How I Came To Believe In Long-Term Therapy

I entered the field of mental health as a 22-year-old-- straight out of college equipped only with my empathy, a few summers as a camp counselor and a Bachelor’s Degree in Experiential Education.  I didn’t know that I wanted to work in mental health, but I did know I wanted a job and these folks were willing to hire me.  My first position in the field was in a group home.  These were the days when we still had group home facilities for children in the foster care system.  Children who couldn’t go home and couldn’t get adopted lived in a big house with adults who came in for a shift and then went home—adults who usually left after a year or two.  We had 16-year-old boys and girls living with us who had been there since the age of 8 with a never-ending revolving door of adults.   

I adored these kids.  No matter how hard they pushed me away, it was always worth it when they returned and tried to connect.  It was the most stunningly beautiful thing I had ever experienced and I knew I would want to help these kids feel good for the rest of my life. 

But this thing happened.  Our helping world changed dramatically and quickly.  Long-term therapy became something we frowned upon.  We started saying things like “We don’t want our clients to become dependent on us” and “Our goal must be to build their natural supports” and “We want to empower our clients to heal themselves” and “Long-term therapy is really therapists taking advantage and wanting to make more money”.  We had bad boundaries if we wanted to maintain therapeutic mentorship relationships outside of the facility.

While I was experiencing first hand the immense healing power of relationship for these kids, I was learning about evidence-based, solution focused, time limited therapeutic approaches.  I remember saying to my peers and supervisors “It doesn’t make sense to me.  These kids start to heal because they finally feel seen, heard and safe and their reward is to loose the people who get them.”  We called it a “successful discharge” or a “successful completion of treatment” as if that would somehow soothe the loss of these new attachments.  Then we sent them home to family systems where they were the “black sheep” and expected our therapeutic results to stick.  Even though it didn’t feel right to me, I was the lone voice in a sea of voices telling me that these ideas of mine were outdated.

I spent the next 13 years being indoctrinated into a philosophy that said that brief solution focused therapy was the gold standard.  I did the training, I practiced the skills and I used the ideas to heal my own wounding.  I found some value in these ideas.  I found temporary relief of my own symptoms.  I decided that maybe I had been wrong all along.  So, when I started my practice I saw myself as a solution focused therapist and advertised myself as such.  But it wasn’t actually working very well for my clients.  It was exactly what they wanted, but it wasn’t at all helpful.  They would make a plan in therapy and go out into the world and do the opposite.  They would come back embarrassed and ashamed that they hadn’t been able to follow through.  They would be ashamed that “thinking differently” wasn’t actually changing anything for them.  They would leave therapy after a couple of months and not come back.  I knew I had to go back to the drawing board.

I was luckily smart enough to have decided that, after 13 years of training and supervision through agencies, I might want to seek out a clinical supervisor who would challenge those ideas and make me think differently.  And it changed everything.  I will never forget the day that, in response to talking about setting goals and working towards solutions she said, “I wonder what it really says when we are solution focused—maybe that we believe the person needs fixing”.  I realized, in that moment, that a solution focused approach was not at all what I believed in.  This was the beginning of a tide shift in me.  I am now completely convinced that a commitment to a long-term therapeutic relationship is the gold standard of treatment.  Here’s why I hope you will begin to believe so too.

Attachment Neuroscience Research Supports The Ideas of Long-Term Therapy:

The neuroscience of attachment and the buzz about that research has been booming as of late.  The cliff note version of the research is as follows:  We attach to a primary attachment figure (usually mom) and if that attachment figure is aware and responsive to our physical and emotional needs we grow to be secure in our world and in our sense of self.  This leads to mostly adaptive and normative behavior in life and relationships.  If our primary attachment figure is not responsive or is unpredictable, we wind up with an “Insecure attachment” type and behave in ways that we are not proud of in life and relationship.  We might self-soothe in unhealthy ways, cling to attachment options in unhealthy ways, push people away to stay safe etc.  This is because our brains learn to wire and fire in ways that would have helped us “get the goods” from our parents when we were infants, toddlers and children.  That wiring is so entrenched that we struggle to get out of those ruts even when we cognitively and rationally understand the ruts.

What neuroscience has helped us understand in the last two decades is that, while our brains may have powerful wiring from our youth, they are “plastic”.  That means that they can change throughout the lifespan.  So, if our brain is wired to experience boundaries as rejection we can, over time, change the way our brain “connects the dots” so that boundaries feel safe and healthy.  But that change doesn’t happen through the rational awareness of these things alone.  Research demonstrates that the primary way that our brains begin to re-wire is through new experiences. 

