{"id":159,"date":"2009-09-07T15:24:48","date_gmt":"2009-09-07T22:24:48","guid":{"rendered":"http:\/\/blog.stevenreidbordmd.com\/?p=159"},"modified":"2009-09-07T15:24:48","modified_gmt":"2009-09-07T22:24:48","slug":"i-dont-want-to-be-in-therapy-forever","status":"publish","type":"post","link":"http:\/\/blog.stevenreidbordmd.com\/?p=159","title":{"rendered":"“I don’t want to be in therapy forever!”"},"content":{"rendered":"

<\/em><\/p>\n

\"flower1\"In this age of managed care it may seem surprising, perhaps even suspicious, that traditional psychodynamic therapy is designed to be open-ended, with no\u00a0fixed number of sessions or duration. \u00a0This can be anxiety-provoking both to third-party payers, e.g., insurance companies, who prefer to know from the start how much a treatment will cost, and to the patient, who also invests money, time, and emotional commitment into treatment. \u00a0In addition, many patients find themselves uncomfortable with a growing sense of reliance or dependence upon the therapist, a feeling intensified by the lack of a defined stopping point. \u00a0 Part-way through the process many patients muster the courage to ask: “How will I know when to stop? \u00a0I don’t want to be in therapy forever!”<\/p>\n

In contrast to traditional open-ended, exploratory psychotherapy, shorter-term manualized therapies have gained prominence in recent decades. \u00a0Based on psychodynamic<\/a>, cognitive-behavioral<\/a>, or other<\/a> schools of thought, these treatments, often 12 to 16 sessions in length and with a defined beginning, middle, and end, appeal both to third-party payers and to many patients. \u00a0Solid<\/a> research<\/a> evidence<\/a> supports<\/a> these shorter-term therapies as effective treatment for depression, anxiety, and other common symptoms. \u00a0They are particularly suited for addressing well-defined fears (flying, spiders, public speaking, etc.), shyness in dating or other social situations, depression after a recent loss, and the confusing squirl of chaotic feelings after a relationship ends. \u00a0The advantages of time-limited treatment are fairly self-evident; one sensibly wonders why anyone would choose the older open-ended alternative.<\/p>\n

In contrast to time-limited therapies, traditional exploratory treatment invites wide-ranging discussion of thoughts and feelings; it is not limited to a specific topic or concern. \u00a0It also has a timeless quality: \u00a0If a topic doesn’t arise today, it may arise next week or next month. \u00a0A person avoids talking about troubling issues for only so long; eventually even the most shameful or ineffable topics are broached, detoxified, and worked through. \u00a0Thus, open-ended therapy excels<\/a> when problems are ill-defined or hard to talk about; when one is vaguely yet pervasively dissatisfied or frustrated with career, relationships, self-identity, or other central aspects of life.<\/p>\n

Open-ended treatment tends to be less directive \u2014 steered less by the therapist \u2014 and thus more conducive to promoting and observing transference<\/a>. \u00a0And since transference interpretation<\/a> is one of the best ways to bring unconscious thoughts and feelings into consciousness, open-ended therapy is well-suited for problems that originate outside the patient’s conscious awareness.<\/p>\n

Open-ended therapy can be more anxiety provoking than time-limited varieties. \u00a0There is no set agenda, no obvious protocol or series of treatment steps. \u00a0It is hard to know how “far along” one is, and sometimes it isn’t clear whether any real change is taking place. \u00a0The “active ingredient” that makes therapy work is less a matter of technique and more a result of a certain type of human relationship<\/a>.<\/p>\n

In the midst of all this murkiness, patients note subtle progress over time. \u00a0Relationships gradually feel less frustrating, career decisions less intractable. \u00a0But when does this process stop? \u00a0The answer is simple and complex at the same time. \u00a0On the one hand, therapy naturally ends when a patient “got what they came for.” \u00a0Feeling fundamentally satisfied with life is a good indication. \u00a0Since this is subjective, no one can say except the patient him or herself, who often takes further investment of time and money into account as well. \u00a0On the other hand, dynamic therapists consider a therapy complete when all major areas and conflicts of life have been discussed, explored, and resolved in some manner. \u00a0As many of these conflicts are unconscious, this assessment is made by the therapist, not patient, and can be quite complex.<\/p>\n

Neither the patient nor the therapist wants therapy to last forever. \u00a0Ultimately our job as therapists is to make ourselves obsolete. \u00a0Nonetheless, the nature of open-ended dynamic treatment provokes concerns about dependency and “getting too comfortable” with therapy, and often elicits a reactive fear that therapy might last forever if the patient isn’t careful. \u00a0These feelings are themselves well worth discussing in therapy; their resolution brings the patient a big step closer to an ending both parties can endorse. \u00a0For more on this topic, see here<\/a> and here<\/a>.<\/p>\n

It is also true that sometimes patients and therapists disagree over whether it is time to end. \u00a0In my next post, I’ll discuss various ways and reasons therapies end, and some of the dynamics that result.<\/p>\n","protected":false},"excerpt":{"rendered":"<\/p>\n

In this age of managed care it may seem surprising, perhaps even suspicious, that traditional psychodynamic therapy is designed to be open-ended, with no fixed number of sessions or duration. This can be anxiety-provoking both to third-party payers, e.g., insurance companies, who prefer to know from the start how much a treatment will […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[8],"tags":[24],"class_list":["post-159","post","type-post","status-publish","format-standard","hentry","category-psychotherapy","tag-transference","odd"],"aioseo_notices":[],"_links":{"self":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/159","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=159"}],"version-history":[{"count":17,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/159\/revisions"}],"predecessor-version":[{"id":177,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=\/wp\/v2\/posts\/159\/revisions\/177"}],"wp:attachment":[{"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=159"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=159"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/blog.stevenreidbordmd.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=159"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}