What to expect from therapy in the longer term

December 1, 2019 9:49 PM

So I am going to therapy (think I may have found the right therapist for me) to work on my issues with interpersonal relationships and dealing with negative emotions. Can you tell me what to expect, ie what benefits I can expect, over the longer term, assuming I can stick out the 15-20 sessions my therapist has recommended and at least make a medium effort to do the hard work. I’m trying to be realistic- what can I hope for vs what is expecting too much.

So far I have had one trial appointment so we have not set any firm goals yet, though we discussed my reasons for coming to therapy and what I’d like to achieve more broadly.

posted by EatMyHat to Human Relations (11 answers total)

A lot depends on the type of therapist and more importantly what you want to get out of it.

For me, when I went into therapy the first time I was dealing with significant agoraphobia — being out of the house was uncomfortable, sleeping anywhere but home was impossible, and air flight was unthinkable. Understanding why things were that way was intertwined with me trying new ways to handle my anxiety in those situations.

At the six month mark I could see a realistic path to the end of the agoraphobia. I had the tools, I had the knowledge, it just was going to take time and at that point there was nothing more a therapist could do except cheer me on.

We also worked on a lot of short term anxiety and there is no question that my day-to-day life was infinitely less harrowing, but the agoraphobia was the biggie for me in terms of long term.
posted by Tell Me No Lies at 10:54 PM on December 1, 2019

If they mentioned any specific techniques or processes they tend to use that would give a better idea of how it might go. For instance a cognitive behavioral therapist works pretty differently than more traditional psychotherapists that might focus on your childhood.

Really broadly, over that length of therapy I would expect they would start by talking through your issues and working out a treatment plan. In the beginning you'll probably spend a lot of time explaining yourself and your history so they can understand how you think and feel. Then they may start to give you some homework and specific areas to work on. I would expect to get better at talking about your thoughts and feelings during this process, and hopefully you'll see some paths for real substantial improvement.

Past 10 sessions or so, you may find that you're spending more time taking the concepts you've worked on and applying them to specific life challenges, as well as just generally asking your therapist for advice about problems in your life. I've been in therapy for multiple years and I don't see them as often, but when I do see them it's half specific things I want to work on, and half using them as a sounding board to help me work out my own solutions to problems.
posted by JZig at 11:11 PM on December 1, 2019

Response by poster: Just wanting to clarify - the therapist has not mentioned any specific approaches yet, except for maybe CBT. I am really looking to understand what benefits I can expect as a result of doing the work in therapy over the long term - ie trying to be realistic but also hopeful about what it can offer me.
posted by EatMyHat at 12:25 AM on December 2, 2019

The most useful therapy I’ve been to was in childhood (11-12 years old), and what I remember out of it was that the hard work for me at that age was accepting that this person talking to me was smart and might know stuff I didn’t know. Specifically, I tended to catastrophize and have outsized reactions to things, and I remember her mildly telling me things weren’t likely to be as bad as I was imagining. Then I had to live my life and see, well, actually she was right and things were imperfect but basically fine. In a way I think the process only took as long as it did because of the value in repeating things I started out unready to hear, and because of that waiting for life to unfold. The therapy did not make me into someone who never catastrophizes, but it gave me another perspective I could pull out of my library, and sometimes that worked and sometimes it didn’t. I think it did help me do a better job learning from my experiences: I remember making some social errors in the year or so that followed that I was able to learn from without drama, which I think would not have been possible before that point.
posted by eirias at 5:26 AM on December 2, 2019 [3 favorites]

Specifics are going to depend on the issues you're working on and the therapist's approach. In general you'll develop more self-awareness and the ability to understand how you're approaching situations in your life and why you might be approaching them that way. If you're engaging in behaviors counterproductive to your life goals, then you may get more insight into those behaviors as well as coping strategies and protocols that may help you achieve those goals. It's not a panacea and it really does require you to listen to things you might disagree with and implement things you might think won't work, but it can be incredibly rewarding.
posted by Anonymous at 5:47 AM on December 2, 2019

I hope what I'm about to type is helpful. A lot of your questions are about how do you get what you want, like how do you get your boss to stop correcting your work or how do you get the answers you want here or how do you get a partner.

There's nothing wrong with wanting those things, but there is an underlying theme that you want a kind of roadmap that is rigid and which spits out the recognition/friends/partners/answers that you think will bring you satisfaction and happiness.

I would suggest that in 15-20 sessions, you will hopefully have the tools to navigate uncertainty and the emotional grounding to deal with feelings of uncertainty. In other words, in 15 sessions, hopefully you don't have to ask this question because you'll have a sense of progress, rather than a gold star of achievement.
posted by warriorqueen at 6:34 AM on December 2, 2019 [19 favorites]

Best answer: Longer term, therapy ushered me towards:
Naming my emotions quickly, instead of everything confusingly being just Panic or Defence
Part of this is the therapeutic process of learning what *are* appropriate emotions (it took me a long time to say “I am angry” even though anger was an appropriate emotion for some situations) Then learning to recognise them and listening to what was disrupting me. I became calmer.
Getting quickly to what was causing the emotions, navigating my life accordingly
Defining boundaries and guarding them more appropriately in interpersonal situations
Finding value and delight in myself instead of crippling doubt and self castigation
Articulating myself in relationships more clearly, asking for what I want. Eg using the phrase “I want” in a sentence was a new skill I learned.
I learned to be my own therapist by gradually internalising my therapist’s approach to problems - eg asking myself what do I need right now/in life.

