My first therapist thought I'd see her for about 12 to 14 sessions (CBT) as that was her average patient duration for anxiety disorders other than PTSD.
Then we uncovered abuse in my past plus my anxiety disorders were not responsive to CBT treatment due to their emotional strength.
She transferred me to her colleague who does schema therapy, ACT and DBT. Schema therapy is considered "long term" treatment (with a minimum of 50 sessions in clinical trials) because it's formulated for people with chronic MH issues and/or personality disorders which are commonly caused by chronic abuse and neglect.
I think this forum skews heavily toward longer term therapy because we more likely have backgrounds which cause attachment issues. People who merrily sail on their way after 1 to 20 sessions have no need to find support regarding their therapy.
In all the personal blogs and documentaries I've read, clients with trauma histories (neglect is also trauma) tend to spend longer times in therapy. At least a year... several years etc. Even if they "got into therapy early" in their teens.
Yes there are those 8 to 20 sessions of trauma focused therapies (most commonly TF-CBT, Trauma Systems Therapy) in the clinical literature for children who have been abused, but that's "early intervention" and issues are expected to re-emerge around puberty etc. And of course there are those kids who have been in therapy for longer periods because their issues are complex.
Of course not everyone with trauma needs long therapy...there's a blog talking about
"the 3 session wonder for PTSD"...
Then one can be untraumatised but have conditions which relapse regularly...not uncommon to need supportive therapy for years to manage the conditions.
Then there's also the goals of one's therapy. Is it simply focusing on symptom reduction or on the deeper underlying issues? Jonathon Shelder has written many papers proving that psychodynamic therapy can outperform CBT because the gains last longer.
Quote from
Trauma & Attachment Therapy: Long-Term Clients
(Not saying I like her tone...)
Quote:
- Fly-over: never a "customer", leaves after a few sessions because it wasn't his idea to come, or the therapist isn't a fit (lost one because I wore Birkenstocks in the 80's), or she's too scared to stay.
- Questioner: Needs something normalized. "Am I crazy because. . . I'm grieving/I like to have sex the way I like it/I just moved and I don't immediately have new friends, etc." This client needs information about normal human behavior and reassurance that a trained professional finds her/him sane. (Not to be mistaken for a client with underlying issues who tests you with this kind of question.) One session.
- Three-session wonder: The famous (and extremely rare) well-attached car accident victim who clears the trauma in two sessions and comes back to praise you wildly on the third. I've treated about 20 of these in the 14 years that I've been doing EMDR. For them, therapy is penicillin: Take a good dose, and the symptoms go away.
- The Next Developmental Step Client: She's at the cusp of differentiating from her family of origin/partner/workplace and finding out how to be herself. If she's reasonably well attached and reasonably untraumatized, she'll be around from three to eight months. If more traumatized or with an abusive or alcoholic or otherly dysfunctional family and/or attachment issues, you might be seeing her from months to a few years.
- Big "T" Trauma client. She takes some time. If she was raped more than once or injured badly in the accident, or spent too many months in that war zone or horrible work environment, you have months to a few years of work. Best case, you nail the root trauma early (that molestation by the neighbor) then the rape, then work on integrating it all and dealing with her current, hopefully safe, life. Worst case: despite your thorough intake, you keep finding more and more suprise antecedents and the current life stays unsafe and in flux, and you spend three or four years getting her life in order and trauma moved through.
- Horrible attachment, relatively light trauma: Years of finding the baby parts that go into shut down or cling or fight or flight. Years of helping him own the baby and hold the baby and soothe the baby, instead of reflexively disappearing or pushing you away. He de-hunkers. He connects. He finds someone else with whom to connect. He learns self-regulation. He leaves therapy, after checking 6 times that he can return, if necessary.
- Bad chemistry clients. It depends. If she gets on the meds and "feels like myself again" and the good feeling stays, say goodbye and thank your favorite diety. If he only gets depressed in the summer. You may see him for a year or so, the first go round, and then every time he goes down. You'll remind him to call his medicator person for a medication adjustment, and help him cope with the affects and effects of the bipolar/major-depressive dx/schizo-affective dx. In every round of therapy, you'll help him clear some more trauma and help him reset his thoughts (there's nothing wrong with Cognitive Behavior Therapy, when you need it.). When he's back on the horse, you review what you both learned, and cut him loose until the next round. If he's more chronic, fighting debilitating chemistry with little respite, or rapid cycling, you become insulin. The attachment relationship is paramount. Attachment to you may be thing that keeps this client around. Each interaction raises hope, reregulates your client, gives them an experience of being witnessed and loved. You won't fix him. You will help him cope. If attachment disruption and trauma created the depression, therapy can, finally, nail it. And it will often take years. If it's 95% "bad brain", you need to hold to your presence as the most healing tool you have. Use all your tools: CBT, EMDR, adoring your client, cheerleading ability, and connectivity. Work with them to try yet another med, keep exercising, keep eating well, get to work. Find them the best psychiatrist in town. And settle in for a long-term relationship.
- Severe dissociation with awful attachment and horrible trauma: Settle in for the long haul. You and the therapy are both penicillin and insulin. It may take months or years to make a good, trusted attachment relationship. It may take just about the same years to stabilize your client. Then you can tackle the trauma with some good penicillin (EMDR, Life Span Integration, Brainspotting, etc.) And tackle more trauma, and more trauma, and more. Then you can help her integrate all the changes. It's 10 years later. She's in a good relationship; has a better job; can have sex; and finally can say, "How do I know if I'm done?" She's making her own insulin. She may come back for another dose of penicillin. Maybe more than once. But you did your job.
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