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Page Contents: Wondering how long psychotherapy should last.                    


I have been in therapy for about 5 1/2 years. My therapist, as far as I can tell, is competent and wise. After the first year of therapy, I went through a 12 day manic episode. Since then, I have painstakingly worked to achieve a greater awareness of my unconscious mind—depression, rage, high anxiety, feeling overwhelmed, terror, fear, crying so intense I feel I could shatter, etc. I feel like I imagine a soldier would feel living day by day in the combat field. It’s so draining: I want a break; I want to sleep without waking with terrifying dreams; I want not to feel absolutely isolated and alone; I want not to cry so intensely; I want the suicidal thoughts to stop. I feel that I am improving; yet, it is so hard to perceive when wading through so many repressed emotions and conflicts. I ask him constantly how long it takes for the process to end, but he only says that we will know when it does. How long should therapy last? Is 5 1/2 years too long? How come every time I feel like I’ve taken a step forward, the emotions coming flooding back in? I wish the effects would lessen, but they only get stronger. When will it abate?

You ask a question that started the whole managed care business in the first place. The business executives in the health insurance industry, concerned about their profits, started asking, “How long should psychotherapy last? When does it all end?” Well, they may as well have been asking, “How long is a piece of string?”

So let’s look at how you end your message: When will it abate?

To interpret your question, let’s look at how you began your message: you have been in psychotherapy for 5½ years, and after the first year you had a 12-day manic episode.

So what’s missing between the beginning and the end? Well, actually, what’s missing is what came before the beginning. Now, this statement might sound obscure, but you cannot navigate to where you’re going if you don’t know where you are, and you won’t know where you are if you don’t know where you have been.

In other words, you say that after a year of treatment you had a manic episode. But you don’t say if you ever had any manic episodes before you began treatment. You don’t say what sort of life you had before treatment. You don’t even say why you decided to begin treatment.

So there you are, a soldier in the combat field who doesn’t know what he is fighting for or with whom he’s fighting. He’s just there, fighting, in tears.

So when your so-called “therapist” says that “you will know it when it does,” what does that mean? Does he even know what he means? The truth is, it’s necessary for you to find out how it all began; that is, to discover the unconscious childhood roots of your current symptoms. Trying to eradicate symptoms, like a soldier in combat getting rid of enemies, is the equivalent of pushing away a crying child. When you can attend to that child with compassion, understanding, and comfort, the real healing begins. So, when you can attend to your symptoms as if they were frightened children, your psychotherapy will have started. When you can attend to the child’s tears with compassion, the flood of pain and tears will abate because the joy of understanding will have begun.


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Raymond Lloyd Richmond, Ph.D.
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