I've been in therapy 9 years but only 3.5 years with my current therapist, which is short for this thread!

You asked, "For those in long or even very long term therapy like me, how has your therapy changed over time? Do you still feel it is effective? Do you ever see an end date? How do you know when you are done?....."

I don't see an end date for my therapy. Bipolar doesn't go away. For most people, it doesn't even go into remission ever.

When I'm not in an episode, I absolutely ask myself, "What am I spending all this time and money to get here?" I ask my mom because she reminds me of why. "So we have him in our back pocket for when we need him." I maintain weekly appointments because my ultra-rapid cycling episodes are so unpredictable that I never know which weeks I'll need somewhere to go and be reminded that bipolar is huge, it's out of my control, I'm doing a great job, I need to just get through the moment and then the episode will end like they always do. He is excellent at talking and encouraging me through episodes, so yes my therapy is still effective and helpful.

On good weeks, I chat with him about what's going on in my life. He often has good suggestions. Or I bring out my list of "Things to Talk to T About - Shame" with old, old stuff I haven't told him about yet. I haven't run out of things yet.