If a person's in therapy for years on end without improvement...

isn’t that a clue that it’s time to change therapists, or approaches, or something?

I’m about to discontinue therapy. I’m not upset about it, but it’s less at my instigation than at my therapist’s. She’s very vocal in her belief that most people should NOT be in therapy indefinitely; she sees therapy as a means of teaching a person coping strategies for dealing with life, and ways of recognizing and correcting destructive behavior patterns. Though she makes exceptions for people who have bipolar disorder and the like, she thinks that most patients should have set agendas and goals, and that one of the goals should be to get the client to the poing where they can end the therapeutic relationship.

I’m cool with this. But I know people who aren’t, and I’d like some input from you guys. Anybody care to share either theoretical or experiential thoughts on psychotherapy?

Different people go to therapy for very different reasons. Personally, I’ve recently been seeing a psychologist (first time for me) and I expect it to end eventually. Like your therapist, I see it as an opportunity to learn something (ex. how to cope with certain types of things in positive ways). If it was just to make me feel better temporarily, before moving onto the next problem, then I really wouldn’t see the point. If the person isn’t seeing an improvement after “years” then they need to switch to a different therapist.

But that’s just me. I know others look at the situation very differently and see therapy as a means to just “let it all out”, even if it’s only for temporary relief. Not that there’s anything wrong with that, but it seems like an expensive habit to me.

I don’t have much to share other than that I agree. I never understood going to a therapist for years on end without signs of improvement. You wouldn’t go to your GP for years on end for the same thing without improvement and not start looking for another opinion, why would you do that with your mental health?

I guess I do see that some things are going to have ongoing needs – where medication is required – but just a therapist*? Nah, I don’t get it. I’m a pretty results-driven person, though – if I don’t see some improvement/change, I get annoyed/frustrated and look for a new approach.

I think your therapist is pretty cool to be so honest with herself (and you) by admitting that it’s time to move on from her. I think too often, doctors in general get comfortable with seeing the same patients for the same things and lose their ability to care whether the patient gets better or not. I am not saying this is a bad thing – it’s usually (IMO) a defense mechanism for the doctor – just that I think it happens all too often.

*by “just a therapist” I mean, not someone that also dispenses/keeps track of your medications.

If a client is getting existential support from long-term therapy, I don’t have a problem with it, but that person probably wouldn’t say the therapy wasn’t helpful.

For most people, yes, changing approach, changing therapist, or changing type of intervention (i.e., to something other than therapy) would be appropriate.

Personally I think it’s a waste of time and money.

Unless there is something wrong with your brain that can be altered with drugs, surgury, electroshock, how does therapy ever “fix” someone? You can’t talk yourself out of feeling a particular way. You feel what you feel.

I mean if you angry and depressed because you lost your job, what will a therapist do? Give you job hunting advice? Help you plan your finances so you don’t lose your house? Help you understand why you feel angry and depressed? You KNOW why!

I think the problem with therapy is that there is no point to it. People just go and talk to some person with a couple of degrees and years later they have made no tangible changes in their life and they are still a jerk.

Well, there are all kinds of therapy. “Talk therapy” may not work for someone, but something like Cognitive Behavioral Therapy is intended to “reprogram” thought patterns that screw up your life. On a more simple level, you can get people with various phobias to lose those irrational fears. It can work for other anxiety or mood-related issues.

But yes, any time someone is going to any therapy and it’s not providing any help (whether improvement or maintenance), that’s not a good thing. Something has to change.

As a general rule, of course. But it depends on the person, the therapist and the type of psychotherapy. Bear in mind that the goal for some people with chronic, serious mental health problems may be to prevent deterioration and maintain a level of stability. Psychoanalytic psychotherapy is usually longer-term, and it does work in the long run for some people.

One of the main reasons there’s been such a revolution in briefer therapies over longer-term therapies is partly financial. If you can’t show that longer-term therapies are more effective on average, then why not go with the quicker, cheaper one first, right? For the sake of both the patient and the system. They’re also a lot easier to do evidence-based trials on, since they are short and sweet. And that’s very much changed the attitude of mental health professionals towards shorter-term, results-oriented approaches. Which is nothing but a good thing. But you don’t want to go overboard - that doesn’t mean that structured, brief psychotherapies are best for every single patient.

But even so, both the therapist and the patient should be able to articulate what the goals are, what the measures for the goals are, and why they are with this therapist or in this type of therapy vs. another one, and be open to change if the therapy isn’t helping.

What makes you think that your brain can’t be physically altered by talk? It’s called “learning.”

I think it also depends on what type of illness and how complex the illness is. Many people have more than one mental illness, and it can take a while to untangle what’s going on and tease out the appropriate solution.

