Sometimes Therapy Just Takes A While, Even If You're Doing Everything Right
This is one of those topics where some people will see the title of the article and go, "Yeah, duh", but it will be a new perspective to others.
There's an idea floating around that effective, modern therapy should last maybe six months at most, and that if it goes longer than that something's gone wrong. If you're thinking of working with a therapist you may hear messages like:
- Only outdated, inefficient, unscientific therapy methods see clients long term.
- New evidence-based scientific modalities can cure everyone in 8-12 sessions, sometimes even less.
- If you're seeing a counselor longer term they may be dragging things out to extract more money from you, are a quack, or simply less competent.
- The kinds of people who do therapy for years are bored, self-obsessed navel gazers. Anyone who really wants to get better can do it faster.
There are also practical realities that send the message that therapy should be shorter term:
- Insurance or employee health plans often only cover less than a dozen sessions. They may also force the therapists in their network to use supposedly briefer models.
- Non-profit or university counseling centers may only offer clients something like eight appointments a year. Again, counselors working there may only be allowed to practice short-term methods.
- It's in private practice, with clients paying out of pocket, where therapists can most easily use longer-term approaches. It makes it seem like they're an optional luxury for wealthier people with too much time on their hands.
I totally understand why someone would want therapy to be quick. Mental health and life struggles are painful. No one wants to suffer for years. We'd rather spend our money and time on something other than speaking to a psychologist.
The good news is people sometimes can feel better after a half dozen sessions, maybe in only one visit. Some cases where this could apply are:
- They're going through some passing life stress, like starting a new job, and just need some extra support until it naturally resolves.
- They have a single straightforward-to-treat emotional issue, like a specific phobia or anxiety after a car accident. Sometimes even seemingly severe, long standing problems can be addressed quickly with the right approach.
- They're frustrated or confused about something in their life and just want to vent and have a sounding board to bounce ideas off of for a month or two until they figure out how to proceed.
- They need to learn and practice some easy-enough skills they're missing, like techniques to give a semi-decent presentation at work.
- They have a simple unconscious block holding them back, and once it's unearthed and resolved they're quickly able to change.
But the fact is therapy can just take longer than a few weeks or months, sometimes years longer. That's even when...
- ...the client is seeing a skilled therapist who's trained and experienced in working with their issues.
- ...the therapist is using a method that's a good fit for the client's struggles.
- ...the therapist is going as fast as they can.
- ...the client is motivated and works hard on their recovery.
- ...the therapist and client both feel useful progress is being made each session.
If counseling goes on for an extended period it doesn't necessarily mean the treatment has gone awry or that a scummy practitioner is milking their client. Here are some general cases where the process can take longer:
- Someone just has more difficult-to-treat issues, like the tangle of problems that can arise from having a traumatic childhood. This could involve having more severe symptoms and more intense emotional pain, but not always. Sometimes milder complaints still have complicated roots that take a while to get to the bottom of.
- They're dealing with several interconnected issues, which all get in the way of each other.
- They have extra barriers to getting help, aside from their primary concern. Like they have trouble trusting or opening up to people, and it will take time to feel safe with the therapist and be able to get into the main work.
- They have deep rooted unconscious motivations against changing, and even though a part of them wants to get better, another part will make sure they drag their feet.
It can be frustrating to hear you may have to grapple with your problems longer than you'd like, but ultimately it's better to have a realistic idea of how things may play out. That's not to say you should always blindly stick with ongoing treatment that seems like it's spinning its wheels. It may make sense to take a break, or switch counselors or therapy methods. But everything could be going fine. It's just going to unfold at a slower pace than you initially hoped.
Here are more thoughts on some of the ideas that have come up so far:
I'm a counselor and sometimes I have a tough time accepting therapy can take longer
I just wrote that I know therapy can't always be over with quickly. However, the messages against longer-term counseling can be so strong that even I get sucked into them despite myself. Everything in my clinical training and professional and personal experience tells me that legitimate longer-term psychotherapy is a thing, but at times I still doubt myself. I wonder if I'm a failure or a fraud if I've been seeing the same client for over a year. Did I overlook some blindingly obvious solution? Am I missing a key skill? Could another counselor have fixed them up by now? Every so often there is something to my doubts and I change course as needed, but often I have to remind myself healing just takes longer for some people, despite what some sources may claim.
