Demystifying Mental Health Treatment: How long will I need therapy?

It’s the start of a new year, and while you don’t need the calendar to tell you when to make a change, the whole #resolutions thing makes it a convenient time for many to reflect on goals for themselves in the upcoming year and start taking action steps. My #resolution is to do my part to bust myths around mental health treatment, so that nobody has to feel embarrassed or judged for struggling. To get things going, I’ve decided to start off 2018 with a series of posts demystifying the process of therapy. I’ve noticed that many people considering therapy have the same questions and concerns about the process. Today, I’ll address the one I most frequently get: how long will this take?

Well… at the risk of sounding wishy-washy, the truth is that it’s different for everyone. People seek therapy for various reasons, so treatment is not “one size fits all.” Some people are struggling emotionally with things like depression, anxiety, or grief, or having difficulty coping with a past trauma, navigating a difficult relationship, or managing self-criticism. Others may be struggling to stop engaging in certain behaviors, like addiction, substance abuse, compulsive behaviors, or unhealthy eating and exercise habits. Some people may be looking for help adjusting to a major life change or while going through a life transition (such as graduating from college, starting a new job, getting fired, going through divorce, moving to a new city, grieving for a loved one, or having a child). The list could keep going on—humans are complex and messy, and so it is natural at some point in our lives to experience a disruption to our mental health, just like it’s natural to get sick or injured physically at some point.

I suspect that the reason this question is so common is that we like to know what we’re getting ourselves into. Totally fair. Humans are wired to solve problems. When something is bugging us, we want to figure it out right away so that we can fix it and move on. If you’re coming to therapy, you might have been experiencing difficulties for a long time and are finally ready to commit towards change and growth. Or, maybe something just recently popped up, and you want to “fix it” before things get worse. Either way, you probably want some instant gratification. So even though I can’t give you a straight answer about how long it will take, I can do my best to help you get some immediate relief, as soon as the very first session. In fact, it’s a good rule of thumb when you’re looking for a therapist to consider when you walk out of the first session whether or not you feel understood, supported, and hopeful about the possibility of change (even if you don’t feel “better” right away).

Research over the last several decades has shown that therapy has the best chance of being “successful” when the client and therapist have a strong rapport, or therapeutic alliance. Rapport is developed when the therapist and client build trust in one another and work as a collaborative team. Most people need a little while before they are comfortable opening up. However, if you’ve been going to your therapist for awhile and still don’t trust them, this is important to address. I’ll be writing a future post about what to do if therapy isn’t helping you or if you want to break up with your therapist, so stay tuned for more on that later. In the meantime, just know that the sooner you and your therapist form a connection, the sooner you can get to work.

The length of therapy also can depend on how long you’ve been struggling with certain behaviors or experiencing symptoms, how motivated you are to change, the approach your therapist is using, and how open you are to trying new and sometimes difficult things. I often will suggest something many times, over the course of weeks or even months, before a client is willing to give it a try, and that’s okay. We can’t force change—you have to be ready for it when you’re ready for it. So that might take a degree of patience from both of us. Plus, it sometimes takes a lot of repetition before something finally “clicks,” since therapy involves shifting belief systems and worldviews that have been in place for many years. I like to tell people, “you didn’t get this way overnight, so you won’t change overnight either.” If you’re trying to change a lifelong habit, it can take some time to start seeing results because the habit might be really deeply ingrained, and you may not have ever really used other tools (or even known there were other tools available) for dealing with certain experiences. That being said, just because someone has been stuck in a certain pattern for 10 or 20 years does not mean it will take 10 or 20 years to change it. Just don’t expect to break longstanding habits in one session. If you find yourself feeling impatient with the pace of change, speak up. Therapists are not mind readers and if we know you’re feeling frustrated then we can figure out how to get “unstuck” and moving again.

