How Long is Too Long in Psychotherapy?
Mailbag: quality vs quantity in therapy
Posted Mar 31, 2014
Drinking too much water can be harmful. Eat too many carrots and you'll turn orange. Help others all time and you'll deplete yourself. A daily massage would be…nice, actually, but probably expensive. It's possible to have too much of a good thing. So if therapy is a source of healing and health, can you overdose? How long is too long in therapy?
A kind reader sent me an email recently about this very topic, and I thought it was great mailbag material. Again, this is a disguised and distorted letter from an unidentifiable and possibly fictional reader:
“I’ve been seeing the same therapist for nearly ten years, and I think it’s one of the best parts of my life. He knows me, he cares about me, and he encourages me to grow in areas I know I need to. My problem is, whenever I talk about therapy with my friends they say that ten years is way too long and I’m dependent and wasting my time. I don’t feel like I am, but they sound so certain. Is there such a thing as too much therapy?"
Good question! Will therapy spoil or become harmful after too much time? I've seen this question stem from fears that:
- I'm going to become overly-dependent on the therapist
- I'm moving too slowly and the therapist is getting tired of me
- If I've been in therapy this long (3 months or 3 years, etc.) and I'm not well yet, will I ever get better?
- Maybe a better therapist would have cured me by now
Fictional Reader is happy with the therapy, but feels concerned because her friends may think one of the four points above have become a problem. She wants to know if her good feelings may actually conceal blind spots. Let’s take a closer look.
Dependency: Many people are scared of becoming dependent on their therapist, and this is often equated with the amount of time they're in treatment. But dependency is about quality, not quantity. One client could have a totally enmeshed dependency after three sessions while another could spend 20 years in therapy and maintain a healthy sense of individuality. Dependency is about how the relationship functions - is the client handing over their power for decision making? Is the therapist demanding control? Are other relationships suffering because all the client's emotional energy is going toward therapy? Is the client paralyzed for a week or two when the therapist is away? That's dependency. Sure, someone stuck in their dependency may stay in therapy for a longer period of time, but if the therapist is worth their salt they'll make the health of the relationship a primary focus of treatment. Furthermore, I believe there is such a thing as healthy dependency in therapy. I hope the client can rely on the therapist as a stable, healthy relationship to lean on in times of need as a source of empowerment, not a power drain. The ability to look to the therapist for guidance and support can be good for the client and the overall relationship. Dependency is clearly a potential problem in this work, but with clear boundaries and good communication therapy can be more of a healthy, stable resource than an emotional dependency.
Boredom: I recommend the therapist and client have a State of the Union talk every few sessions. How are we doing? How am I feeling about coming? What's frustrating me about this work? How is progress coming on my original goals? I think having this all out in the open is crucial for clients wondering how their therapist feels about them and their work together. But there's another part of this I hear quite often: clients think I must get tired of listening to them. This couldn’t be further from the truth. Therapists join this profession to listen to people and help them. Those with good training, experience and self-care should know this process takes time and requires patience. If they lack that knowledge and patience, perhaps they're in the wrong line of work. That's like a plumber getting frustrated or resentful toward leaky pipes, or a chef getting sick of food. It's what we're trained (and some would say called) to do. I usually find this question is more about the client feeling frustrated with their issues and tired of talking about the same problems. They assume I must be tired of it, too.
Progress: People grow, heal and change at a different pace. Everyone's story is different, and so the healing process will be different. A woman reporting depression following a divorce may feel great after six sessions, while a man reporting depression regarding childhood abuse may move into a deeper depression three years in. We just don't know. It helps to educate yourself about your issue (there are books out there for everything) and talk with your therapist about your treatment plan and your prognosis (whether or not, or how much relief you can expect). The body and psyche want to heal, and through providing the right environment and removing blockages we tend to move in that direction. If I didn't believe it, I'd be in the wrong line of work.
Competence: There are a few basics: does your therapist have a degree and a license (or a supervisor with a license), do they have experience with your issues, do you feel comfortable with him/her, and are your boundaries respected? With these fundamentals in place, most therapies move along fairly well. But if it doesn't, I would hope you're discussing this in your regular State of the Union talks. And if it seems you're still at an impasse, it may be time to start the termination process and begin test-driving other therapists.
So how long is too long? The answer depends on whether you're seeking therapy based on the illness model of therapy or the wellness model. In the illness model, going to therapy is like going to your physician. People come to therapy to alleviate a disorder or symptoms and treatment lasts as long as those unpleasant symptoms exist, from a few weeks to a few years. If you are symptom free and that's all you wanted out of therapy, you're all done.
In the wellness model, going to therapy is like going to the gym. You go to make a good life better, to reach your potential, and to prevent problems in the future. There's no mandatory end date for that. Imagine someone saying they've gone to the gym regularly for ten years. What's your response: "You're done! Enough already!"? Or is it: "Good for you, I admire your perseverance and focus on wellness and prevention" (or something like that)?
So, Fictional Reader, I say if therapy works for you, and you're not experiencing the dependency noted above, enjoy your sessions. For everyone else, let's try something - if we stop backseat driving on other people's therapy, offering unsolicited advice about how long therapy should last and not trusting their judgment, maybe this will help decrease the stigma associated with going to therapy in the first place. And maybe if there's less stigma, more people who need the help therapy offers will give it a try. Deal?