Verified by 
Key points
- Long-term therapy is used to address deep-rooted patterns that are not helping the client.
- Understanding the diagnosis and the root cause of struggle can inform the need for long-term therapy.
- Discussing the goals and length of treatment with a therapist is important for building trust.
By Taylor Neff, Ph.D.
Are therapists just milking you for your money? Does the mental health field take a page out of Paramore’s book and profit from a so-called “misery business” in which professionals benefit more from individuals remaining sick and hurting than providing relief that no longer requires therapy?
It is part of my role to provide recommendations to patients for their next steps after discharge. Not uncommonly, the recommendation to engage in long-term therapy is made alongside specific recommendations for styles, core issues to focus on, and the various interdisciplinary aspects of their ideal care (a particular treatment program, psychiatry, couples/family work, support for specific diagnoses, etc.). In doing so, I wonder how often those patients or family members look at such a recommendation with skepticism.
Why long-term therapy?
When you imagine long-term therapy, you might imagine a detached, Freud-esque man studying you as you expose the depths of your heart and mind for years on end. As the highly effective, short-term treatments for specific mental health issues become more prominent, it is no wonder that long-term, intensive psychotherapy may appear obsolete at best; predatory at worst.
Long-term therapy may be recommended for treating problems related to entrenched patterns. These patterns are rooted in one’s view of self, others, their emotions or relationships. In long-term therapy, people are motivated to understand themselves deeply for the purpose of increasing their freedom and agency to make more satisfying choices for themselves.
How do I know when it’s right for me?
The mental health field can do a better job communicating with less jargon and more humility regarding diagnoses and how we understand people. Diagnoses are helpful categories which describe various sets of symptoms and problems that help professionals quickly communicate an experience and provide recommended treatments. Like myriad specific, time-limited therapies we now have, diagnoses are instrumental to effectively providing care (not to mention getting covered by insurance). However, culturally-speaking, diagnoses can also unintentionally restrict our understanding of what it means to be a human in pain.
For example, a person may be depressed and meet criteria for major depressive disorder (MDD), but they also struggled with their self-esteem long before they were depressed. They may have always had many friends but now feel alone because those relationships lack emotional depth. Also, perhaps this person realized through the pandemic that their only means of coping was through their job, exercise, or some other means of staying busy, and they don’t know what to do without those external activities.
Of course, an underestimated or unidentified history of trauma may be thrown into that cauldron as well. The point being, such a person may receive the gold-standard, most efficient psychiatric and therapeutic treatments for depression, but other aspects of their struggle (self-esteem, relationships) may not be addressed. It is out of respect for these types of complex issues and presentations that long-term therapy is recommended. A common refrain around the hospital is that these types of problems did not develop overnight or even over the course of a few months, so it is natural and an act of self-compassion to expect that treatment that results in long-term positive change will also take time.
Who is long-term therapy for?
Not everyone needs or wants long-term therapy. Sometimes those who want it don’t necessarily need it to live their life but can see room for growth. Moreover, there are certainly mental health issues that do not require a long-term approach to therapy in order to resolve pain and dysfunction. However, nowadays, therapy clients are more likely to go through multiple rounds of treatment purely by medication and/or a variety of short-term therapy treatments than they are to start with long-term therapy in the first place.
Another important piece of knowledge for the mental health client is the value of sound assessment by a professional. Assessment, whether by formal tests or expertise, can cut down on the discouraging (and expensive) process of finding the best-fitting treatment. While considering working with a therapist for a year or more is no small investment, many people invest comparable amounts of time and resources into finding a treatment that works for them but with heartache and hopelessness along the way.
In short, is long-term therapy a way for therapists to take advantage of clients? No. Or at least, hopefully not. It is always the therapist’s responsibility to collaboratively determine whether a person is continuing to benefit from treatment. A patient and therapist may not always see the situation the same way, so determining when to end treatment can be an important therapeutic issue in its own right. Nonetheless, patient agency is necessary for trust in the therapeutic relationship, just as it is the therapist’s responsibility to share their sense of the patient’s problems and progress.
If you’re doubting a recommendation for long-term therapy or are wondering about the helpfulness of a current long-term therapy relationship, for the sake of trust, bring it up and see if you can have a meeting-of-minds with your provider(s).
Another way to sum this up is to say that people are far more complex than we sometimes give ourselves credit for, and the process of therapy is at least as complicated—one might even say messy—and sometimes a long relationship and in-depth approach is indeed the recommended treatment.
Taylor Neff, Ph.D., is a psychologist at The Menninger Clinic and an assistant professor in the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine.
