Why Does Therapy Take So Long?
It takes time to get to the root of emotional problems.
Posted Mar 27, 2018
By Jane S. Hall, CSW, FIPA
Overheard conversation at Restaurant in Manhattan
Ann: “Three years?? You've been going to your shrink for three years!!? What on earth for. I know you're not crazy!”
Maria: Not crazy but I feel stuck. I just want to meet someone right for me and yet every time a guy showed interest I ran. I even dated a married man - so yup – And now I'm in psychoanalysis, going four times per week and even using the couch now because it frees me up.
Ann: OMG, I cannot believe you'd want to spend all that time talking to a shrink. It must cost a fortune too!
Psychoanalytic therapy takes time
No it need not cost a fortune but yes, it does take time. Let me try to explain why.
"Sue", a patient of mine, began her therapy in her late twenties but problems with commitment had been brewing since childhood. Her Dad was killed in a car accident when she was five-years-old. This sudden and tragic loss affected her in many ways but especially apparent was her fear of loss. Leaving her mom became scary and she had trouble going to school for a year. In fact fears of separation haunted her making connection with others problematic. It is not as though Sue made a conscious decision to avoid closeness, but powerful unconscious forces (defenses) took on the role of protecting her from future trauma.
The unconscious is where our defenses are born. Defenses protect us from situations that could be painful and the historical context in which they are formed is key. A defense might be adaptive at the time it is formed but eventually becomes problematic. Like if you are still wearing the shoes of a five-year-old when you’re 20 it will cause all sorts of problems that limit and impede your journey through life. Changing those shoes isn't so easy. Because these defenses are unconscious, it is not possible to alter them without assistance. This is where psychoanalytic work is most helpful. You see, the analyst has experienced her own analysis, along with years of study so he/she is a trustworthy guide.
Sue had developed a combination of defenses which formed her character or personality. She avoided situations that might hurt her – like close relationships. She denied certain feelings for fear they would overwhelm her. And she even learned to shift her feelings to other people (we call that projection) because it felt safer that way. And the defenses were adaptive in many ways. She became a leader and was good at bringing people together because of her empathy with vulnerable, injured people with whom she could identify. When faced with a dangerous situation Sue jumped right in, ignored the warning signs and forged ahead where others would have been more cautious.
This covered her wishes to depend on others. And she unconsciously avoided people who were nice to her lest she end up counting on anyone. Sometimes she just didn't hear a compliment or realize that someone was attracted to her. And when on a date, she tuned out the potential partners and found herself attracted to people she knew would hurt her - like married men. After a few disastrous flings she decided to seek help.
She tried a cognitive behavioral therapist who gave her homework and tips to practice which seemed sensible but after a year with no improvement, she asked a relative who was in analysis for a referral.
How does psychoanalytic work help?
When Sue began therapy she was sort of clueless but as she began talking, twice a week at first, a picture slowly began to emerge. Her therapist was thoughtfully quiet but it didn't feel like the lonely silence she had heard about. In fact, the quietness gave her space that felt good. As they proceeded, a partnership developed. It was like being on a journey with a competent guide.
Traveling back and forth from past to present, Sue began to welcome emotions she had once pushed aside and it felt good. Increasing sessions from two to three times a week enabled the work to deepen. After the second year Sue added a fourth session and chose to use the couch. Not looking at her therapist was a major step. The trust and consistency of the relationship had helped to lessen her anxiety – she didn't have to look at her analyst to know she was listening.
Sue began dating a person who seemed appropriate to her – based on mutual attraction and trust. It was as if her relationship with her therapist over the years extended to relationships outside of the room. There were still ups and downs but by continuing her analysis she learned how her current anxieties resonated with old fears. Things began to make sense and Sue no longer felt rushed or pressured.
When a person feels thwarted, inhibited or even just plain sad, there are reasons. In order to change and grow the roots of problems need light and expression with words. Staying on the paved roads of behavior focused therapy is useful for some, but Sue chose a more adventurous journey that she hopes will lead to lasting change.
About the Author: Jane S. Hall, LCSW, FIPA, Past President of the Contemporary Freudian Society, member of the International Psychoanalytic Association, American Psychoanalytic association, and AAPCSW. She is a Training and Supervising Analyst who teaches, lectures, and consults around the world on how to deepen psychoanalytic work and other topics for the past thirty years. Hall is the author of Roadblocks on the Journey of Psychotherapy (2004), Deepening the Treatment (1998), and various articles, and is on faculties of three NY institutes. Hall is in private practice in New York City.