capturing the beautiful calamity of healing in therapy

When is Therapy Over?

As clients pursue the complex formula that is therapy, many will ask, How do I know when I’m done? During intake, the common question is, How long is this going to take?

Unlike most (if any) relationships, therapy is a dynamic both client and therapist enter with an intention of ending it. There is a beginning, middle, and end; when therapy is successful, the client transitions through these stages, growing and healing, and the termination is met with equal agreement and readiness.

Of course, this situation is picturesque, and, therefore, it is not representative of all therapy processes. In an ideal world, therapy would be readily accessible to anyone who needs it, at whatever pace and timeline the client requires. Neither money, location nor time would affect the client’s ability to participate. Unfortunately, this is not the case. Clients and therapists alike have to work within the societal constraints and limitations regarding mental health care.

And yet, despite third parties insisting on completing the therapy within, say, 4, 6, or 8 sessions, many therapists, including myself, find that it is impossible to follow such a cookie-cutter approach in our practices.

I compare it to the abstract intricacies of an intimate relationship. How long does it take you to fall in love with someone? It would be easy and desirable if we could concretize the answer to three weeks or even three months, but the reality is, as the reality typically is in therapy, it depends. It depends on so many variables. Similar to an intimate relationship, it depends on how much we trust the other person; it depends on our general feeling of safety and ability to disclose and expose ourselves. In therapy, it depends on the presenting problem, but further than that, it depends on what lies underneath the presenting problem, the blindspots hidden deep within the client’s subconscious. Moreover, it depends on the client’s willingness and capabilities of change: and how he or she bounces back after the inevitable life obstacles and stressors arise. It depends on the therapist’s treatment planning and direction of therapy, how he or she prioritizes the issues the client presents with.

It depends. It depends. It depends.

Creating a timetable is difficult for both clients and therapists. I think this is because there is no 100% finished. For instance, I will never tell a client that he or she is “healed” or “recovered.” I don’t believe in either of those words. The pinnacle of mental health is an active journey, a moving exercise if you will, that represents action and intent. There is no destination. We are healing. We are recovering. By using the verb, we accept the present movements that maintain our responsibility in this work.

So how do we know when we’re done? 

Really, this is a question that merits an entire novel, but for this post’s sake, I will do my best to simplify. When I work with clients, we regularly assess progress. I compare my subjective experience to theirs. We collaborate. We talk about what’s working and what isn’t. What’s healing and what still hurts. Where they are versus where they came from versus where they want to be. We brainstorm, we imagine, we make a plan. We talk about what’s in their reach, what’s maybe in their reach, what needs to be released. This “checking in” happens within the flow of our sessions; it’s for the client’s barometer of progress as well as my own.

With this said, there are absolutely amazing therapists who can accurately pinpoint the number of sessions needed to work on a specific problem. Some have mastered every moment of the session with detailed structure and time limits. I am not one of them. I admire their organization. I admire their ability to concretize the variables that often change the course of my therapy work. They have carved an incredible science, and many of them are highly successful.

I accept that a more fixed approach to therapy will probably never be my style. The unpredictable variables, for me, make the therapy. That’s the real stuff, the buried, hidden crevices maintaining the current challenges the client faces. Humans are fascinatingly complex with layers of awareness and unconscious drives. How long that stuff takes to process is not something I have been able to predict. I’m at peace with that, and I’m confident that it actually helps my clients more in both the short-term and long-term.

Again, Then how do we know when that stuff’s done? 

Ideally and ethically, it’s “done” when the client has been able to adopt the principles he or she wants into everyday life, when the client feels a sense of guidance and healing that can be enacted without the therapist’s assistance. The client can identify progress as much as he or she can identify potential barriers and room for growth. The client has let go of the perfect recovery module and has accepted a “work-in-progress” mantra. There is no “finished.” There is no “totally, 100% complete.” There may not even be a 90% complete. However, the client has essentially learned to minimize the people, places, and things that cause pain and maximize the people, places, and things that cause pleasure.

It’s done when the client can and does believe that his or her life is better now than it was before. It’s done when the client is ready to venture out safely into the world, explore new terrain, take on new challenges, knowing the safety net and support will be back should he or she ever need it again.