The New York Times has a series called Couch on psychotherapy and this morning’s article by Michael I. Bennett focused on the way both patients and their therapists handle winding down the frequency of treatment. It’s a good article and raises some good points. Most intriguing from my perspective was that sometimes both patient and therapist can come to see the weekly session as essential to the patients well-being and recovery. Speaking as someone in therapy, it’s easy to see how patients can fall into this pattern of thinking. A therapy session can make you feel good about yourself, put problems into perspective and provide you with some structure. To make a change or take that away can be disruptive and stressful, maybe even to the point where you may regress in terms of depression or anxiety. But it’s eye opening to see this same issue from the perspective of the therapist (in this case, Bennett):
“I know what it’s like, as a psychiatrist, to feel that your patient’s safety depends on your availability to provide emotional support.”
Thinking a patient may be a danger to themselves if therapy is cut back or discontinued is a strong incentive to keep treatment up at a regular and frequent schedule. In someways it becomes an unhealthy relationship.
Going on to remind readers (and his professional colleagues) that there are a variety of reasons that sometimes appointments are missed (sick days, vacations, etc.) that patients don’t necessarily fall apart over, we may be overthinking the benefit of weekly therapy. I would add that in many cases therapy doesn’t happen on it’s own either- often patients are also taking medication to treat their anxiety and depression- and so while it’s beneficial, there’s a ceiling on the benefits of weekly therapy. Bennett then gets to the core wisdom of the piece:
If weekly therapy does, indeed, have only a limited potential to heal and protect, then our patients must be stronger than they, and we, think they are. We know that depression and anxiety routinely distort our ability to think realistically by making us see nothing but our faults, failures and worst-case scenarios. When we’re sure that things will fall apart if weekly treatment isn’t readily available, we may well be accepting and stoking this distortion and, inadvertently, helping our patients believe that they are as weak and helpless as they feel.
Of course, intensive treatment and emergency-room care are sometimes necessary. Instead of assuming, however, that weekly support is needed for many months, we should remind our patients and ourselves that they can usually do fine with less intensive treatment, and that the goal of treatment is not to make them feel more secure or comforted. On the contrary, the goal is to show them, when they’re not feeling secure or comforted, that they are actually more competent and stronger than they think they are and that there are many things they can do to make themselves even stronger.
It’s a great truth to keep in mind if you’re currently in therapy. After all, isn’t the goal of therapy to see improvement over time? As one discovers the skills and confidence to manage their condition, the frequency of therapy ought to slow down. In my own case I’ve gone from weekly therapy, to every other week to monthly appointments. Each time the schedule changed it was because my therapist and I discussed where I was in terms of managing my mental health issues, how I was feeling on medications, and, what to do in cases where I felt overly anxious or depressed. Each time the schedule changed it was because I was doing better and it was a mutual decision. Understanding that not everybody has this luxury (like the article says, sometimes your insurance company may interfere with your preferred schedule, which is a goddamn travesty, but one to be tackled in another post), in most cases the decision to stop therapy or scale back therapy should be a positive step taken by both patient and therapist.
It’s not necessarily an easy decision or one to be taken lightly, but a considered choice based on how strong you really are.