What “Size” for Therapy: Long or Short?

The buzz in therapy circles in April 2012 concerned a New York Times article written by a NYC psychotherapist, Jonathan Alpert, who inflates his credentials and bashes long-term treatment and the therapists who provide it. He implies that long-term therapy is only for severe psychological disorders—and he doesn’t consider depression and anxiety to be severe issues.

Tell that to anyone who’s suffered from major depression or disabling panic attacks!

Alpert claims to be able to get to the bottom of problems such as being stuck in unfulfilling jobs or relationships, unable to reach life goals, being fearful of change, and therefore depressed (this is how he grouped these problems) quickly, sometimes in less than one session.

Is therapy a series of commands or a process?

Alpert tells people what to do, rather than helping them with their thought processes, so they can make their own decisions.

Many people begin treatment wanting the therapist to tell them what to do, but if a therapist does that, patients will never learn to think through things and take responsibility for their own decisions.

I often make a feeble joke, saying that I forgot to buy batteries for my magic wand, before explaining that I wouldn’t dream of telling someone what to do.

My job is to help them explore the things that get in the way of satisfaction in their daily lives, so they can decide what they want to do, based on rational thought, instead of impulse, emotion, or an unconscious motivation that drives their decision-making process.

The treatment approach Alpert embraces fosters childish dependency, with patients waiting for the therapist to “feed” them, rather than the therapist helping them look at the dependency and blame that often motivate this insistence on being told what to do.

Remember: Dependency is the idea that I need you to do something so I can feel okay, and I get to blame you when you don’t do it right.

Alpert’s approach is the “give a man a fish and he eats for a day” method, instead of teaching him to fish, so he can eat for a lifetime.

Short-term therapy has its place…

Short-term, goal-focused counseling has its place in dealing with situational problems that are right on the surface:

• How can I set limits with my clients or boss?
• How can I help my teenager learn to accept more responsibility?
• I just moved here and need support to adjust and integrate myself into a new community.

…as does long-term therapy

But

• major depressive disorder
• bipolar disorder, alcoholism
• drug addiction
• narcissistic personality disorder
• borderline personality disorder
• anxiety disorder
• long-term dissatisfaction in a relationship
• a pattern of unsatisfactory personal or professional relationships?

Even the example he uses of a woman who’s been unhappy with her boyfriend for the past year is fatally flawed in his formulation of the case. He says that he would ask what could be missing from her relationship and how she could take care of the missing elements or end it.

He leaves out a few basic important points:

1. Was she happy before she was in the relationship, i.e., is this a woman who knows how to be happy?
2. Is she looking for her boyfriend to make her happy and give her happily-ever-after in life, i.e., are her dependency issues getting in the way?
3. What are her contributions to the lack of satisfaction in the relationship? No one person holds all the good or all the bad in the relationship. It’s a dynamic
4. Did she grow up with a model of parents who enjoyed each other and were satisfied in their relationship, or did she grow up with a parent who was disappointed in his or her partner, who subtly or obviously passed along the idea that men are disappointing?

Those questions are just a first pass look at what Alpert has left out in his simplistic, I’ll-just-tell-her-what-to-do approach.

What “size” for therapy: long or short? Wrong question! Good therapy.

There is effective and ineffective short-term therapy and effective and ineffective long-term therapy.

As a therapist in private practice since 1995, I’ve done lots of short-term and long-term treatment of patients. New patients frequently want me to tell them how long treatment lasts.

I make a treatment recommendation about session frequency, based on clinical assessment, but the duration of the treatment is something that evolves, as I learn more about them and their issues, and as they learn more about themselves and their issues. It’s not a one-size-fits-all process, despite what Jonathan Alpert says.

Bob Newhart’s character in the following sketch beat Alpert’s quick-fix record by a mile. He could do it in just two words. Watch it, have a laugh, and feel free to leave a comment below.

If you want change that takes more than two words, read up on the differences between short-term counseling and therapy.  If you’d like to learn more, contact me here. I look forward to speaking with you.