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How long does therapy take? | Online Therapy: Online Couples Therapy: Online Therapist

JANUSJUNO: Online Therapy

Online Therapy for Individuals + Couples


How long does therapy take?

Client: “How long will therapy take?”
Therapist: “How crazy are you?”

The length of therapy depends on many factors. First, I ask about how severe and how fixated are my client's cognitive, emotional, and behavioural patterns are? For example, someone coming to me with a formal borderline personality diagnosis will probably be seeing me for at least a year of twice/week sessions, while someone who just failed an important exam and feels devastated may be in my office once.

Second, I ask: "How much work have you already done?" The client with a borderline diagnosis might have already done years of work and only need maintenance work on a monthly basis for six months, while the person who failed the exam might reveal that the exam wasn't the real cause of his distress, and we find out that he is traumatized by his parents for underachieving his entire life (i.e., again, probably months of therapy to get to a feeling of peace and/or power).

Third, we need to know what complexities in the client’s circumstance they are operating under? Are they living in a situation where psychological change is frowned upon? If they are living with a partner who doesn't want them to change, therapy is going to take a lot longer than if they are with someone who is friendly to change.

Fourth, how many times a week or a month does a client want (or can afford to) to come to therapy? If a client is strapped for funds, therapy can stretch out much longer than someone with the available funds; and, to be effective, since I believe that once a week sessions with homework in between is optimal and advisable, clients coming less than once a week are actually not progressing at an equal ratio. That is, I believe that clients who come twice a month are not progressing at half the pace: I believe the progress is more like
in comparison, as the intensity is just not there week-by-week to deliver the therapeutic goods they want.

How serious is a client about doing the work? Some clients may refuse to do any work outside of sessions. How afraid is the client of
doing the work? Some clients remain adamantly focused on intellectualization and distant from emotional processing. How much can a client deal with at once? Are health concerns intercepting the sessions? Is the presenting issue actually the issue—or is there something deeper that has not been said or even found in awareness?

The questions underneath the simple question of “how long” are complicated. So, it is impossible to say exactly how long an individual’s psychotherapy will last, and if some therapist gives you a straight answer, be very wary of that simple answer.

Although it may be impossible, financial institutions however hold on to this dream. The “impossible profession,” as Freud put it—hinting a hard to pin-down professional practice—goes against current financial procedures from employment assistance and insurance programs. These programs inform clients that they have either a small amount of sessions, or a set amount for psychotherapy every year—while also informing them that they are covered for amounts for other such issues as dentistry or massage. For example, “You are covered for 80% of your dental bills—up to $500/year.” The problem with framing psychotherapy in tandem with hard services like cleaning a tooth or relieving back pain, is this: it makes psychotherapy out to be some sort of a short-term, easily fixed, physical issue—with resulting costs and timeframes being comparable.

Yes, psychotherapy is not cheap—
yet neither is it expensive. The cost is what it is. On that note, although some decry the “expensive” cost of food, nobody decides not to eat. Now true, psychotherapy is not a necessity like food; yet, psychotherapy can however make the difference between surviving and thriving. So, if thriving is “expensive,” then yes, psychotherapy is expensive; however, if thriving is necessary, than psychotherapy is necessary.

Interestingly, when you look at the discrepancies between what insurance companies will cover for psychological services and what other government agencies will cover, it is notable to examine the differences. For example, from the Crime Victim Assistance program’s website in Vancouver, take a peek at a snippet from their site:

Pasted Graphic

Forty-eight hours seems like a reasonable amount of time for victims of a crime to psychologically process what happened to them. Contrast this with meagre insurance and employee assistance programs. Given that most clients I see have issues stemming from childhood relational experiences, I am baffled to see that insurance companies concoct that a mere 3-5 hours of contact with a therapist will somehow be enough for clients who have had years of abuse/neglect or have self-identity issues from other childhood sources. What is really being said is this: “48 hours for victims of a crime is warranted; however, if you have had thousands of hours in a bad home and come to find yourself feeling depressed or anxious, or any other psychological issue, we leave that to you to fix in a few sessions.”

Note, the second red lined box above is even more surprising: it suggests that people who were minors when their victimization occurred, could have even
more counselling than the maximum stated. This portends that childhood issues play even a larger role in current traumatic psychological processing. So, why do insurance companies and employment assistance programs continue to downplay how much costs could and should be devoted to helping people with psychological issues, when most of this work comes from childhood issues to begin with? It is time that these carriers clarify to clients their clients what they are actually covering: that is, initial visits, consultations, and evaluations—not the actual long-term work.
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