Just because counseling might take longer doesn't mean clients see no improvement the entire time
Even if you've got a stew of more complicated issues that may take years to fully resolve, you probably won't feel as crappy as always right until the final session. Hopefully you'll gradually feel better and better, and be more and more functional in your daily life, until one day you decide you don't need to see a therapist anymore.
Though counseling doesn't always follow a predictable, linear path. If you start digging into painful issues you've suppressed or avoided your whole life, you may feel worse for a while, while you actually deal with them. But tougher patches aside, over the long haul you should see a steady, if uneven, path of improvement.
The idea that new, more-scientific therapies can fix everyone in just a few sessions
There are all kinds of treatments that have been portrayed as the exciting new breakthrough that can supposedly cure clients in a handful of appointments - Cognitive Behavior Therapy, Solution-Focused Brief Therapy, EMDR, Internal Family Systems, Coherence Therapy, Psychedelic Assisted Therapy, I could go on.
I'm not saying all these modalities are an over-hyped scam. In fact, there are miraculous sounding case studies for each of these methods, where clients did get relief in a session or two. Even if they can't provide an insta-cure, they can help many people after a few months of work. They've introduced valuable new concepts or techniques into the field that are more efficient than previous methods.
However, every type of "official", evidence-based therapy can point to examples where a client's issues cleared up quickly. You can say the same about alternative, less-scientifically supported stuff like hypnosis or energy healing (not that that means every type of treatment is equally as useful). The fact is everyone is different, in what they're dealing with and what will help them. There are many types of therapy, and with the right client most can show speedy results.
On the other side of the coin, each type of trendy, fast-acting modality also has clients who just have to do it for longer, if they don't bounce off it entirely. A few examples:
- There are people who do Solution-Focused Brief Therapy, start thinking about practical changes they can make to improve their situation, and feel much better after two sessions. And there are clients who don't get anything out of it.
- There are people who start CBT for their anxiety and feel significantly less nervous after three months of weekly sessions. There are also clients who can't get themselves to do the required between-session homework, make little progress, and drop out.
- There are clients who start Internal Family Systems therapy, find its parts work approach to be a welcome breath of fresh air, and are finally able to shift some stubborn self-destructive patterns after a few appointments. There are also people who begin it to treat their complex trauma, and stay with their therapist for three years. Others think it's weird and flaky and never come back after the first meeting.
- There are people who have been in clinical research trials for psychedelic-assisted therapy and their severe PTSD resolved after three or fewer sessions with the substance. There are also subjects who felt three sessions was a promising start, but they still have significant symptoms. You can also find accounts of underground psychedelic therapy where people with really traumatic childhoods had to do dozens of trips over many years before they felt healed.
Just because a therapy method has some studies supporting its effectiveness as a short-term treatment, that doesn't mean it quickly works for every last person either. Without going into too much detail, when a model has a study behind it, it usually just means that on the whole the method was shown to be somewhat more effective than an alternative condition, like no therapy at all, or generic supportive listening. However, within that overall positive result some of the individual subjects may have improved a great deal, some modestly, and some not at all.
Also, research studies can be designed in ways that don't reflect the messiness of real life, and limit the conclusions you can draw from them. Like they may only use subjects that have a single, simple diagnosis. In reality most people with that diagnosis have other ones as well, which would complicate treatment. That's not to say every hyped-up therapy method with a promising study behind it is a worthless con job at the center of some grand conspiracy. It's just that it's not as simple as saying, "There's a journal article saying Therapy X treats Issue Y in four sessions, therefore if you don't get that outcome something fishy is going on."