I have found that most adults have some level of attachment wounding—even when they believe their parents were amazing.  My mother’s generation was equipped with very little information on parenting, but most of the information they did have told them not to attend too much to children when they cried lest we spoil them.  It was also a generation struggling with how to tend to children’s needs while having two parents working outside of the home.  Compliance and good behavior was the goal and the solution, many thought, was to strictly control our children’s emotional reactions with consequences and strongly enforce expectations with punishment.  My parents were raised by a generation that believed that children should be seen and not heard—a generation struck with fear about a lack of resources.  We have generation upon generation of parenting ideas that were detrimental to our attachment needs as infants, toddlers and children. 

So, what type of experience could possibly help us re-wire our brains when we are trying to get at this attachment dynamic?  You got it… relationship.  So then I should be focusing in therapy on building my clients’ relationships, right?  Sure, and I do talk about that with clients.  But for many of us that is easier said than done.  Because our brains are wired to respond to attachment figures in a certain way, we keep doing that no matter how hard we try until the wiring changes.  For example, a woman may have a new partner who asks for some alone time.  Even if she knows rationally that this is a fully acceptable request, her brain will panic because she was left untended by her parents when she felt scared and unable to care for herself.  Her brain is trained for a panic response to this.  She will likely lash out or cling to this new partner even knowing that it’s not helpful in the relationship.  Then she will feel shame at her child like behavior and spiral.  When we do those things over and over again in our relationships we get a similar response of rejection or punishment that we got from our parents.  This reinforces our wiring and our brain says, “See, you can try to believe people are safe all you want, but I know better.”

This is where therapy comes into play.  A long-term therapeutic relationship with a therapist who is skilled at joining with your defense mechanisms instead of tearing them down and who is able to hold space for your attachment patterns without rejecting you can provide you with just the relationship you need to begin re-wiring.  In this way, therapy is less about giving advice or identifying solutions and more about the process of being seen, heard and held safe consistently and over time as you explore all parts of your inner world.  This becomes a safe haven and a place where you are seen—even when everything in your world is wonderful and you feel perfectly happy.  It is the consistency of the relationship that makes the difference, not the solutions you find while you are there.

It Has Worked For Me

I remember walking into therapy with a Modern Psychoanalytic therapist (the husband of my current clinical supervisor/therapist) and saying “I’ve done a lot of work on myself.  I think the only thing I really need to still work through is the grief of this particular relationship”.  I hear some version of this statement from many of my clients in their first session.  Now I can’t imagine those words coming out of my mouth ever again.  The idea that I have “worked through” anything to completion seems completely ridiculous to me now.  My brain still holds it all.  My body still holds it all.  I’ll need to talk about it again and again and again so that the unconscious becomes conscious.  I’ll need to have that experience of being heard and understood and seen for exactly who I am over and over again.  Because that’s what we need.  That’s what we’ve always needed.

I knew, for sure, that I was convinced of long-term therapy when I found myself driving to my therapists office thinking about how truly screwed up I actually was.  I realized I thought I had tricked her into believing I was actually a good person.  (This feeling is reported by almost every one of my clients at some point in the process)  I decided I’d test her.  I decided I would finally tell her how horrible I was deep down inside—I was going to risk her rejection and disgust.  After two years with her, I finally felt that maybe I could put voice to these fears I had about my own brokenness.  And she did not reject me.  She was not disgusted.  It made sense to her and that allowed it to make sense to me.  She saw my shadow side as human, natural and completely justified.  That allowed some small piece of me to be soothed and healed.  That healing allows me to walk in this world without having my damage do damage to others (most of the time). I now look forward to many years of knowing that I can bring in my ugliest self and be seen as human—every week on Wednesdays at 11:45.  I can bring in my ugliest self and be unafraid that she will judge me, talk poorly about me to her peers or get rid of me in her life.  My brain is re-wiring.

So, Give It A Try

Not for me.  While it may be tempting to imagine that I believe in long-term therapy because it keeps me in business, it’s simply not true.  I have the good luck of having enough new client calls each week that I could discharge 5 clients a week and still stay full.  Do it for you.  Give yourself the gift of being seen and heard.  Give yourself the gift of taking up space.  Give yourself the gift of being your ugliest self and not being rejected.  When times are good and when times are bad.  It works if you allow yourself to commit to it and believe in it.