Have you ever found yourself going to therapy and wondering if anything is actually shifting?

You’re showing up when you can, you’re focusing on important and relevant issues in your life but still not sure you’re making any progress?

Believe it or not, this is a common experience and yes! it can be frustrating.

Without clear expectations it’s hard to know what “real change” even looks like, or how long it should take.

In most area’s of healthcare, doctors or nurse practitioners can give us an idea of how long it will take to “feel better”. And they will also tell us how often we need to visit other healthcare professionals to see the results we want.

For example, we generally we know we want to visit our dentist every six months, check in with our family doctors every 2-3 years for annual physicals (unless you’re over 50 years old or managing chronic conditions). If we are pregnant, we know we have increasingly frequent appointments as the due date approaches.

These are recommendations in healthcare because this is what we know works, across the diversity of myriad factors each individual brings, coupled with what we know about the condition they are suffering from. It reflects the best treatment approaches for our health over time.

When it comes to mental health, the expectations are often less clear and the process can feel more ambiguous than it should.

Without guidance and clarity it’s easy to feel lost or discouraged when things don’t shift as quickly as we hoped.

Meaningful change in therapy takes time.

It also takes consistency, active engagement, and a strong relational fit between client and therapist. All these components support each other. While it’s different for everyone, having more of an understanding of what factors may influence the pace of change can help you manage expectations, take ownership of your healing and better advocate for your needs to get the most out of your sessions and your healing journey.

It’s common to overestimate what therapy can accomplish in just a few sessions. Although even one session can be powerful, sustained meaningful change is usually gradual.

If you have tried therapy, but attended sporadically (every few weeks or months) for years, you might wonder why you aren’t seeing much progress, but it might simply be the frequency of the treatment.

Change takes time… but, how much?

In terms of what the research says, the ideal number of sessions isn’t a one-size-fits-all, but generally 20-40 sessions is recommended to see meaningful change. This will vary depending on goals, approach/modality and what the client brings into the therapy.

Even though this is the range of sessions that often yields progress, the frequency of sessions matters more than total number of sessions, especially in early stages of treatment. Many studies show that clients attending weekly or twice a week tend to see the most significant progress and faster trajectories of change over time, experiencing stronger therapeutic outcomes.

Why? Weekly or bi-weekly sessions build, establish the therapeutic relationship and maintain momentum in therapy. This helps to keep you engaged in the process, help you build skills and practice them more regularly, and catch issues in the moment, preventing them from escalating (or deteriorating).

With regular sessions, it’s easier to deepen the relationship, track real life symptoms or challenges, notice and practice changes and celebrate progress.

Frequency also helps establish the component of therapy that we know is the most important, which is the therapeutic relationship. This is also what makes your work with your therapist really different than your work with your family doc. While their tools are medicines, surgical procedures, blood tests – your therapists’ primary tool is the therapeutic relationship. And like any relationship, it takes time and consistency to build trust and connection.

Regular attendance seems to help strengthen it more quickly helping the work go deeper, faster. The more often you attend, the more you’re supporting the development of that core therapeutic relationship. Therapy is inherently relational, so while the number and frequency of sessions matter, the fit between client and therapist matters more.

Connection comes before change.

Therapy is not just about techniques and tools it’s about connection. It’s a space where healing happens when a person feels seen, understood, and supported without judgement. It takes time, and the most important part of the process is the therapeutic relationship (or ‘therapeutic alliance’) that’s built.

It’s a relationship based on safety and trust, which often develops gradually. If you walk out of the first session feeling even slightly less weird or nervous, you’re off to a good start, and it’s important to keep checking in with yourself along the way. If something feels off or you’re unsure about therapy, sharing any hesitations or concerns, about the process or about your therapist, can be a powerful part of the healing process (and actually really helpful) even if it feels a bit uncomfortable.

These conversations are often where real change begins and can lead to meaningful shifts in old patterns making way for growth.

But, like other aspects of therapy, finding the right fit isn’t always straightforward. Finding the right fit is step one, but it can take a few sessions, or even a few therapists to find someone you feel you can trust. It’s important not to settle and it’s okay to move on and find someone that feels more “right.” It’s all a part of the process.

But what about when you feel safe enough, you sense openness and trust within the relationship but there’s something that just isn’t working? You might have a strong rapport but maybe the pace isn’t working for you, or you’re unsure if you’re working towards the goals that are most important to you. This is where the next key element comes in which is communication and engagement.

