibited drugs is a clear violation of the law and could implicate a clinician in racketeering, conspiracy to commit a crime, or aiding and abetting unlawful acts.

Malpractice litigation is another potential risk associated with psychedelic HRIT. If a client is harmed during a psychedelic experience, a therapist may be sued for failing to protect the client from harm, especially if psychedelic HRIT is considered a new treatment that lacks scientific evidence. Violation of standards of care could also be argued if a therapist does not take a more conventional approach to treatment. Practicing in any new or less proven area of practice will necessarily increase your liability and HRIT is no exception.

Professional reputation is also an area of risk for clinicians offering psychedelic HRIT, particularly in more conservative regions or traditional therapeutic contexts. If clinicians perceive that publicizing their HRIT services might jeopardize their income or employment, it may limit the accessibility of this type of therapy for the public. Agencies may not support or permit this type of practice, and clinicians must be aware of these risks. It’s best to consider how your agency, your locale, and your colleagues might react before you offer this type of therapy.

Mitigating these risks includes many possible steps, such as avoiding facilitating access to prohibited substances in any way, whether it be by referring clients to websites to obtain illegal substances or by providing a space in which psychedelics could be used. It is also important to carefully consider language used in advertising and documentation to ensure clarity and reduce the probability of misperceiving HRIT therapy as involving the administration of psychedelic substances. Clinicians should expand their competency by obtaining adequate training and access to consultation resources, and they should become familiar with empirical support for psychedelic-assisted therapy, including both strengths and limitations. Understanding the science and being able to speak from an informed, balanced, and evidence-based perspective demonstrates sound ethical practice.

Psychedelic HRIT is an emerging clinical area that requires careful consideration of risks associated with this type of therapy. Although it can be a powerful tool for mental health treatment, clinicians must be aware of the potential for licensing board sanctions, criminal prosecution, malpractice litigation, and professional reputation damage. By avoiding facilitating access to prohibited substances, carefully considering language used in advertising and documentation, expanding competency through training and consultation resources, and becoming familiar with empirical support for psychedelic-assisted therapy, clinicians can mitigate risks and provide a valuable service to their clients. If you want to learn more about the ethical and legal aspects of working with psychedelics as a therapist before widespread legalization, you can read more at this paper that researchers at Portland Psychotherapy wrote that is a result of months of work and consultation.

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