Most people wait longer than they should to get into therapy. Between the stigmas, the overwhelming feelings, and the logistical constraints, it’s easy to understand why people hesitate. And it’s probably true that a good portion of people leave therapy before they should. Problems like scheduling, payment, and the therapeutic relationship are often to blame. But what if you really enjoy going to therapy, and you’re not really sure if you need to quit? Let’s talk about some answers to the question, “How long should I stay in therapy?”
The Therapist in Therapy
I’ve mentioned here on the blog that I’m currently in my own therapy. It’s part of our professional duty to occasionally get therapy for ourselves. It’s a way of keeping ourselves healthy so we can continue to pour out for our clients. When my latest depressive episode lasted from December well into the spring, I knew it was time for another round. I was crying pretty much daily, and especially on Sundays, when my church wounds were activated. I upped my meds and found a therapist, to whom I talked about my heartbreak with church.
This week, she pointed out that I’m not crying anymore. I can talk about church without crying, I’m functioning well in my daily life, and I don’t feel depressed. (I’m not decreasing my meds anytime soon, though!) She suggested that I don’t need to meet every two weeks anymore, that I could do a session once a month, and eventually just call when needed. I agreed that the reduction in support would be manageable for me. It feels good to know that I came through something and I’m doing better now. It got me thinking that sometimes we don’t know if we’re done with therapy or not!
The Course of Therapy
Last year I wrote about what to expect over the course of therapy in my post entitled “A Road Map for Therapy.” I talked about the beginning, middle, and late stages of therapy, and how these are accomplished in a perfect world where people can always fit therapy into their schedules and pay for it. So today, I want to talk about that ending stage of therapy, because termination hardly ever goes as planned in the beginning.
The Pocketbook Problem
When health insurance is paying for therapy, clients must meet medical necessity for the service to continue. That means we can’t treat you for symptoms you no longer have. Many therapists will use brief questionnaires to find out if you have improved on the symptoms that brought you in. Others will simply find out through observation and asking questions. Even if you don’t use your insurance to pay for therapy, your therapist has an ethical obligation to phase out services if you no longer need them.
Sometimes, however, clients are happy to continue paying for therapy simply to have someone to talk through everyday stressors, as well as long-buried issues. They may not be having panic attacks or daily crying spells. But they know they could be happier in relationships or more effective in their calling.
Because modern therapy mostly relies on the medical model due to the high cost of services, many people do not get to do this deeper soul searching. Their time in therapy is spent stabilizing and learning new skills. When the symptoms are reduced enough, they no longer meet medical necessity, but they also don’t get the opportunity to dig around for buried wounds.
Very severe mental health issues require hospitalization, and stepping down from inpatient care are partial hospitalization, intensive outpatient, and then outpatient sessions multiple times a week. Run-of-the-mill mental health episodes will likely just get you into therapy once a week to begin with. After they build some momentum and things start to stabilize, you may go down to every other week or once a month.
If a client can maintain progress at this level, I like to move to an as-needed basis, like I mentioned above with my own therapist. I tell clients: “It’s like you have me on retainer, but you don’t have to pay a fee like an attorney would collect.” I know all your issues and I’ve seen what works for you. It’s nice to know that you have a therapist that you can call if the sh*t hits the fan and you need help. No one likes having to start over with a new person (unless you didn’t like your therapist in the first place). I hate suggesting to a client that she should come less often, and then I hear a comment like “Are you trying to get rid of me?” No! I’ve just seen your progress, and I’m trying to do my job in an ethical way.
Setting New Goals
If you are able to stay in therapy and you want to keep exploring deeper issues, it’s wise to have a conversation with your therapist about the additional topics you would like to discuss. In fact, your therapist should be asking about your goals, anyway. To keep therapy productive, it’s good to continue to make goals. Your first goals may have been pretty straightforward: “Reduce daily crying spells,” or “Drive on the freeway without panicking.” But different types of goals might be harder to nail down, like: “Figure out why I cry when I talk to my dad,” or “Stop sabotaging myself in new dating relationships.” You will also want to continue talking to your therapist about how you will know when these goals are accomplished. What will be different about your life if this part of therapy is successful?
There are a few people on my caseload that I have continued to see regularly for years. They continue to come for a variety of reasons. For some, because they are so emotionally repressed throughout their lives, it takes this long to get to the heart of the matter. For others, they continue to need ongoing support for long term emotional difficulties. Their mental health ebbs and flows, and during the easier seasons, regular therapy is kind of a maintenance program to prevent the big crashes when harder times hit. Still others simply find the therapeutic relationship and the hour we talk every couple of weeks to be supportive and stress-reducing.
Your Other Counselor
I spend most of my time and effort trying to show Christians that going to therapy is a good idea. But today, I want to make sure I say something that might sound the opposite (but it’s not). Therapy has its place and is very necessary for some and a generally good idea for everyone. But if you’re sticking around in therapy past its expiration date, you might want to talk to God about it. Have you come to rely on your therapist more than Him? Are there some supportive social connections in your local church body that you could make? God designed the Church to take care of one another with His help. Many of the people who hang around in therapy too long are not connected either to the Source or to the Body.
I’m nervous making the statement above because, as I said, it’s so different from what I usually say. I want Christians to go to therapy because I want us to be a healthy body of healthy individuals. I want people with real mental health challenges and trauma to take as long as they need in therapy. But I also want to remember that the Holy Spirit is our ultimate Counselor and Advocate. He will show us when it’s time to get professional help and when it’s time to draw near to Him.