Why long-term psychotherapy asks for time, not shortcuts
What most people secretly want from therapy is a reliable shortcut. A focused set of techniques that produces results within a defined timeframe. That’s understandable, and it’s also not quite what long-term psychodynamic therapy offers. The kind of work I do, relational, attachment-based, and trauma-informed, is slow and non-linear. That’s not a design flaw. It’s the nature of the change it’s trying to create.
There Is No Manual
People often arrive hoping for strategies, tools, something concrete to take away. One person said to me early in our work: just give me the manual. The thing is, there isn’t one, and that’s not a failure of the model. What therapy offers instead, over time, is the capacity to pause before reaching for the fix. To make space between a feeling and the impulse to manage it away. To discover, slowly, that it’s safe to feel what you feel, even if you once learned otherwise.
In long-term work, a single moment of recognition, a pause, a shift in how you describe something, can carry more weight than any number of techniques. You might come to understand that the way you avoid certain conversations at work connects to something much older than your current circumstances. No app or workbook can do that unpicking for you. It requires a relationship, developed over time, in which something gradually shifts. This work isn’t glamorous. Sometimes it’s tedious. It can feel like nothing is happening for weeks, until something quietly moves. That movement is real, even when it’s invisible.
On Self-Help
There is nothing wrong with tools. Breathing practices, journalling, grounding exercises, all of these can help regulate a nervous system under pressure. But when self-help starts to feel like one more way to stay busy above the feeling layer, managing symptoms rather than understanding them, it can become another form of avoidance. When that happens, it stops being self-care and starts being a way of not quite arriving at the thing that actually needs attention. Long-term therapy asks you to stay with what’s difficult rather than reach for something to make it more bearable. That’s harder. It’s also usually what creates lasting change.
A Genuine Caveat
Long-term therapy isn’t available to everyone. NHS provision is limited and often time-restricted. Private therapy, including mine, isn’t affordable for everyone at every point in their lives. Low-cost and community-based options exist in some areas and are worth exploring when longer-term private work isn’t possible.
Timing matters too. There are periods in life when the commitment that sustained therapy requires simply isn’t feasible, financially, practically, or emotionally. That’s a real constraint, not a failure of willingness. The work will still be here when circumstances allow.
If you’re at a point where longer-term relational work feels right and you’d like to explore what that might look like, I’d be glad to have a conversation. Get in touch at samanthamerry.co.uk/contacts.
Resources worth exploring:
- Maybe You Should Talk to Someone by Lori Gottlieb, an honest account of long-term therapy from both sides of the room, which gives a realistic and warm picture of what the process actually involves over time
- Psychotherapy for the Advanced Practice Psychiatric Nurse by Kathleen Wheeler, for those who want a more clinical account of what long-term relational work involves and why it takes the time it does
- Speaking of Psychology, the APA podcast, with episodes on what therapy actually changes and why sustained work produces different outcomes than short-term intervention
- Attention Seeking by Adam Phillips, which addresses what we actually want from therapeutic relationships and why the desire for quick resolution often gets in the way of genuine change.
- BACP’s resources on types of therapy (bacp.co.uk), useful for anyone trying to understand what distinguishes long-term psychodynamic work from shorter-term approaches
Samantha Merry is a BACP Senior Accredited Psychotherapist in private practice in Bromley, South East London, and a doctoral researcher at the University of Chester.