You Don’t Have to Be in Therapy Forever

Recent media discourse about therapy has been dismaying. There seems to be an idea circulating that going to therapy is a moral imperative, and that everyone needs to lead “an examined life” to be truly happy. Simultaneously, we are seeing a backlash against therapy, which has been criticized as a lengthy process that delves into every aspect of one’s childhood and upbringing, is much too costly, and never ends. In fact, neither of these ideas is true.

Let’s start with the idea that therapy is for everyone. Certainly, if you have a mental health condition like depression or anxiety, therapy can be immensely helpful. Certain types of therapy, like Cognitive Behavior Therapy (CBT) and its offshoots (Dialectical Behavior Therapy, Trauma-Focused Cognitive Behavior Therapy, Mindfulness-Based Cognitive Therapy, and others) have also been demonstrated to help with quality of life concerns that do not necessarily meet the threshold for a mental health condition, but may contribute to a person's distress or discomfort. CBT can help with issues such as insomnia, anger, stress, and relationship problems. In addition, talk therapy may be a helpful companion to medical approaches for migraine headaches, chronic pain, irritable bowel syndrome, and more.

However, therapy might not always be right for clients with these conditions, for various reasons. Some individuals may prefer to take medication for their health or mental health conditions; they may have success with mental health apps or online computer programs designed to help people with specific problems and issues; or they may prefer to cope on their own, perhaps by talking with a friend or spiritual leader. Some individuals may feel better after implementing other interventions that have been demonstrated to help with mild distress, like exercising or spending time in nature. Going to therapy just because it seems like everyone else is doing it, or because you feel like you should, may not be enough of a reason to justify the investment of time and resources.

During your first appointment, your therapist should conduct a thorough evaluation to determine your diagnosis and your specific goals for treatment. You should be up front with your therapist about your reasons for seeking treatment, and they should be transparent with you about whether they can help you, what they think your treatment should do, and how long you can expect therapy to last.

For most people, therapy should be relatively short-term. CBT and its offshoots were designed to be time-limited, focusing on the issues that are most important to clients, and teaching clients how to be their own therapists so they can take control of their lives, move on, and flourish. Six to twenty sessions are sufficient for many clients with depression or anxiety to get better and stay better.

CBT is based on the idea that the way people think about the situations in their lives is more closely related to their reactions (emotional, behavioral, and physiological) than the situations themselves. When individuals are distressed, some of their thinking tends to be inaccurate. CBT therapists teach clients to evaluate the accuracy and helpfulness of their thinking and to view problematic situations in their lives in a holistic, realistic, and helpful way. When they do that, they feel better—and are better equipped to solve problems, connect with other people, and achieve their goals.

Throughout CBT treatment, clients learn to handle difficult situations, make good decisions, improve their relationships, become more productive, manage their negative emotions, and increase their sense of well-being. Unlike the way in which therapy is often portrayed in movies and on TV, the therapist and the client sit together, usually at a table, and work collaboratively. Having finished discussion of an important goal or problem a client has put on the agenda, the therapist makes sure that the client has written down the most important points they want to remember. At the end of sessions, CBT therapists ask clients for feedback about the session: Did the therapist understand the client correctly? Was the session helpful? Is there anything the client wants to do differently at their next session? When clients provide negative feedback, their therapist positively reinforces them and then they collaboratively figure out how to get back on the same page together.

CBT therapists also measure progress so both therapist and client know whether treatment is working. When therapists and clients see that clients have achieved a sustained improvement in their mood and sense of well-being, either one may initiate a discussion about tapering treatment, with the goal of termination when clients feel ready. The decision to terminate is not taboo, but instead is discussed openly.

Staying in therapy for many years is not a moral imperative, nor is it a part of being a healthy functioning adult. In fact, the opposite may be true. Staying in treatment for too long can lead individuals to depend on their therapist, instead of using the skills they have learned in therapy. CBT aims to teach clients how to make long-lasting and sustainable improvements to their mental health that continue to benefit them long after therapy has ended.