How Long will this take? 12 Factors That Contribute to Prognosis in Therapy

One of the most essential things I cover in my informed consent is how long it may take a child to work through the therapy process, from saying that first hello to meeting  goals and wrapping up the therapy process.  It is so crucial for therapy retention that parents and children have an appropriate expectation of everything that therapy may entail and how long they can expect the process to take. 

When you take the time and care to be open about this at intake you can avoid some of the painful differences in expectations that parents or caregivers may have when they come into the third session quite disappointed and frustrated that the therapy process is not done and symptoms are not resolved.  

This may even prompt them to say something like “Therapy isn’t working, he should be better by now”. And I get it.  As a parent you want relief for your child and family system.  You want them to be living a life they love to the fullest instead of having a painful struggle.  

And at the same time parents will show up differently for the therapy process if they can realize that it is a marathon, not a sprint.   

Part of giving a good informed consent is discussing length of therapy and prognosis.  This is where we communicate the expected results of treatment including the length of time expected results may take.  This is where we gently remind parents that, yes, angry outbursts are totally normal, teens want to spend time in their bedroom, and sometimes all kids lie. 

It’s also where we paint the picture of what is possible for their child and how long it will take.  It is the complicated clinical judgement that goes into identifying that two clients with the exact same symptom profile on paper may take significantly different lengths of time to complete treatment or may require different therapeutic supports. 

So what’s the difference?  Well So. Many. Things. I wanted to detail out the 12 areas I consider when thinking about prognosis, pace of therapy, and the therapeutic journey: 

• Intensity of symptoms and level of care a child qualifies for including therapy, skills support, social work support, day treatment, partial hospitalization, etc. 

• Length of time the symptoms have been present 
• How the child has responded to family attempts to resolve symptoms or to past therapy attempts 
• Attachment  
  • To parent or caregiver 
  • History of seperation from parent or caregiver 
  • Adoption or foster care history 
• Trauma history and presence of preverbal trauma 
• Stability or instability in systems 
  • Family systems including divorce, separation, high conflict, absence of parent or other family member, and changes in extended family support system
  • School including classroom, change in teacher, change in school 
  • Physical home location or recent moves 
• Current safety
  • Current physical or sexual abuse 
  • Bullying at school or harassment 
  • Systemic racism 
  • Descriminiation 
  • Community violence 
  • Natural disasters 
  • Housing security or homelessness 
  • Chemical use in the home 
  • Ability to meet basic needs including food, clothing, and transportation 
• Comorbidity of medical conditions 
• Willingness of child to engage in therapy 
• Parent or caregiver mental health or chemical health difficulties 
• Engagement in services ​
  • Parent or caregiver in therapy 
  • Capacity for child and parent or caregiver to follow through with tasks/skills outside of the therapy session
• Resources and resilience factors and supports 
  • Access to supportive adults 
  • Supportive and engaged friendships 
  • Activities, hobbies, sports, or structured group engagement  

So there you have it!  The 12 areas that I consider when I evaluate for prognosis of therapy.  
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This is by no means an extensive list - drop a comment below about what other areas you may consider when thinking about prognosis for your clients! 

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