"See and be seen, touch and be touched" - Viola Spolin
People often ask me how long should therapy last? It's a great question, one that I deeply appreciate, but always feel hesitant to answer. "That depends" is my signature response, which is then usually met with inquisitive silence. I know it takes a lot of courage to enter treatment and I also know that long term psychotherapy can be costly.
I know that people, especially high achievers put great pressure on themselves to "fix the problem" quickly and efficiently. For some, they feel a sense of shame because they need the help of someone else in the first place, which can then intensify when things aren't happening as fast as they think they should. But "it depends" is the honest answer.
It depends because there are many variables in this complex equation - variables that are unique to each individual client. They include the presenting problem, this history of the problem, the other issues discovered during the course of treatment, the inherent ambivalence towards change (the devil we know is sometimes safer) and more.
However to really answer the length of time question, I think different questions need to be asked and answered first: what actually happens in therapy and how does it work? Although it's impossible for me to completely de-mystify the practice of psychotherapy, I will try. Yet I do so knowing that it will be a reification, inevitably resulting with it's meaning partially lost in translation - but nonetheless, here it goes.
Therapy works in many ways. It's an art form, as well a science. When it goes well, the client feels a certain safety with the therapist where they can explore the painful questions they came to ask. Building this safety net, which I like to call the "therapeutic embrace" takes time. Jumping in too quickly can leave the client feeling overly exposed with little modeling of healthy boundaries that the therapist ideally teaches.
However, once the rapport is established, which then allows the client the freedom to explore painful truths, therapy becomes a space and place, to understand, grieve, learn, laugh and grow. Just like rushing a child to run before they can walk can do harm - the same holds true for therapy. What matters most is achieving the milestone or goal, rather than doing so in 12 sessions "a la " the managed care way.
Now don't get me wrong, as a lot can happen in 12 sessions. They say it takes 90 days to learn a new habit, and learning new skills and tools to help you be in the world in a healthy productive way is important in treatment - but in my humble opinion, it's not the heart of the work.
The art of the work is what happens in the intersubjective space between the client and the therapist. It's a synergistic stream of collective conscious that allows the client to discover their many complicated parts, freeing them to be seen, heard, and understood, with the end result of the client transforming back to their authentic self. It's a coming home that prepares you to leave home, and then create a new home to return to whenever you please.
Better put, it's the combined paradoxes of:
- 1. The more you change, the more you stay the same
- 2. The only thing permanent in life is change
- 3. Hurry up and wait.
The science of psychotherapy, which is less esoteric, and more left brain and linear, basically deals with learning and memory. When we learn something new, whether it's how to improve relational skills, decrease anxiety, or change an addictive behavior - the brain - which is the hardware of who we are, initiates a process of potentiation - also known as an action potential.
When this learning becomes a way of being, it's called a long term potentiation. For those who like metaphors, in the ocean of the brain, I like to think of the action potential as a gentle current and the long term potentiation as the wellness gulf-stream that guides the client safely to shore. Playing with the notion that It takes 90 days to learn a new habit or "potentiate" (gentle current) but longer to form the wellness stream, it begs the question, can a gentle current pull you away from the riptide of old ways? Perhaps.
Yet, in therapy we are striving for that "new way of being" ... the long term potentiation, which can often take a year or two or more, depending on how strong those old riptides really are. Yet, how long therapy lasts is ultimately up to you, the client.
If all you want is a gentle current to help you swim to the sand, by all means, go for short term therapy. If you are looking for deeper transformation, and a safer current to chart the inevitable stormy seas of life, then be prepared to stay for awhile - and know this: Barring your therapist closing her or his practice, therapy ends when you decide, whether you have met your goal or not.
It goes without saying, but I will say nonetheless, everything in life ends. And we never really know when that end will be. As a therapist, I believe it is my job to honor the process of the work, while also respecting the client's autonomy and saying goodbye when the client decides.