NOTE: THIS ARTICLE WAS ORIGINALLY PUBLISHED IN BINAH'S COLUMN THERAPY: A SNEAK PEEK INSIDE
Personally, I don't hold a gun to anyone's head, forcing them into my room for therapy. Maybe parents or spouses do that, but not me. So when new clients come into my office, even the ones who made their own decision to make that first appointment, they oftentimes walk in the door as if it were a jail cell, a holding pen until their execution.
So inevitably, they ask the question, “Okay, I'm here. But for how long?”
Am I supposed to feel successful as a therapist that somehow in the short time we have met, they have just realized their sentence has been commuted from death by therapy to a prison sentence?
And this is the myth that circulates about therapists: Because we get paid every time a client walks into our office, we wouldn't ever want that client to get better and terminate therapy.
So my clients are often very sure that entering therapy is a life sentence.
Unfortunately for me, as much as I try to make a living, my clients quickly get on with their lives, getting back on track, so that their therapeutic journey barely covers the price of the new tennis courts I have long wanted to build on the roof of my home. Or the swimming pool I figured I may as well dig out in my basement. Or finally take those trips to the jungles of Africa and the volcanoes in Hawaii that have lately been on the back burner. It's very frustrating for me, as you can well imagine. It would be so much more rewarding for me if my clients had the decency to hang around at least long enough to finish paying off the mortgage on my house.
So, when my clients finally ask the question as to how long therapy will take (and if they don't, I will usually bring it up), I actually do have an answer. “You will be in therapy for approximately sixty seven years, give or take a few months for good behavior.”
Just kidding!
Although I am sure each therapist has his or her own way of assessing the answer to this question, this is usually my answer.
“Within a session or two you will begin to feel a hope that life will actually get better. Within two or three session, your symptoms of distress will begin to decrease. Then we will begin the journey to improve your functioning while continuing to alleviate anxiety and depression. You will begin to solve the specific issues you bring to therapy as well as learn tools to apply to a wider variety of situations.”
I don't necessarily use the same words, but the gist is the same.
I say, “After a short amount of time, maybe 8-12 sessions, you will feel you have accomplished what you had wanted when you first came in. At that point, you will choose to terminate therapy, or want to achieve even more than you had dared hope you can achieve. And then you can use therapy for as long as it is useful to you.”
For individuals who come in for trauma work, the same applies, except that trauma impacts on so many areas of a person's life, that therapy may take longer. For deep rooted trauma, I find 2-5 years is a normal length of time for a therapeutic experience (although positive change is occurring regularly), but when the traumatized client finally has the courage to ask how long therapy will take to cure her, she is usually relieved to hear my answer of five years. It validates her knowledge, but paradoxical disbelief, that terrible things had been done to her.
There is one caveat I would like to address. For some clients, depending on the severity of the issues they present like addiction or mental illness, sometimes maintenance therapy is mandated for the rest of their lives. And some people, despite successfully finishing a therapeutic run, will return to therapy years later when new things disturb their disequilibrium.
How does a person know when to terminate therapy? When does a therapist?
The beauty of a therapist working first in a clinic setting before entering private practice is that the therapist gets to know who she is as a clinician when money is not a factor—as the clinician gets paid by the agency and not the client.
And this is what I learned about myself: I will not force a client to terminate. However, if I feel I am no longer being helpful in some significant way, I may recommend a transfer to a different therapist. Maybe because the client entered therapy at one stage of her life, made wonderful strides, but now needs another therapist, who will meet her at the new level of functioning, to move her onto the next level.
I may refer to another therapist when a client wants to try a different type of therapy in which I am not trained, or if the therapeutic relationship is not a productive one. Therapy is like a shidduch; there needs to be a click between client and therapist. And sometimes I am simply not the right fit for a client. And that's okay. Ethically it's the right thing to help a client transfer to a new therapist who may be the right shaliach to help in ways that I may not be able to. The client is not terminating therapy, but simply terminating with one particular therapist.
So if I don't terminate a client's therapy, then how does a client know when is the right time?
Clients figure it out very nicely. It's when they have accomplished their goals in therapy that had been clearly delineated in the beginning sessions and assessed periodically.
As a therapist, it's easy for me to see the signs that a client is ready to terminate. It's when their lives become so full and busy that they arrive to appointments late and then call to cancel altogether. It's when they radically change from creating their whole week's schedule around therapy to trying to fit therapy somewhere in their life. These are good signs and I make my clients aware of how their behavior is signaling to them that it's time to terminate. (These same behaviors can also be signals that the client is avoiding therapy because she feels it is not helpful but doesn't know how to confront the therapist with her fears and doubts—more on this in another article!)
Termination may be painful, but the concept is built into the very beginning sessions of therapy.
By the time a client is ready to leave therapy, they are kind of hoping I will adopt them and they can serve out their life sentence in my office.
If they sponsor an ice-skating rink in my backyard, I may seriously consider it. Otherwise, we work out a plan for termination and learn to say goodbye, so that termination doesn't have to mean loss; but rather a positive internalization of the therapeutic relationship and experience that will continue to impact them years after termination.
It's a wonderful feeling walking out of the prison their life once was.
Case closed.
My book, Therapy, Shmerapy, can be found in bookstores or online