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What is long term therapy and who is it for?

Updated: May 20, 2023

Before we start therapy, we do worry (sensibly) about some difficult situations that may happen. A common scenario is: 'You start working with a therapist/practitioner after a crisis point of your mental health. You work for a while and the crisis signs gradually fade. You start to work on the deeper underlying self-issues.

Then, as much as you see the benefits of therapy, you start to wonder if the PRICE is too much – you need to pay the pricy weekly sessions to get the ‘gradual change’. You don’t know when the ending of therapy is, or how to talk to the therapist about getting some conclusive ending.

There are different reasons you ponder about to end therapy. Perhaps you question if it is still worth it to afford such an expensive support; or you hope that you will end therapy when challenges subside now anyways.'

‘So how long should I invest in the therapy?’

This article intends to clarify about the benefits of long-term therapy. By reading this you will get more clarity about what long–term therapy really does and its benefits. This will also demystify some misconceptions or stigma around the seemingly ‘endless length’ of therapy.

Aside providing the core conditions for a good therapy, your working therapist/practitioner should also be experienced in ‘how to deliver a good long-term therapy’. For example, a good practitioner holds the responsibility to ensure that clients are clear, or at least they know they have the right to learn about what does having a long term therapy imply.

Indeed clients are and should be entitled to receiving the most relevant information for them to make the most sensible decision for themselves. In therapy, I proactively and regularly discuss with my clients the length of therapy and review the different stages of therapy. I try to ensure that clients have a clear sense of expectation and goals setting from time to time as they commit to long self-development or healing journey.

So when does long term therapy come into play? Here I share with you four exemplary situations you can consider.

Factor 1: The complexity of your confronted mental health/wellbeing issue (or issues of someone you know)

The length of a treatment for one’s mental health problem depends on the level of severity of the confronting issues. If symptoms or the challenges are mild, therapist treatment usually takes 10-12 hours and with self-help exercises done between the sessions.

However if your condition is very severe, and some basic treatment or self-help options have not helped, you may require specialist support. The severity of your conditions can be due to the fact that you have longstanding mental health issues which are without any professional input, and they may have become difficult-to-treat. Therefore your treatment will be longer, sometimes for at least a year or more if you require regular medication. A specialist support or professionals with certain specialized training will be necessary to help address such severe level or the complexity of the mental health issues.

Factor 2: You need to/want to deal with the deeper and traumatizing past and disturbed self-conditions

We struggle with mental health not just because it is ‘a mental health problem’, but more importantly mental health mirrors our real-life struggles – relationships, achievement (work, studies, etc.), poverty, socio-cultural political induced adversities, chronic physical illnesses, abuses… Our struggles are related to the present but often more from the PAST. Trauma is a big term – the extreme suffering and pain stemming from the past experiences. People may maintain the daily life functioning, but are still overshadowed, physically and emotionally, by the past trauma. Long-term therapy then helps us to look in-depth to the past and understand how it became the root causes of our problems.

‘Mental health is a trigger to us looking at the multiple problems in life. The scary thing is, mental health forces us to go deeper to the roots of the problem, often entangled with the muddling past.’

In therapy, what we deal with is much more than ‘the mental health’; also the longstanding impact of our psychological suffering: a lack of self-esteem or confidence, poor social relationships or not having the equivalent skills to develop a connection with another person. For a long time one may feel he/she is living without a sense of direction, or he/she constantly gets bombarded by emotional distresses and feels he/she has no control over it. (I am quite interested to share more about the long-lasting impact of mental health or psychological suffering in the upcoming articles.)

Everyone can relate to some of these struggles. Our negative past experience have shaped our current selves, including some parts of us which we do not feel satisfied about. A specific example in relation to mental health is anxiety. Some people are very aware of their conscientious self in the public as they grow up to be fearful of social situations. This probably is a result of long periods of feeling unsure and insignificant as a child.

Another example is, some clients want to work on their repeated pervasive and unstable social relationships, as they realize their relationships are repeated sabotaged by their own disturbed personality patterns, inability to control emotions and negative (sometimes destructive) consequences after their impulsive behavior. Certainly to make a change one needs to be motivated to commit to a long period of self-discovery and hard work. Find your own ‘itch’ to change. In fact, therapy is not just a healing process, but also one of the biggest developmental opportunities to attain growth and competence.

Factor 3: Desire for the more sustainable changes and growth

A long-term therapy does not just help us gain an insight and self-awareness of our past trauma, and how it has contributed to the development of our habitual patterns and personalities; we also work to be equipped with skills and competencies to shift the own thinking and emotional patterns to a positive and constructive manner. From being paralyzed by having no control, we learn to take the driving seat of our life. Such work takes time, as well as a persistent trial and error practice and continuous dedication. Back to my given examples of social anxiety and personality difficulties in Factor Two, one may use therapy to rebuild different skills to lead better communication and emotional control; interpersonal effectiveness and resilience to stress require learning via experience and the constant practice.

Factor 4: It helps those who cannot settle with a quick solution.

Can short-term intervention work? Can clients work intensively to get a quicker result? Short term intervention is effective in providing a quick solution for a specific problem. It mainly helps us deal with the current conditions of the situation, e.g. managing mental health symptoms or restoring the current living functioning. It is also effective for those who catch their problems which are still in their early stage, hence the saying – never ignore our mental health; it is ok to seek help.

There is never a quick fix to a problem. However, when we have to confront our longstanding, complex and muddling psychological health, short-term intervention cannot fully incorporate our progressive and procedural adjustments or restructuring of persisting behavior, emotions and even personalities which are developed and shaped for years. Time is a big issue, so as the fluctuating status, unpredictable and uncertainties in such time. However, the good thing about long term therapy is, once you invest in it, not only do you overcome the challenges and SUSTAIN such changes, you also naturally fulfill self-development purposes. Your investment in a therapeutic relationship and this reflective space often help you apply your learnt skills and competence in other relationships, as well as other areas in life.

In the next article, I will share about tips which will help individuals fully utilize therapy, and including long-term therapy.


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