Long Term Counselling or Psychotherapy: Is it Effective?

Calendar datesSome people are highly critical of long-term therapy. To others, ongoing conversations with their psychotherapist might be as frequent and regular a visit as to their motor mechanic, hairdresser or fitness centre. How effective is long term therapy and how is it different to seeing a counsellor for a limited amount of time?

Differences between Short Term and Long Term Therapy

Long term therapy often is equated with psychotherapy and even a belief that the therapist will be analysing the person to reveal deep seated ‘issues’ that may take years to uncover let alone resolve. People speak of being ‘in therapy’ or even ‘in analysis’.

In the short term, therapeutic relationships are often referred to as counselling. Some people assume counselling is about the counsellor just listening, and indeed some practitioners might do only this. More recently, the elevation of CBT as a preferred approach by health authorities has established the idea of counsellor or therapist as a kind of teacher of skills or techniques.

But is there really such a difference between what happens during long-term and short-term therapy? The idiom ‘how long is a piece of string?’ comes to mind. When exactly does short-term counselling become long term psychotherapy?

The Role of the Therapist

In thinking about the difference between long term and short term therapy, we can start by asking what ideas are influencing us when we ask this question.

In both the examples above, the practitioner is the expert and the person attending therapy is very much a subject of treatment. Most therapists have been through training courses aligned with this model. They have learned certain strategies to approaching problems, even formulas for addressing particular ‘issues’ or diagnoses. Some of these are traditionally associated with psychotherapy, some with counselling. Many practitioners are very clear about what constitutes long-term therapy and what is the realm of short-term counselling.

But could these definitions get in the way of the effectiveness of the work?

For me, the role of both therapist and counsellor is about opening up a space where people can make meaning of their lives. There isn’t a formula to this or a set time-frame required. Similarly, the therapeutic relationship is a collaboration where the therapist can also have permission to ‘not know’. This is the creativity of the therapy space.

The Hopes and Expectations of Talk Therapy

I recently heard a story of someone who met with a psychologist for an initial appointment and was told that ‘the treatment’ would take 2 years. Now I wonder, how did the psychologist know this?

Because they have experience in working with people, psychologists, counsellors and other talk therapists can have a sense that some conversations might take longer than others. But they never really know when the work will be ‘finished’ when they meet a client for the first time. As I mentioned previously, I don’t believe there is a formula that can be applied with any guarantee. As much as we hear and would like to believe promises such as “proven to increase self esteem” or “guaranteed to build confidence”, these promises locate therapists back in the expert position which, in terms of effectiveness of the therapy as a creative space to explore and construct meaning, might not be a particularly useful place for the therapist to be!

Even this concept of ‘effectiveness’ can be questioned. What are the expectations of the therapy space? What invisible promises does it suggest? These are subjects that can be explored in initial appointments. Making hopes and expectations visible can help to give us an idea about the length of time we want to continue meeting and what might be possible in the time available.

Why Continue with a Therapist for Long Term Therapy?

No doubt building a relationship of trust can take time. Someone who has previously met with a counsellor or psychotherapist, and felt this to have been a positive experience, often finds it easier to talk than someone who has reservations about what might be ahead or bad memories of unpleasant experiences of therapy. These are also helpful things to discuss early in a therapeutic relationship.

I liken narrative practices to rebuilding or renovating aspects of our lives. Sometimes it is necessary to start with a bit of de-construction: what does ‘getting closure’ look like if you are doing it? If we took apart ‘self-esteem’, what might we see it to be comprised of?

There might also be some redesign required. Before we start to reconstruct, it can be worth exploring some alternatives or the expectations behind the plans we have for our aspects of our lives.

Often our ideas, particularly psychological ideas, are so familiar that we do not stop to notice them. What evolves from these conversations, and how effective we judge them to be, depends on the relationship we develop with the therapist and, of course, the approach we take in the therapeutic space.

Want more information about long term therapy? Send me an email and we can talk options.

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About Forward Therapy

Ash Rehn is a counsellor and narrative therapist with over 20 years experience. He specialises in therapeutic conversations and collaborative therapy for anxiety, burnout, depression, midlife crisis, sex and relationship issues, pornography use problems and counselling for lesbians and gay men.
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