We recently posed a question to the New Mexico Psychological Association listserve about how long psychotherapy should last. We suspected that professionals may have wide disagreement about this issue. It involves a variety of important clinical and possibly ethical concerns.
Specifically, the issue is how long should psychotherapy last? Sounds simple enough to answer, but is it? Here are just a few of the thoughts we shared with the NMPA group:
- Should psychotherapy last until the presenting problem is no longer diagnosable?
Should psychotherapy have set limits similar to what’s found in published journal articles for a particular disorder? Or are those limits pragmatically necessary for research studies, but not for clients in the real world?
- Who should make the decision about termination — the client, the psychologist, or should it be a collaborative process? If collaborative, what do you do if there’s disagreement?
- Does having no pre-determined limit to psychotherapy result in exacerbation of abandonment issues upon retirement or health concerns that necessitate termination?
Most empirical studies have strict limits of for example, twenty sessions. Others also have defined limits, but these can run as long as three years or more of therapy particularly for issues involving chronic personality disorders. Most ethical therapists urge clients to at least consider termination after signs of considerable improvement have been made.
But what about clients who feel that coming in every three to six weeks for general problem solving, consultation, and support would be helpful? Should we refuse to see them even if it does appear that such work is helpful? If we do continue such intermittent support for many years are we fostering unnecessary dependency? Does length of therapy depend upon theoretical orientation and, if so, should it?
A few psychologists responded to this question and they were generally supportive of the value of long-term therapy as opposed to short term therapy. One cited a study by Dr. Martin Seligman (published in Consumer Reports in 1995) which indicated that long-term therapy of over two years resulted in the greatest reports of psychological improvements (note that this study also has been criticized on methodological grounds by some). Another psychologist felt that psychotherapy should continue as long as there appears to be a benefit. That person also suggested that psychotherapy length should not be determined by diagnosis or insurance imposed limitations, but ideally by the client and the therapist together.
Frankly, we don’t know the answer to all of these questions, but we’d love to hear more opinions — from therapists and patients alike. How much psychotherapy is enough? We may have further thoughts on this topic later.