What this looked like in my out-of-therapy life:
I worked more intelligently with my marriage and I learned when to stop the work. The marriage ended at my instigation.
I changed my relationships within my family of origin - set boundaries and ended dynamics and contact with abusive elements within that family
I cried a lot after some sessions, some was hard and I wondered why I was doing it. (I’m so glad I persevered)
I learned to feel proud and self honouring of the commitment I made to therapy. After each session I gave myself a personal reward like sitting in a cafe, buying a new magazine and sitting with myself, letting things percolate.
I stopped panicking all time and got to the heart of the instigator of the panic quickly.
I learned to trust my gut. I was afraid and distrustful at times because actually those people causing the feelings *were* fearsome or untrustworthy.
I found more empathy for others and saw the origins of their formation and wounds far more quickly. I could be a better friend.

I just ended a loooooong therapeutic journey. It was the most important thing I have ever done for myself in my life. Cheer yourself on, you are making a good decision.
posted by honey-barbara at 7:25 AM on December 2, 2019 [5 favorites]

From my experience of therapy, your goals won't be the same after a few months. In a way, I wonder what the point of therapy would be if your goals didn't change, if you already had a firm grasp on what you needed to do to make your life and relationships better.

By "you" I mean "one," and include myself. A lot of therapy, for me, has been about accepting things as they are, but really accepting them, in order to move forward. I could probably have told you that in so many words when I started, but putting it into practice takes, well, practice. In that sense, eiras's description strikes me as very apt. It's less about blinding insight and more about achieving greater perspective.

It's not bad to have goals, though. You're going to therapy because something's not working, or could be working better. What is that thing? Or maybe there are a few things, and you need to order your priorities. As others have suggested, it's going to be very individual.
posted by BibiRose at 11:21 AM on December 2, 2019 [3 favorites]

Response by poster: Just to point out as a few people seem to have missed it - my goals for therapy are to improve my interpersonal relationships and deal with negative emotions better. Thanks for the answers so far!
posted by EatMyHat at 12:02 PM on December 2, 2019

In 15-20 sessions, I think it is reasonable to expect some progress on the aspects that warriorqueen and BibiRose described so nicely. In both life and therapy, it will turn out that very often the things we demand are not the things we desire. Exploring and understanding how this tension works for specifically you, in the ways unique to you, may open up a greater sense of flexibility in life overall, in terms of what goals are desirable to pursue, and/or what means are acceptable/even worth trying out for pursuing them. This often both requires and results in a greater tolerance for uncertainty.

I have a bit of a hard time parsing whether you mean 15-20 sessions to be the "long-term," or if 15-20 sessions is the prelude to the "long-term." I will just say, though, that past that length -- if you go on to a year, or two years, or even more -- you could find yourself both changing as a person and becoming more yourself.

As others have alluded to, even after moments of epiphany and insight in therapy (or life generally), you will still remain you. And while not all things are possible for a given individual, you might still discover aspects of yourself - talents, capacities, knacks - that you had never known were there. For some, who might have lived and grown through a life so hemmed in by whatever forces, finally recognizing and cultivating these no-longer-invisible capacities can produce changes so drastic that it might even seem that they've become someone else altogether. But maybe, in another sense, it was always who they might have become, if only the circumstances had been different, earlier on.

The changes, after a year+ of therapy and life-while-going-therapy, are not always so drastic, but they are not less valuable or worthwhile for that.

FWIW, I've been in therapy for about 7 years (not consecutively, but never with more than a 2-year gap), and I've changed in a lot of ways that other folks here have already mentioned. I'm also still morbid, pessismistic, weird, and dispositionally an outsider, which are all things I've been for a very long time and will likely remain for the rest of my life. But yet, I'm now much less likely to alienate the important people in my life with those aspects of myself, and in a way that does not feel like I'm hiding myself. On my better days I even find myself being morbid/pessimistic/weird/outsider in the service of kindness, connection, compassion. None of this is to say that you need 7 years (or even 1 year) of therapy, because it is a lot of time and money to commit. I can only say personally that it was well worth that cost because of how it helped (and continues to help) me change my self to be more...well, myself.
posted by obliterati at 1:23 PM on December 2, 2019 [2 favorites]

Response by poster: Just to answer obliterati’s question - I meant that 15-20 sessions was the prelude to the long term - the long term being say 5-10 years after therapy. Apologies for not being clear!
posted by EatMyHat at 2:14 PM on December 2, 2019