But, yes, I think therapy should have an end goal, and there should be some point where you’ve accomplished what you’ve set out to do. So, it helps a lot to have a specific goal in mind when you enter therapy.

That’s not what I mean.

Alright, say I’m disatisfied with my job. I could see talking to a therapist to help me identify what exactly I am disgruntled about. Then working with them to come up with ideas, based on my personality, interests, aptitude, etc, what sort of job would be a good fit. I could then proceed on a track to finding a job in that field. Basically, the therapist would be more of a coach helping me achieve a goal.

But just going to some guy day in and day out to complain about how much my job sucks seems like a waste of time.

I agree, if you’re dealing with it on your own just fine, you don’t really need a therapist. Normal life isn’t always happy, and not everyone who hates their job needs to go to therapy (or get an anti-depressant).
On the other hand, if you’re the sort of person who is having fantasies about killing yourself or killing your boss because you hate your job so much, then I think talking to a therapist to work on your “coping skills” is absolutely a good idea.

mssmith, just because you can’t envision it helping you doesn’t mean others cannot benefit from it. lavender, there are more reasons to talk to a shrink than wanting to kill yourself.

You don’t just “feel what you feel.” Believe it or not, you have control and volition over your feelings. No one can “make” you feel an emotion. As some level, even if you can’t access it right away, you are choosing to feel what you feel. And as such you can choose to feel something else in place of unproductive, unhealthy emotions.

Many of us need assistance in understanding and utilizing this kind of stuff. That’s what a good shrink is for. What a gift it can be when you get it.

My therapy has been helpful, largely because it had specific goals. Hell, one of the first things we did was write down what I wanted and needed to accomplish. Some of it was big stuff; some of it was little. But now that the big stuff has been accomplished, my therapist has said, “Hey, you know, I think even though you retain some compulsivity issues, you’ve learned the cognitive skills you need to handle them without me, and part of my job is getting you to the point where you simply don’t need me. Of course I’m available if you really DO need me, but let’s try NOT making an appointment any time in February. Instead, you apply what you’ve learned about dealing with phobias to other things.”

There are some people in the world who are never going to ‘get better’. They do not have coping skills themselves. They are incapable of developing them. They are ‘damaged’ for whatever reason.

For those people, continued therapy can mean the difference between being able to contribute (even in a small way) to society, or being totally disabled by their illness. It makes no sense, whatsoever, to terminate therapy in those cases.

What I mean is that with therapy those people won’t get better, but without therapy they would get much, much worse.

Skald honey, I hope you and the missus stay warm tonight. As cold as it’s going to get here, I can only imagine Memphis. Brrr!

If a person’s in therapy for years on end without improvement…

My first thought is, if a person is looking for improvement and not getting any, then either 1) they and the therapist are not a “good fit” or 2) at least one of them is not working hard enough.

If your question is more along the lines of your therapist’s position, that people go through a process with talk therapy, emerge better, and don’t need to go to therapy anymore, then I agree with that. In a lot of cases.

'Course, as others have said, it makes a difference what your condition is and what you’re trying to accomplish.

ETA: From personal experience, I highly recommend consistently using the tools learned in therapy. It’s kept me out of the therapist’s office for 15 years or more, now. :wink:

Aren’t you in Southaven? That’s Memphis for everything but tax purposes. I mean, does ANYONE there or Horn Lake not work for FedEx? :smiley:

My question is one-third hypothetical, one-third professional, and one-third personal (though not about me).

See, when I’m not being a corporate drone, like today, I write freelance. I was just offered the opportunity to a piece on–well, a therapist other than my own–which I declined. He keeps his clients (one of whom I have written about in another thread this week) going for years and years doing psychodrama; but the clients of his I know personally never seem to improve, but rather live for the opportunity to to do “intensives” with him–weekend-long sessions that leave them emotionally drained in the short run, and financially drained, I suspect, in the long. Now, obviously I’m not a mental health professional, and obviously I don’t have anything like a statistical universe to base any conclusions on; only my personal and limited observations. But from everything I’ve heard from the clients of his I know, their sessions don’t have the specific aims of changing behavior. They talk about EXPLORING their feelings, UNLEARNING their shame, but not IMPROVING.

Talk therapy has been shown to change brain chemistry:



I spend ten minutes looking for this, and you post it first. I don’t know whether to hate you or salute your google-fu, and I can’t even talk about it in therapy!


Skald - Have you addressed your megalomania and world domination issues? Because I think your alter ego may need some intensive therapy. I think work therapy might be a good solution. I need my floors refinished and the tin roof on my house sealed.


I’m feeling guilty about having caused you pain, and may have to double up on the anxiety meds tonight. :wink:

Check my sig. :slight_smile:

And you don’t want ME using power tools around your house, anyway. I once tried to change my own wiper blades, and in the process accidentally started a grass fire.