Sometimes, we are chugging along nicely, and then – surprise – life drops a metaphorical bomb. Unexpected stressors can barge in (a breakup, a medical diagnosis, an accident, etc.) and interrupt progress or take priority over whatever we had originally been working on. That might mean we shift course and then return to the original plan at a later time (or abandon the original plan if necessary). It’s important to stay flexible as we go along. I’ve also found that as we progress, we sometimes uncover or make room for other topics to address that weren’t the original reasons for seeking therapy but that are still worth focusing on. For example, maybe you came in to treat your anxiety, but along the way we realize that most of your anxiety is work-related and it’s because you’re in a work environment that just isn’t right for you, so we start to explore a job change. Or, once we’ve helped you resolve depressive symptoms, we start to look at an unhealthy romantic relationship that you weren’t ready to address before.

If you’re dealing with trauma or grieving for a loss, the change may be slower than you’d like it to be, since the healing process often involves feeling an increase in pain or discomfort before experiencing any decreases. If you’re dealing with symptoms of an eating disorder, phobia, or obsessive-compulsive disorder, you also might notice symptoms worsening before they improve, because a component of treatment involves exposure to things that you prefer to avoid in order to get you more comfortable with anxiety “triggers.” This is often a very challenging and stressful process, but ultimately if you stick with it, you will find relief in the long run.

Typically, I like to start off meeting once weekly, and then scale down and meet less frequently as treatment progresses and you start to see change, to give you a chance to try things on your own. Occasionally, we may increase frequency to twice-weekly sessions for a brief period of time in situations where a person needs more support than once-weekly sessions can provide, and there are many clinicians who will meet two, three, or even four times weekly with their clients (this is not my policy). In the initial session, we can get a sense of what’s going on and what level of support would be best, and if you need more than what I am able to provide in a private practice (such as inpatient/ residential treatment or intensive outpatient treatment), I will refer you elsewhere. While it’s important to consider your unique situation when making decisions about how frequently to meet, I have generally found that people who commit to coming in regularly and making it a priority to stick with therapy have seen the fastest change.

Now, I don’t take it personally that you might not want to see me every week forever and ever. In fact, I have the opposite perspective. I don’t want my clients to have to come any longer than necessary. Once you’ve reached your treatment goals, we discuss whether anything new needs our attention, and if not, we decide that it’s time to say goodbye. My goal is to essentially make you into your own therapist, so that you can internalize our work and go about your merry way. As much as I love working with my clients, I also love sending them off into the world to spread their wings! That being said, in times of high stress, it’s not uncommon to slip back into old habits or patterns of thinking, feeling, and behaving. So my door is always open for a “booster” session down the road, even if we haven’t worked together in awhile.

Some clear outcomes of therapy include:

  • Developing skills for effective communication and problem-solving
  • Feeling more self-confident and becoming more compassionate towards yourself and others
  • Learning new ways to cope with stress and anxiety
  • Becoming more equipped to manage and regulate your mood
  • Improving your social, intimate partner relations, and family relationships
  • Changing old behavior patterns and developing new ones
  • Gaining self-awareness and a better understanding of your values

The start of a new year is the perfect time to begin making changes to enhance your life, and therapy might be part of the plan.

If you are considering therapy and want to know more, or if you have a question about how therapy works and would like to see a future post about it, comment in the section below or send me an email, drpaulafreedman@gmail.com.

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3 thoughts on “Demystifying Mental Health Treatment: How long will I need therapy?

  1. I agree that the most important determinant of success in talk therapy is the rapport developed between patient and therapist, irrespective of whether the therapist is an MD psychiatrist, a PhD psychologist or a MSW social worker. An outstanding therapist that I know of today is Jon Frederickson, a social worker in Washington DC. He practices Intensive Short-term Dynamic Psychotherapy, as developed by Dr. Habib Davanloo of Montreal Canada.
    I recently published a book entitled “Neurosis Revealed” available on Amazon.com in both paperback and e-book forms. It is written in lay language and covers all aspects of this ubiquitous malady.

    Like

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