Growth announces itself in different ways.

Discomfort doesn’t always mean something is wrong. It’s often a sign you’re approaching something meaningful. If something in your therapy experience doesn’t feel quite right, whether it’s about the process, the pace, or even something your therapist said, you can and should bring that up.

In fact, it can be one of the most powerful catalysts for growth. In the therapeutic relationship, like any relationship, honest communication deepens trust. It might feel uncomfortable to bring up concerns or hesitations but those conversations can be huge turning points in your therapy. You don’t have to articulate everything perfectly to speak up.

A simple reflection can sound something like:

“I’ve been reflecting on our progress and I think this is the right fit but I’m not sure if the direction is going in the way I want it to.

Can we talk about it?”

When therapists care about your progress, we want to know when something isn’t working so this is highly encouraged. As a therapist I believe in regularly checking in on my clients and their progress, asking for feedback and making sure we are on the same page but if you feel it’s time for a check in you don’t have to wait for an invitation, you can initiate this conversation too. This can lead to a powerful discussion that helps strengthen trust, clarify direction and even break lifelong patterns that may have kept you quiet or feeling disconnected in other relationships in your life.

Collaboration is key.

Therapy is a collaborative process, and we’re in this together, working side by side to explore, grow, and heal. While committing to regular sessions is important, the work continues beyond the therapy room, with both parties playing an active role. Therapy works best when it’s not just something that happens to you but something that you are actively engaged in. While the therapist brings their knowledge, tools, support and care, you must be committed to bringing your insights, honesty, and willingness to explore your inner world.
I believe therapeutic change and growth happens not by forcing yourself out of your comfort zone, but by gently expanding it through supportive relationships and experiences that help you heal and feel seen.

Therapy is not about ‘fixing you,’ because you are not broken.

It is also not about “finding yourself” but rather slowly returning to the version of you that’s been there all along. It is likely hiding under layers of cultural and social expectations, conditioning and what we all have to learn to survive though in life. Therapy creates a space to rediscover that self through a supportive attuned relationship.

Therapy invites curiosity and discomfort into the room instead of avoiding it. Those uneasy feelings that show up like doubt, frustration, sadness aren’t always red flags or signs that therapy isn’t working. They most often are signs that something important is surfacing.

Meaningful change doesn’t always look dramatic.

It’s often subtle: responding to your discomfort and stress differently and with more self-awareness, choosing rest instead of burning out, finally expressing your feelings and truth. Sometimes it starts with one uncomfortable conversation. Sometimes it looks like just showing up even when you’re not sure if it’s working.

Progress requires therapy that is consistent, relational, collaborative and active.

Finally, what kind of therapist would I be if I didn’t leave you with some reflection questions to ask yourself.

• What would it look like to be more engaged in your therapy process right now? Whether that’s attending more regularly or doing more work and reflection outside of session.
• Is there something you’ve been questioning or holding back in your sessions that deserves space?
• What would it be like to let yourself trust the process a little more?

When you find the right fit, commit to the process and stay engaged and active even when feeling uncomfortable, that’s the work. And over time that leads to meaningful, lasting change.

References
Ciharova, M., Karyotaki, E., Miguel, C., Walsh, E., de Ponti, N., Amarnath, A., van Ballegooijen, W., Riper, H., Arroll, B., & Cuijpers, P. (2024). Amount and frequency of psychotherapy as predictors of treatment outcome for adult depression: A meta-regression analysis. Journal of Affective Disorders, 359, 92–99. https://doi.org/10.1016/j.jad.2024.05.070

Erekson, D. M., Bailey, R. J., Cattani, K., Klundt, J. S., Lynn, A. M., Jensen, D., Merrill, B. M., Schmuck, D., & Worthen, V. (2022). Psychotherapy session frequency: A naturalistic examination in a university counseling center. Journal of Counseling Psychology, 69(4), 531–540. https://doi.org/10.1037/cou0000593

Li, E., Kealy, D., Aafjes-van Doorn, K., McCollum, J., Curtis, J. T., Luo, X., & Silberschatz, G. (2024). “It felt like I was being tailored to the treatment rather than the treatment being tailored to me”: Patient experiences of helpful and unhelpful psychotherapy. Psychotherapy Research, 35(5), 695–709. https://doi.org/10.1080/10503307.2024.2360448