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Page Contents: When you have to decide about how long to continue psychotherapy.                    


I have been seeing my current psychotherapist for about three and a half months. The issues I want to work on include depression, suicidality, and trying to move beyond the wounds of having been physically and sexually abused as a child. Psychotherapy sessions have been going well. I’m only rarely suicidal. The depression seems to have morphed into vague content. But I still feel emotionally frozen. I still think that there is more work to be done on the abuse issue. I don’t feel any resolution about it. Today the psychotherapist, seemingly out of the blue, asked if I wanted another session. I responded by saying “I don’t know,” and switching to something humorous. A major theme of the day was my ambivalence. We had also discussed the fact that I am distrustful of labeling things as progress, that I have no well defined marker for when psychotherapy will have been a success, and that I cannot tell the difference between being happy and distracting myself from negative things. My question is how do I deal with being asked if I want another session? I feel unable to decide. I don’t want to seem needy or bothersome. I can’t bear to be put in the position of asking for it, and being denied. If the psychotherapist thinks I’ve met all my goals, maybe I have. But on the other hand, I do want to get better. I don’t want to ruin the chances of that happening.

Do you want another session? How about another year of treatment?

OK. Now that quip sounds flippant. And I said it to help you get the feeling of precisely how flippant the managed care environment can be.

“So, you’ve had 12 sessions? Well, you should be cured by now. You are cured, aren’t you? Aren’t you?”

Yet the truth is that the emotional traumas around sexual abuse are not cured in 12 sessions. It can take a very long time to grind away all the defenses that have been encrusted around the emotional core of your life. It’s no wonder you still feel emotionally frozen. The treatment you have had so far is a bandage on a deep wound. The wound itself still has to be treated.

Now, the problem in all this for you derives from your being emotionally frozen. Right now, you’re not capable of asking for what you need because your defenses themselves prevent you from even knowing what you need. So it’s your psychotherapist’s job to notice your pain and take action to treat it properly. And if your psychotherapist cannot notice your pain—either because of incompetence or because the managed care environment has blinded him or her to reality—then you might need another psychotherapist.

And most likely, to get what you need, you will have to pay for it with your own money. That’s the downside of good treatment. The upside is that once you pay for your own treatment, no one can deny you. Only you can deny yourself.


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Raymond Lloyd Richmond, Ph.D.
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