How Long Is Too Long In Therapy?

Therapy can be one of the most rewarding and empowering experiences you’ll ever have — or it can be costly and insufficiently productive. Here are three ways to check whether the process is still on the right track.

Recently I was involved in a roundtable discussion with several health care benefit plan administrators, employee assistance program directors, and other mental health services coordinators and “gatekeepers,” many of whom were asking a host of similar questions:

• How long is too long for someone to be in therapy?
• When does therapy stop becoming a source of support and start becoming an emotional crutch?
• Why do some folks stay in therapy for years and never seem to get any better?
• How do you know when someone is really benefitting from their treatment, healing, and moving forward as opposed to becoming too ‘dependent’ on their therapist and therefore staying ‘stuck’?

All of these are valid questions, and unfortunately, there are no simple answers. But there are some commonly accepted principles and guidelines that can help anyone determine whether the benefit they’re deriving from therapy is commensurate with the time and resources they’ve invested in the process.

Mental health professionals see different kinds of people and for many different reasons. Even the most well adjusted folks can find themselves needing therapy sometimes, especially when atypical stressors have entered their lives, taxed their usual ability to cope, and altered their normal mood and/or behavior patterns. When folks simply aren’t themselves anymore, they can find themselves in need of professional guidance and support (and sometimes the benefit of medication to restore normal biochemical balances) to help them get back on track. Therapy in these cases is generally a relatively short term affair, with the therapist’s primary objective being to help the client solidify their existing resources and hone the additional skills that will enable them to no longer have any need for the therapist and gain increased immunity to future stress.

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Mental health professionals also work with individuals whose problems are of a more chronic nature. Sometimes such problems stem from clinical conditions that are in large measure the result of biochemical abnormalities, and adequately managing these problems often involves not only medication but also supportive therapies to help people better manage the emotions, thinking patterns and behaviors that can accompany their conditions. Depending on the kind of illness being treated and the kinds of additional conditions that can sometimes accompany the illness, therapy for chronic conditions can last a long time, although it might not necessarily entail frequent, regular sessions for the entire course of treatment.

Some people need therapy because their very personality — a product of their innate tendencies, environmental shaping influences, and the dynamic interaction between those two factors that shaped their unique way of perceiving and relating to the world — has negatively impacted their life and relationships. When a person’s habitual way of coping is in itself problematic, modifying it does not come easily or quickly. By definition, personality patterns become ingrained early on and persist throughout adulthood across a wide variety of situations. Changing such patterns to any significant degree and learning new coping strategies requires specialized intervention, and even with specialized therapy, generally a lot of time.

Some folks use therapy purely as a vehicle for personal growth. It’s not that they’re all that unhealthy to start with, just that they want to be even healthier and more fulfilled. These are the folks who want to know themselves at a truly deep level so they can realize as much of their potential as possible, and there are a few types of therapy designed to do exactly that. Such therapies can indeed last for years. But if a person has the resources to underwrite such an effort (most insurance entities balk at paying for therapy purely for the purpose of “personal growth”), such therapy can yield untold dividends.

As I’ve written before in “When Therapy “Enables””, sometimes therapy can actually “enable” dysfunction. There are cases where folks become so “dependent” on therapy or even on a therapist and derive so much comfort from the support afforded by the therapeutic process that they lose any incentive to get better. I’ve seen all too many such cases, and when they occur the therapist generally bears as much culpability as the client for the imprudent use of resources.

So how do you know when therapy has gone on too long or has become counterproductive? Here are some suggestions about how to help ensure the therapy you’re involved in is not the kind that will drag on forever with questionable results:

Be sure your therapist has rendered a diagnosis and that you both know and understand what that diagnosis is as well as what it means.

The most judicious treatments are those fashioned in a manner to provide the best known intervention for the particular kinds of problems you have. You may have more than one diagnosis. Some conditions co-occur with others and can exacerbate problems and/or complicate treatment. Be sure you know and understand all that you’re being treated for and why any particular treatments have been chosen.

Know and understand your therapist’s treatment plan.

These days, most insurers require therapists to submit a plan that includes a formal assessment of your strengths and needs, sets short and long term goals for your health, and outlines the objective ways in which your progress in meeting specific objectives will be measured. But even in the absence of such a requirement, it’s simply good practice to have a plan for both addressing your problems and gauging the amount of headway you’re making.

Be of one mind with your therapist with respect to achieving results.

The goal of therapy is not just to feel better for the brief time you’re “venting” but to get better mentally, emotionally, behaviorally, etc., and for the long term. Successful therapy should help you feel more empowered, in control, and able to thrive in more situations, even challenging ones. When that’s not happening, both you and your therapist should have some concern about it. Perhaps the intervention strategies you’ve been using need to change. Perhaps the diagnosis itself might need re-evaluating. In some cases, perhaps even a change of therapist might need to be considered — there are occasions when a therapist’s level of expertise simply isn’t a good match for your problems. In any case, as important as the therapeutic relationship is (and there’s plenty of empirical evidence attesting to its importance), it always has to take a back seat to whether or not you’re becoming healthier.

Therapy can be one of the most rewarding and empowering experiences you’ll ever have. Unfortunately, it can also at times be an insufficiently productive, yet addictive and costly enterprise. But when you embark on it with a good idea about why you’re in it, what you can and should expect to get out of it, and how you’ll know if you’re getting what you truly need to get out of it, it can not only be well worth your while but also worth the costs in time and money.

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