How Long Does Therapy Last?!

“So, how long does therapy last?”

It’s a really good question, and it’s always helpful to talk about what to expect. But, what if you don’t like the answer… or it just isn’t clear? Time in therapy is influenced by many things, like what brings you there in the first place. A therapist needs to learn about you - and the social anxiety, occasional depression, recent argument, or old trauma that needs attention.

A therapist’s training and skill set can also affect the process. This blog doesn’t describe the various approaches, but you may have heard of CBT, or “goal oriented brief therapy” or that Psychoanalysis usually lasts longer, for example. Check out links below for further information about some of the types and the science behind the answers. Techniques, the severity of issues you’re seeking help with, and experience are all factors in the amount of time you participate. There are a few things you can keep in mind to help anticipate how long is right for you!

Maybe you already know…

There is a good chance that you have some idea, even vague, of how long you’d *like* therapy to last. If you’re seeking help around a breakup, that can be your focus, and once you’re feeling less shattered and more stable, you’ll be ready to stop. Or you might know that your stress is nearly all related to being new in the city, transitioning to a new job, or planning a major life event - and you’ll be ready to take a break from therapy when things feel like they’re in place. That is absolutely fine. Sharing this with your therapist early on really helps to structure the work together.

On the other hand, it’s possible that once initial goals are reached, you choose to re-set and continue. You’ve uncovered important stuff and are making insightful connections and deeper shifts. You’re finding greater understanding about why you feel so disconnected, and feeling comfortable enough to open up. You finally have a place to talk about sensitive things that have been “in the back of your mind" all this time. These are all great reasons to keep participating.

Some people just know that they want to create and maintain a consistent support over time. Maybe you had a great therapist before, and you’re looking for another good experience. It’s a very special thing if your therapist really knows your story, and you get to work together through multiple life changes. A consistent therapeutic relationship is a unique and valuable support.

Have You Thought About Ghosting?

Sometimes, you just want to vanish! If you’re just not connecting with your new therapist, or over time you find yourself thinking “I think I’m ready to be done”, it’s a good idea to bring it up, even if it feels hard to talk about. Communication in therapy often reflects communication in other relationships, and it can help a lot to have a “better end than usual”. An abrupt stop to therapy can take away your chance to reflect on the work you’ve accomplished, and it may leave a residue of guilt and avoidance that devalues what you’ve actually done in therapy. Even one closure session can make a big difference!

A word about boundaries - if you feel there is inappropriate or unsafe behavior by your therapist, you should end therapy immediately and consider reporting to the licensing board. Boundaries in therapy are super important, and if you feel someone has crossed the line, address it as soon as you can, or simply end the therapy. This is a subject for a different discussion - but it’s important to be aware of.

Endings are hard.

There are some parallels to ending therapy that can feel very familiar. Have you had a job that was hard to leave, even though you knew you had basically stopped learning or growing in that role? The daily routine felt a little dull, but maybe you liked the people, or the location, so you just… did nothing, for too long. Similar feelings might happen when considering a move out of a shared apartment, leaving your home town, or ending a romantic relationship. You may struggle with the idea that you’ll hurt someone’s feelings, or the fear that just when you’re “free”, something terrible might happen and you’ll long for the security and support of what you walked away from.

Many people avoid transitions and endings because it’s so hard to move out of that (slightly uncomfortable) comfort zone! They don’t have a lot of experience in helping themselves prepare and adjust to something new. If ending therapy reminds you of other times when you were reluctant to make the transition, this is an amazing opportunity to learn some skills and do it better. You can apply strategies and insights that you’ll learn from ending therapy well to other life situations in the future.

But wait, is it really the end?

When clients finish therapy, they usually have the option to return later on if they would like further support, or have a new issue to address. During the stress of the Covid pandemic, a number of former clients reached out, and shared that resuming with someone who knows them felt like a natural choice. I’ve been honored to have many people return over the years, when they felt it was the right time.

A tip at the beginning - if you have a consultation, or during your first session, ask the therapist how they like to end! Most therapists have a preferred way of concluding the work, and having a chat about it early on can help clarify what you can expect. Therapists should help plan for endings, and generally want to facilitate a useful transition. This can include identifying ongoing supports, outlining personal goals and practices for you to continue working on, and making further recommendations or referrals.

If you’ve had a good ending with someone, it’s that much easier to “pick up where you left off”. If that means ending after initial goals are achieved, and then returning even years later, you should feel free to ask if that’s an option.

How I work:

At the beginning, I try to set some expectations around how we will wrap up. I ask clients to share their thoughts and bring it up when they feel ready, and they’ll always have my help around the decision. I check in during the course of therapy to make sure we’re focused on the main goals, and create steps to develop skills and track progress. When a person feels they’re achieving what they came for, that invites the conversation around “what’s next.” Having a closure session gives us a chance to reflect and recognize how much has changed and been accomplished, and acknowledge that it’s okay to move on.

By ending well, you’ll get the most out of the whole experience. Working to figure out what is best for you means there is a range of options. Throughout therapy, your communication about wants and needs, including how you want to end, contributes to your best experience.

I welcome your thoughts! What’s been your experience of ending therapy? Do you have an example of a good ending - or a terrible one? How would it ideally happen for you? There is no one right answer, but by making the ending part of the discussion, you’ll have a better result on your investment overall.

For more information:

https://www.talkspace.com/blog/how-long-does-therapy-take-science/

https://www.helloself.com/advice/how-long-does-therapy-last

That Thing You Keep Repeating...

