Tuesday, January 13, 2009

How Long Should Therapy Take?

By Kevin Murphy, M.Sc.,
Psychoanalytic Psychotherapist
Dublin, Ireland.

A question that is often asked is how long will therapy take? Will it be six sessions or will it be sixty? And there is the financial question too. Therapy costs money so it is reasonable that people will want to know how much they have to budget for in terms of fees.
The fee is fixed (see my website) and so the budgetary maths are fairly straightforward. But there is no one answer to the question of how long it will take. It depends on what the issues are and the attitude of the person seeking therapy. My own approach is to try and keep people in therapy for as short a time as possible, particularly those not seeking an analysis. But if the situation demands long term treatment, then I am equally prepared and trained to do so.
At the beginning I tell clients that we should do a few sessions to ‘see how it goes’ and to find out if they are suitable for this kind of therapy. Besides, it generally takes about three to six sessions to actually get to the nub of some problems because often they present as one thing but are actually about another thing entirely.
Assuming they are then suited to analytic psychotherapy, I continue seeing them on the basis that they have the freedom to say at any given session that they feel they have done enough and so bring the treatment to an end. On occasions I bring the treatment to that closing point myself but more often than not I leave it in their hands.
Part of the ‘cure’ with this treatment is bringing the client to a point where they feel they are ready to leave of their own accord. But as I said, different situations take different lengths of time.
Say, for example, someone in a relationship that has long since ended has a partner who is linked in to their life through the children. This partner continues to exercise a negative influence on the person’s life and the cumulative effect of years of living this way have left the person unable to think straight or make a confident judgement call about their own life.
In a situation like this, a short six sessions of therapy can achieve quite a lot in terms of allowing the person regain confidence in their own decisions and to look objectively at the reality of the situation they are in.
The benefit is not achieved through suggesting or advising on the part of the therapist. Instead it is through considering all aspects of the situation, or as many as practicable, often from new perspectives that had never been considered before. It allows the person make up their own mind. When we are in a bad place, the last thing we are able to do is think straight.
Another example would be someone who is unable to carry out a specific part of their job requirement, say writing up reports or dealing with challenging tasks. It becomes such a problem that they are continuously worried and stressed about it. A back log builds up that threatens their sense of job security. Some forms of therapy would treat this symptom as if it were the problem and work on getting the person to confront the problematic area head on.
But what if further probing reveals that behind it there are other, more deep rooted tensions in the person’s life – an inability to conduct relationships, problematic family circumstances, questions over their sexuality? The work issues now become a symptom of the background tensions and we are into a different arena that demands a lot more patience, time and attention to small detail. In terms of therapeutic work, how long should that take? The answer depends on the person’s ability to engage with the issues, or not.
Or, take the person who comes to therapy without any definite symptom other than a vague sense that they are not living the life they want to live. They are forever getting into unsatisfying relationships, they constantly feel their contributions either socially or professionally are unrecognised or unworthy, they can’t shake the feeling that there is an ‘other’ life out there for them and, ultimately, they don’t see any way out of this? Again, how long should that take?
If there are specific ambitions or goals that have been avoided or put aside, then it won’t take very long to get to that. But if there is nothing obviously missing, no roads that were not taken, then we are once again back to a patient, steady, more analytic attempt to unknot the tangled ball and establish the core issues at work. If this person comes to therapy with a desire for quick answers they will probably be disappointed. Indeed the demand for a quick resolution is almost part of the symptom in some cases.
But the person who comes and is patient with him- or herself in the first instance and with the process in the second instance, and who is prepared to question and consider new perspectives, will find the unknotting process will take place in the most surprising and natural ways.

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