Why does psychotherapy take time?

How our brain changes in psychotherapy

Many of the things we want in life can now be found very quickly and without struggle. When we think about emotional change, it can be seductive to believe that the same rules should apply; meet with a therapist, take away some quick answers and leave a new person.

Yet, those who work in psychotherapy advise that progress takes time, over months and years, as opposed to days and weeks. But why is this the case? From both a psychological and a neurobiological perspective, there are good reasons for this, which I would like to touch upon in this piece. To help me, I will draw on some of the key points from Mark Solms’ 2018 paper: ‘The neurobiological underpinnings of psychoanalytic theory and therapy’.

The emotional brain

Firstly, let’s think about how our brains and minds develop over time. 

One of Solms’ key points is that emotional experience is rooted in subcortical brain structures: the parts of the brain that developed earliest in evolution and that manage basic drives, needs, and feelings. These systems help us survive, attach to others, avoid danger and seek pleasure. They also record what is safe or unsafe, familiar or threatening, based on our earliest relational experiences.

The emotional brain is not shaped purely by rational thought and does not restructure itself quickly in response to insight. For instance, perhaps you’ve been offered a seemingly fitting explanation for a question you have about yourself, such as why you are drawn to certain partners or avoid certain situations. Whilst this might be interesting and thought provoking, has this insight alone changed you? With deep emotional challenges, the answer is likely no.

Insight is an essential starting point, but on its own, it struggles to reach the emotional systems where distress is generated and maintained. This is because the neural networks that generate our emotional life are shaped over many years, from infancy through to adulthood, and systems like these do not change overnight.

The predictive brain

Solms describes the emotional brain as fundamentally predictive, constantly anticipating what is likely to happen next based on past experience. For instance, ‘if I get upset, I will be rejected’ or ‘if I seek help, others will be disappointed in me’. These are not simply ideas, but expectations embedded in how the nervous system responds to others and the world. Over time, these expectations become automated and unconscious, often operating outside of working memory. 

Because these patterns are formed early and reinforced over time, change requires consistent, repeated new experiences. Simply understanding a pattern intellectually does not necessarily shift the lived emotional expectation. For the brain to update its predictions, it must repeatedly experience safety where it expected danger, support where it experienced neglect, or curiosity where it received disinterest. 

From the brain’s point of view, learning only occurs when new experiences are repeated enough to be trusted. This is not quick work and unfolds gradually in the psychotherapeutic relationship.

Outdated solutions

In addition to expectations, the way we behave and respond to situations also becomes wired into our brains. We develop learned emotional strategies or solutions to cope with the situations we predict will take place. 

During childhood, it is likely that these solutions helped our brains to manage distress or overwhelm. There are many ways a child might learn to manage the emotional challenges around them; for example, being avoidant might have once protected us from confrontation with a fragile parent. The behaviour serves as a solution to coping with a difficult situation where options are limited. 

What once helped in childhood can become outdated in adulthood, where we continue to apply predictions and solutions to problems that are no longer there or require less emotional correction. Letting go of an old solution rarely happens simply because we decide to stop it. Generally, the brain needs to learn a new way of operating that feels reliably safer. This is partly why psychotherapy often addresses patterns slowly, the therapist and patient explore not just behaviour, but the emotional meaning and survival value of that behaviour.

This links to the purpose of psychotherapy: not simply learning new ways to think consciously, but experiencing new ways to feel and respond to emotional difficulties, in an environment and relationship where the nervous system can reshape old patterns.

Psychotherapy relationship

Emotional regulation is learned in a relationship, not in isolation. One of the central ideas in psychotherapy is that emotional experiences are shaped through early experiences with parents or caregivers. If a child consistently experiences their emotional needs being ignored or dismissed, the nervous system learns to regulate emotions to this.

Psychotherapy offers a different relational experience: a consistent, attuned presence where feelings can be experienced and reflected upon without judgement or criticism. Through these experiences, in a safe environment and relationship, the brain begins to learn new ways to understand and respond to situations that are more fitting to present reality, rather than the past. For instance, learning that vulnerability does not inevitably lead to rejection or collapse. 

Steady change

Whilst the modern world values quick results, emotional change cannot be rushed if it is to be lasting and sustainable. Psychotherapy is less about hurrying to an end point and more about doing the slow, human work of change, together. Work that involves understanding old expectations, learning to respond in new ways, and gradually cultivating a different internal landscape where life feels more connected to what is, as opposed to what was. 

Seen in this way, the pace of psychotherapy is not necessarily a flaw in the process, but a reflection of the complexity of emotional change. Solms’ neurobiological insights remind us that this kind of change is not only emotional and psychological, but biological too.