While I talk with clients, I listen for phrases they say frequently. If someone repeats a phrase in session, they are likely repeating it to themselves, possibly on a daily basis. Their friends might say yes, they’ve heard it, too. The person who is doing the “negative self-talk” might not realize how often it comes out of their mouth! It might be something like “I hate my job” or “I won’t succeed here” or self-deprecating statements like “I’m stupid” or ”I can’t do anything right”.

When you repeat something to yourself or out loud, it can become deeply ingrained in your mind. It takes on a power of its own. The words start to feel like “truth”. There may be aspects of the job that you don’t like – but do you truly hate it? If not, stop telling yourself that you do, because those words keep you feeling angry and resentful, even while you are planning to stay in that job.  If you honestly say “yes, I really hate it!”, then by all means, stop the complaints and start taking steps. Give yourself permission to get out. Your well-being is worth the effort.

If you’re repeating things like “I’m stupid” or “I’ll never make it”, that’s a big, bad message to your subconscious. You might have started saying this to be funny or to shy away from attention. If you had bad experiences with people putting you down when you were younger, you may have picked up that message - and now you’re just doing it to yourself. You didn’t deserve that to begin with, so cut it out!

The first step is to notice when the phrases crop up. What are the circumstances? Are you sick of hearing them? Would you like to replace them with something better? If so, take action! Find someone to work with you on fixing that broken record. Depending on the circumstances, coaching or therapy can help you shift your thinking.

I can help you learn new strategies and steps to take, and even physical moves and brain-based exercises which stop the anxious/negative internal routines. You can practice consciously "re-framing" the statements. You can make a point of saying things in a stronger, clearer, more confident way. When you use techniques to speak with integrity and self-respect, your brain - and those around you - will get the message.

So… what else can you say?!

Can People Have Two Therapists?

June 25, 2014

“Can people have two therapists?”

This question was put to me by a client during the final minutes of a session.  I thought about it for a few seconds and said “I think that deserves a conversation, can we talk about it next time?” I told her that the short answer is that it’s not usually advised, but I didn’t want to just say that without thinking it through.  I wanted to know what she’s looking for. We agreed to pick up on it next session.

After that, it weighed on my mind. I know from ethics workshops and discussions with colleagues that most therapists would advise against it. I know for myself that I would only be comfortable in very specific circumstances. Perhaps if our modalities were clearly defined and very different, such as if she wanted to see a Reiki practioner, an EMDR specialist or a health counselor for nutrition. But to have two “talk therapists”, I doubt that would be the best way a person is served – but why not?

Turns out it’s pretty easy to find resources and articles that say no, it’s not recommended. The reasons given (often by therapists) include splitting, conflicting treatment plans, creating secrets (especially if they aren’t aware of each other or aren’t in communication). One blog called Jung at Heart has some good points, and interesting responses in the comments section.

http://www.jung-at-heart.com/jung_at_heart/two-therapists----a-matter.html

I saw a comment on another site by a client who wants to have two, saying if a therapist insists on being 'the only one', “It seems to me this keeps the whole therapy-as-mystery and power imbalance going". That doesn't sound like a good experience of therapy, but it's not a good therapist's agenda.

I found other people who advocate having two therapists as a way to get more perspectives and advice, to have more to choose from. This might be true, but could get confusing, as it could dilute each therapist’s ability to create a plan, goals and accountability with that client.

As I try to be open to the idea and imagine scenarios and possibilities, I do keep returning to the place of “probably not the best idea”. Though I'm skeptical, I wanted to honor her question with a discussion, and explore the needs that are behind it.

I considered why she asked… the thought crossed my mind “I’m not doing enough, I’m not providing enough or giving her what she wants”. The implication from someone who asks about two could be that they’re looking for more from their sessions.  But it doesn’t mean I was doing a terrible job, and I don’t think she meant to indicate that. Her tone seemed to have more to do with feeling impatient for change – not just in therapy, but in her life. (She is a very talented young woman who is involved in several fields at once, and had some success in each area, but wasn't fulfilled. She'd like to be a superstar.) Perhaps her desire to have multiple therapists mirrored that sense of needing it all to happen at once.

I think the concerns about “splitting” are valid – it could to set up a “you said/they said” dynamic -- if one therapist’s suggestion or plan is somehow at odds with the other therapist’s recommendation, it would set them up against each other – a classic splitting of parents, being recreated. Even if therapists had permission to speak to each other to try coordinating care, it's probably not realistic to have them in contact on a regular basis. Would the client share what issues they were speaking about in other sessions? If not, what would be missed?

It doesn't sound realistic to “focus on separate issues with each one”, as a comment on an article suggested  - in my experience, people are not that compartmentalized. Issues such as happiness in the relationship, fulfillment at work, time management and self esteem or family history are often intertwined.

When goal setting and homework is planned, would the client be able to manage the extra "assignments"?

One therapist posted in a comments section on this topic that “Even if you have six therapists you still won't get every possible perspective, you'll inevitably be missing out on insights that someone else could offer you”, which I think is true. If someone has a desire to get other viewpoints, this quest can actually get in the way of making clear choices. People can get caught up in "information-gathering" and actually delay their choices that way.

So, I raised the subject at the beginning of the next session, and thanked her for asking a compelling question. She responded that she'd realized it's not the way she wants to do things. We used it as an opportunity to talk about our process and what she wanted to get out of our time together. Having two therapists was no longer on her agenda, but it helped bring new considerations in our session, and was also a thought-provoking idea for my practice.

I welcome responses and ideas - would it ever be useful to have two (or more!) therapists?