Starting therapy can be a harrowing process, filled with all sorts of conflicting feelings: excitement or dread, anxiety or comfort, despair or hope, confusion or clarity. Often many of these at the same time! The final decision to call me or submit an inquiry on my website is sometimes the product of many weeks, months, or years of contemplation (and maybe avoidance!). Since this is a big deal, I’d like to help provide you some scaffolding for how to understand and approach therapy as we begin this process together. This is part I of a series of brief articles, introducing a basic framework and guidelines for starting out, as well as thoughts about the general duration of therapy.
Once we’ve talked briefly on the phone and want to proceed, our first scheduled meeting will be an “initial consultation.” This is simply a time for you to share why you’ve come and for me to get to know you. My main request of you will be “tell me what you’d like me to know about yourself” and we will see what unfolds. During this consultation, we may explore the things that brought you to contact me, the things you want to work on, some of your family and/or relationship history, past therapy experiences, or feelings about being here in the first place. We will decide if this feels like a good fit for beginning therapy together. After that, we will proceed with regularly scheduled 45-50 minute sessions. The first few sessions often continue this “getting to know you” process and give us an even better sense of the decision to work together.
What does it mean to “begin therapy together”? This implies a good-faith agreement that each of us is making to work together over time to help you achieve genuine insight, growth, and change in your life. On your side, this investment breaks down to three basic things: attendance, payment, and certain attitudes (such as honesty, openness, and curiosity). Obviously, a signifiant process of growth and change cannot happen without being here! Consistency and continuity are central to this. This is why, in order to facilitate deeper work, we will set a standing appointment time for the same day/time each week. This is an hour of each week that you are essentially leasing out from me, which is also where payment comes in. My work with you is a portion of my livelihood, and I charge for that time in accordance with my level of training and experience. My investment is not simply just time with you each week, but in providing my undivided attention, a consistent attempt to understand you deeply, and to convey that understanding the best I can. However, in order to do this, it requires your openness, honesty, and curiosity. Besides showing up and paying for sessions, it is your role to bring in whatever is on your mind, and to try your best to push past the temptations to withhold information or censor yourself.
At the beginning of therapy, many people are interested in knowing how long it will take. I do not believe either of us can predict this from the outset. I do not work in “time-limited” models that aim to isolate specific concrete symptoms and treat those with directed interventions. These types of solution focused or cognitive-behavioral therapies have their place, but in my training and specialization, I have chosen to work with people who want to explore the roots of their difficulties, and are interested in working on the more unconscious parts of themself. But working at that level takes time. The process of deeper work is cumulative and requires persistence and consistency.
I have not really answered the question, and again you ask, how long will this take? My general recommendation is that, barring some significant life change (e.g. moving away from the area) you plan to spend at least one year in weekly therapy if you expect to make some discernible difference in the underlying difficulties that brought you in. Recent research has suggested that the lasting gains from depth psychotherapy (not only the gains while in therapy, but additional gains after the end of therapy) really show up after about 150 sessions (and that’s three years of weekly therapy - or 1 ½ years of twice-weekly therapy). I have found this to be generally true in my career so far. Although I have seen some people make significant changes in less time, personality growth takes time. There is a certain common sense to this - in order to make deep and lasting change at anything in life, it requires ongoing, consistent engagement. This is true in sports, professional skills, education, spiritual growth, and all sorts of dimensions of human experience. So - plan on dedicating at least a year to this process (frequently more, sometimes less). Ultimately, I believe that good psychotherapy is a rewarding journey in its own right, and can last as long as you want it to and as long as it is a meaningful process for you. When well-known author and psychiatrist Oliver Sacks died a few years ago, I was not surprised to find out that he had been working with the same psychoanalyst for nearly 50 years! This is obviously an outlier, and I don’t expect to meet with many people, if any, for 50 years, but it is not that unusual for curious, self-reflective individuals that approach growth as an ongoing, never-finished process to find depth psychotherapy rewarding for 5 or 10 years or more.
One last thought about session frequency before ending part I. While I hold weekly sessions as the “standard of care” for ongoing depth therapy, I truly believe that meeting more frequently generally leads to more substantial insight and growth. Meeting two or three times per week can result in much more space for exploration of your inner world, and a much richer therapy experience. It is not unusual if you feel stuck in your life at weekly sessions, that meeting two or three times per week can open up new dimensions in our work together. While I am trained extensively in psychoanalytic therapies, I am not a formally trained psychoanalyst (yet). Therefore, I do not meet more than three times per week for psychotherapy. What about less time (such as every-other-week or monthly)? In my experience, I have found that less than weekly therapy is generally not conducive to the level of continuity or intensity required for deeper growth. While meeting less than weekly is sometimes unavoidable due to finances or life circumstances (e.g. traveling a lot for work), if we are just starting out our work together, I will generally expect that we set up weekly appointments. (If, down the road, you have made consistent growth and want to decrease our frequency, that is another discussion.)
In my next article, I plan to talk in more detail about the structure of the session and some of the details around fees and payment.
*Some caveats: Practically speaking, there are as many unique approaches to therapy as there are therapists. Even the proponents and researchers of major therapeutic approaches don’t agree on exactly how therapy should look. So everything within these writings is my opinion and reflective of my unique individual approach to therapy. While most of these ideas reflect broader perspectives or consensus from specific approaches, I certainly do not assume to embody “the” approach to therapy.