You can hear more from people who did long-term therapy and found it ineffective than the other way around
Like a dissatisfied former client may say:
- I spent years trying to explore the childhood roots of my anxiety and got nowhere. Then I switched to facing my fears with CBT Exposure Therapy, and started actually being able to function in the world again.
- I saw a therapist for half a decade, and they were very lovely and accepting, but all they did was listen, and gave me no guidance. When I switched to a more active, problem-solving counselor I got more done in a month than I did in years.
This absolutely can happen. Sometimes a certain type of long-term approach or particular therapist wasn't the right fit for a client. But there are also stories that go the other way:
- "I tried doing Exposure Therapy, but just couldn't get anywhere with it. Once I switched to exploring my childhood I started making actual progress. It took a while to get to the bottom of everything, but I'm way better now."
- "I had a very solution-focused therapist, but all they wanted to do was give me canned lectures on coping techniques or fill out worksheets. Once I switched to someone who would just listen and give me space to work things out on my own I figured out what needed to change."
Of course, it's not all or nothing. Maybe the client who initially wrote off CBT could come back to it later once they're in a better position to apply that method.
Some people who have stories of short-term therapy being effective may do something longer-term down the road
Sometimes earlier in their life someone will briefly get therapy, it will seem to be all they need, and they'll sing the praises of short-term counseling. Later in life other issues crop up, or they realize they didn't fully address the original ones, and they'll decide to do some longer term work. For example, in university a student may see a therapist because they're nervous about their exams, and feel better after two sessions of venting about the stress they're under and practicing some basic relaxation techniques. Two decades later their anxiety comes back in a big way, but this time they realize a supportive ear and some deep breathing won't be enough. Their lifetime habit of holding themselves to unrealistic standards, due to a slew of childhood baggage, has caught up to them, and will take more time to dismantle.
That's not to say everyone who initially does a brief course of therapy will eventually come crawling back and admit they were wrong. It's just that sometimes people can initially see a therapist for a short time, feel that's enough, and be vocal about it, not realizing in the future they will benefit from seeing someone for a while.
The idea that longer-term therapists are scam artists or obsolete quacks
I'm not naive. I realize drawn out counseling doesn't always have a wholesome explanation. A counselor may know their client isn't benefiting from their sessions, but the person doesn't seem to mind coming, so they keep taking their money rather than referring them elsewhere. Another, older, therapist may be in a comfortable rut, practicing methods they learned decades ago, closed off to new clinical angles that could help them do their job faster.
However, most therapists are honest. They know it's against their code of ethics to keep taking someone's money when they're sure they aren't helping. They put their clients' interests first and refer them to a better suited colleague if they decide they aren't making enough of a difference.
Though a counselor may think their longer-term approach is beneficial, and just doesn't know any better. A good therapist will check in with their clients every so often to make sure they're still being useful. And as a client it also makes sense to consider if you want to shake things up every now and then.
Some types of therapy aren't fashionable or mainstream, and may widely be regarded as outdated and inefficient. However, supporters of these modalities will say their methods are misunderstood. They can point to success stories. They'll explain how their techniques and theories have evolved, and anyone who calls them obsolete is probably referring to a dusty old strawman version of their model.
There are also clients who are just content to let counseling go on for longer, even though they could be done faster if they wanted to
They're not the main focus of this article, but it's worth quickly pointing out. Some clients are content to take their time in therapy and not do a ton of work on their problems in between sessions. They might not have a single issue they want to resolve, and just like having someone supportive to talk to every week or two, about whatever has been bothering them or is on their mind lately. They could be more financially comfortable or have good employee benefits and be able to afford to meander along. They may truly be navel gazers, which isn't always a bad thing, and want to take the time to explore and optimize their minds, without any time pressure or agenda.
To recap, if you've got something you want to work on in therapy, hopefully it won't take years and years to clear up. There's a decent chance it won't. However, sometimes that's just how it shakes out, and it doesn't necessarily mean something's gone wrong. No one's thrilled about it, but some of us just have more complex inner struggles that take a lot of time to unpack.