How Long Should I Go to Therapy, and At What Frequency?

Photo by Illiya Vjestica on Unsplash

In a world committed to quick fixes, self-help books and scams, when I suggest to folks that psychotherapy is best suited to a multi-year process, they are shocked, dubious, and assume I have designed my practice to hook people so I can make as much money off of them as possible. I understand the desire for quick fixes: in fact, I am a recovering addict because I love them so. I appreciate the appeal of self-help books, or in my case blogs, as I am perennially attempting to better myself in life in multiple facets at that same time (currently taking on-line “courses” in minimalist approach to de-cluttering your home and an iPhone photography tutorial). And I know that there are tons of snake-oil sales-folks trying to convince us non-stop how to best use our limited resources; some of value, some not-so much.

People come to therapy for many things. Some of them are indeed things we can help folks with in a fairly short period of time. They may have a big decision they need to make, a recent emotional injury to heal, a current dilemma to face. But mostly the only way we can offer relatively quick help is by leveraging counseling skills and techniques as opposed to psychotherapy. We can listen, support, validate, encourage, brainstorm, suggest resources, and offer counsel on alternatives or perspectives our clients may not have considered. All of that is great stuff. It can help our client feel better. It can help folks through a difficult moment in time. It can frequently help people resolve the issue at hand.

More frequently however, either as the presenting issue that brings them to therapy, or an awareness that presents over the first few weeks of therapy, clients struggle with entrenched, repetitive patterns and places of stuck-ness that they have tried to change for many years before seeking out psychotherapy. It is the issue that lands on their New Year’s resolution list every year. They struggle with confusion and hopelessness about why and how they are unable to make traction in altering a set of behaviors or perspectives that they hate but that they feel unable to change. This is where psychotherapy proves to be a uniquely potent tool.

For as much as most of us feel made crazy by our places of stuck-ness, and insist that it makes no sense why we can’t change, our stuck-ness makes total sense; we just haven’t figured it out yet. People can feel stuck with concrete things, like not being able to adhere to a diet of their choice, get themselves to keep their home clean, or manage their time in a livable way. Or they can struggle with multi-year patterns of getting defensive or sensitive or attacking in their intimate relationships with partners or kids or in their work relationships with supervisors, or peers or supervisees. They find themselves unable to resolve ambivalence or uncertainly about jobs or careers, whether or not to have kids, or about their relationships. They find themselves struggling with an issue they have struggled with for years without relief. These are the issues to bring to a skilled psychotherapist.

I say skilled psychotherapist because many in our field will simply offer you counsel, not understanding that the world of psychotherapy is the world of the symbolic. While we can help you think of concrete ways to deal with your envy and animosity towards a peer co-worker, until we help you resolve your sibling rivalry, you will continue to find other peers to rival. We can help you with strategies to work more efficiently to free up your time, but until we unpack your fears about that freedom, it won’t work. 

If it was easy to understand why you were so stuck, you would understand it. If there were easy answers to the issues that had plagued you for years, you would have found them and fixed them. While as psychotherapists we bring some special skills into the task of helping you understand yourself and find the keys to your dilemma, it won’t be anything like easy for us either. You are not some simple puzzle and us some brilliant diviner of ills. It will take both the therapist and the client, working together, gathering clues to the problem, exploring blurry memories, sitting courageously with hard truths, uncovering complicated connections and experiences and feelings. And it will require a lot of grieving. No one is stuck without very good reasons. Those reasons are connected to pain and loss or else they would have been easily accessible to you.

As I read over that last paragraph, I worry that it sounds so dramatic. But it is dramatic. Being stuck after years of trying a million things to change is a big deal. What got you stuck is just as big.

Another reason psychotherapy is best suited to a multi-year process is that it is at its center about learning a new way to approach yourself, your relationships and your world. In childhood we learn from the repetitive approaches our care-givers had towards us and with each other. Just as a child learns the dialect and accent of their family members as they learn to speak, we also learn about what feelings are, how they should be treated, how to go about making decisions, what to do when we are mad or hurt or happy, what to expect from the outside world, what love means and what it looks like, and on and on and on. Whether we had a fabulous family or a traumatic childhood, we learned from them day in and day out, year after year, long before we know how to critically consider what we were learning. Therapists are great at noticing operating assumptions that we live our lives by. Earlier this week while discussing with my own therapist my distress over how much my son hates school I said “well, it is not like anyone actually likes school”. He said “excuse me?!” Sessions are an opportunity to unlearn and relearn things that took us decades to digest the first time around. It is reasonable that it will take a while to peel away assumptions and evaluate anew our own approach to living and loving. 

The other issue about therapy taking a long time is that it isn’t medicine that is hard to swallow. Few people in a good psychotherapy relationship are counting the days to be done with it. While it is a massive investment in time and money, therapy is a weekly opportunity to contemplate our lives. We won’t always be focused on the one issue we see ourselves as stuck with. We will be sitting (or laying) weekly with a person particularly adept at seeing the symbolic. As they get to know us, our conscious selves and our unconscious selves, we will be exploring together our experiences in relationships, our beliefs about life and the world, or fears and hopes. We will be sitting with someone who gets their own needs met elsewhere and who is able to be focused exclusively on our needs in our session. While some sessions can be difficult and dark, we are unlikely to have many moments in life with someone so highly attuned to us and our journey. Definitely not a hard pill to swallow.

 

Smith is an analytically oriented psychotherapist with 25 years in practice. She is additionally the  Founder/Director of Full Living: A Psychotherapy Practice, which specializes in matching clients with seasoned clinicians in the Greater Philadelphia Area.

If you are interested in therapy and live in Philadelphia or the Greater Philadelphia Area, please let Full Living: A Psychotherapy Practicematch you with a skilled, experienced psychotherapist based on needs and issues as well as personality and style. Request an Appointment Today.

 

If you would like to read more about issues related to this topic, please check out some of these blog posts. 

What Should I Talk about in Therapy Today?

Psychotherapists are like Dance Archeologists

Attending to the Unconscious in a Psychotherapy Session

Myths about Psychotherapy

Author
Full Living Founder and Director Karen L. Smith MSS, LCSW Karen L. Smith MSS LCSW Karen is the founder and director of Full Living: A Psychotherapy Practice, which provides thoughtful matches for clients seeking therapists in the Philadelphia Area. She provides analytically oriented psychotherapy, and offers education for other therapists seeking to deepen and enriching their work with object relation concepts.

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