So begins “My Life in Therapy,” an autobiographical saga that appeared recently in The New York Times Magazine. Here, Daphne Merkin writes in great detail about her 40-plus years (!) in therapy, mostly psychoanalysis. Early in the piece, she starkly declares,
“To this day, I’m not sure that I am in possession of substantially greater self-knowledge than someone who has never been inside a therapist’s office.”
At this writing, more than 600 comments to her article have been posted online, ranging from “Thank you for this eloquent and insightful account” to “Grow up and get a life!” By eyeball reckoning, the latter outnumber the former by at least 2 to 1.
What’s interesting (ironically) is that Ms. Merkin never quite comes out and says how she feels about her therapy experience – whether she is satisfied, frustrated about the time and money, enraged about the lack of results or grateful for having had the opportunity. Perhaps some of each.
Reading the article brings to mind a fairly common question raised by therapy patients: How do I know when it’s time to stop therapy? To the casual observer, this is a silly question: Obviously, you stop when the problem is resolved – the panic attacks stop or the depression lifts.
But as you know if you’ve been there, sometimes it’s not so simple:
If my problem is low self-esteem, how do I know when I have “enough” of it? Ditto for reducing one’s stress level or increasing assertiveness. Not to mention more nebulous objectives such as figuring out who I am or finding intimacy in relationships.
Sadly, therapists are often of little help here. Patients asking this question may be met with platitudes such as “Things take time,” or simply more questions, such as “What do you think it means that you ask this question?”
Well, as Freud famously commented, sometimes a cigar is just a cigar, and sometimes a question deserves an answer!
Here’s the short answer: Therapy should end when your goals have been reached or when it becomes apparent that it’s not helping.
Two qualifications: “Supportive” therapy may go on for extended periods of time without apparent progress in the sense that a “cure” is never achieved, but the individual needs help to prevent relapse or severe deterioration. Such therapy, while life-sustaining for some, is quite different from what Ms. Merkin describes.
Second, therapy for the purpose of personal growth and self-knowledge may not fit the framework presented here. I think this may be why Ms. Merkin isn’t more upset: Her therapy may have been more about the journey than the destination.
Fair enough. But it’s my impression that relatively few people enter therapy with the equivalent of a EuroRail pass, without limits on time or money, just traveling for the sake of the scenery. Most are interested in results – a destination, if you will – and most, in my experience, would opt for the quicker, rather than the scenic, route.
If this is where you are “coming from,” then your best bet is to talk frankly with your therapist, preferably early in the therapy process. Now not all therapists speak this “language” (important information, in my opinion), but many, perhaps most, will be more than happy to “go there” with you.
So, what should you discuss? There are actually two related questions here:
What exactly are we trying to accomplish?
Are we there yet?
You’ll notice right away that it’s difficult to answer the second question without a clear answer to the first. The first, in turn, requires “operationalized” goals. This means defining your objectives in ways that are specific and observable.
For example, “being better adjusted” is hard to measure and means different things to different people. But if you were asked, “What would we see if you were better adjusted?” you might list things like worrying less, socializing more and sleeping better, all of which can be measured.
Even an apparently straightforward goal like “overcoming my depression” is too vague, because it may mean one thing to you and something quite different to your therapist. But exploring this together with your therapist might help identify goals like crying less often, resuming sexual activity, reducing indecision and thinking better of yourself, all of which reflect recovery from depression. Such goals are observable and less impressionistic than simply wondering if you are “getting better.”
Another goal to consider (a given with many therapists) is the internalization of the therapeutic process, what some refer to as “becoming your own therapist.” This is important when it comes to relying on yourself rather than needing to re-enter therapy whenever life presents you with new challenges.
So, here’s the bottom line: It’s time to end therapy when you determine that your goals have been met (unless, of course, you want to set some new goals). On the other hand, it may also be time to stop (or make a change) if, after reasonable time and effort, your goals haven’t been achieved. The definition of “reasonable” is a matter of opinion, of course, but let’s hope that it’s well this side of 40 years.