Long term therapy

This week a discussion has challenged my thinking with regards to long term therapy. So, I decided I needed to do some more research into this to dig a little deeper to decide how I felt about it. This included doing a little research on this and talk to fellow counsellors to get some perspective on how they felt about long-term therapy.

When looking at short term therapy vs long-term therapy we are looking at two different types of therapy here. Short term or brief therapy of around six to twelve sessions are often suggested to help clients manage, resolve and change their issues / problems. This type of therapy works best with up to two goals or concerns. Often longer-term therapy is required if the issues are more in-depth, deep rooted and long term. (Which have not been helped by the 6-12 short term sessions.)

So how long should you be in therapy for? Well that really depends on you. Are you the quick fix sort of person who sorts out the issue, becomes symptom free and then your off until the next time or are you the sort of person who uses therapy as a fitness regime, you go to make yourself feel good, until life feels better, you can reach your potential, thus helping prevent problems in the future.

When looking at our friends across the water who are seeing the same therapist for years, is this right or wrong, ethical or unethical, especially if they are being helped by their therapist? Is this beneficial if it is keeping them in work, keeping them motivated and helping them to maintain a healthy lifestyle?

So, as we look further into this, thinking more about a client and their initial consultation, whether this is long or short-term counselling. What do we expect of a client who brings years of buried trauma and emotion into this session. Are they going to open up and talk to us straight away? Possibly not! We need to build trust, respect and the therapeutic relationship. Not all of our clients will find this easy, it can take weeks, months or even years for a client to gain trust in the therapeutic relationship. We must be patient and remember our clients have been on a journey that has lead them to us. So, each week of their therapy they are building a relationship and trust no matter how small.

So how can we ensure that we are keeping the therapy ethical and beneficial for our client? Really it is quite simple, do a stock check of the therapy sessions. Regular reviews are an important part of practice, these allow the therapist and client time to take stock of their sessions and how they are working together. It is a time for the therapist to get some feedback on the therapy to ensure it is going in the right direction. For instance:- How are you doing? How are you feeling about the session? How do you feel you are progressing?

Remember we are unique human beings, so the healing process will be different for us all. So, if we all progress at different paces then we will all need to have different goals. One person’s story is going to be different to another so why should their healing be any different. People all heal, grow and change at different paces. Somebody going through the grieving process living with depression may go to therapy, set goals and have between six to twelve sessions and find resolution. Whilst somebody else may be living with depression due to childhood abuse, struggling but achieving the smallest of goals after a year of therapy. Each client needs to be open to their goals, to challenge themselves but also to understand that everyone is different. If you are achieving, healing and challenging yourself in your therapy you are progressing.

In long term therapy it is important to watch out for the client becoming dependant on the therapist. But is it just in long-term therapy that we need to worry about dependency? After all a client can become dependent in short-term therapy after 4 – 6 sessions. To ensure that dependency is not taking place, the therapist must ensure their client still needs the therapy, there is independency, there is a quality to the therapy and that it is enhancing the client’s well-being. There needs to be a healthy relationship of good communication which includes trust, support, clear boundaries and regular reviews.

The BACP ethical framework highlight three of six core principles for counsellors to  follow :-

Autonomy – To respect a client’s right to be self-governing / to make their own decisions in the therapy.

Beneficence – A commitment to promoting the client’s wellbeing.

Non-maleficence – A commitment to avoiding harm to a client.

As written in (http://www.bacp.co.uk/ethical_framework/documents/GPiA004.pdf) Practitioners are expected to make clients their primary concern while working with them, and to work to professional standards by practising within the bounds of individual professional competence and by keeping skills and knowledge up to date. The Ethical Framework for the Counselling Professions makes clear that we are committed to working to professional standards and that ‘we must be competent to deliver the services being offered to at least fundamental professional standards or better’ (Good Practice, point 13). Our commitment to clients is defined further in the Ethical Framework with commitments to building an appropriate relationship (Commitment 4), maintaining integrity (Commitment 5), and demonstrating accountability and candour (Commitment 6). Clients will expect to engage with their practitioner in surroundings that are safe and conducive to the counselling process, and to be actively involved in reviewing progress on a regular basis. The therapeutic relationship should last no longer than necessary, and clients must retain the right to end whenever they feel it right or necessary.

So now that you have read all the above, where do you stand on this? Are you a client? Therapists or family members? Maybe you are a medical practitioner with a client seeing a counsellor long-term. Is this therapy helping? Is the long-term therapy keeping them in work, helping them to maintaining their relationship, friendships, keeping them off medication or stabilising their medication? To the client, is this working for you, if you are not experiencing dependency, if you are trusting and progressing does it matter if you are having it for six sessions, one year or ten years? Remember it is your choice you can end at any time! Maybe if more people had the courage and confidence to achieve a healthy mind as they would a healthy body by going to the gym, the stigma which is carried with mental health could be reduced.

The contents of this post are the personal views of the writer.