Is it unethical to keep a patient in therapy for years?

My understanding of the way therapy works is that if you have a psychological problem that you cannot solve on your own you hire a paid professional, you share your problems with him or her, he or she helps you understand how to solve your problems, and then you move on with your life and hopefully apply what you learned in therapy. The therapy itself should last only a few months. But then you have people who, by their own admission, have been working with the same therapist for as many as 3-15 years. I believe that keeping a person in therapy for so many years not only says a lot about the curative capacity of the professional but also suggests a lack of ethics on their part.

seems you enslave?yourself with such rigid thinking...good luck with that

personally i enjoy a friendly intellectual conversation and i find my sessions very stimulating, if i can replicate that i would and quit going but i have yet to find anyone, therefor i will gladly hand over my money. You have a right to stop therapy whenever you want to, no one is forcing you unless by court!

You did not mention for how long you have been in therapy, but it sounds like it's been a while. I am inclined to think that a competent, ethical professional would have taught you the skills necessary to have friendly intellectual conversations with people you encounter in real life, without the need of paying those people any money.

You sure have the right to stop therapy whenever you want, but can it ever be the case that a psychologist uses his knowledge of psychology to make the patient believe that he or she needs the psychologist more than he or she really needs it? Or can it be the case that the psychologist does not try hard enough to help the patient understand his or her problems so the patient can achieve independence? Cases of psychologists who use their knowledge of psychology to prey on vulnerable patients abound, like when a male psychologist seduces an emotionally unstable female patient. Of course, most psychologists are genuinely nice people and wouldn't do anything like that, but this discussion does not concern psychologists who are ethical and competent.

LOL! You for real?

mental disorders and mental problems are not always as simple as hiring a therapist, see them for X amount of time and bam all better now.

each person has their own rate of healing, processing and unique problems. for example Some people with depression can be in therapy only for a few sessions where as another or other person(s) with depression can be in therapy for a life time.

some people are also what is called medication resistant. this means they have been on all kinds of medications there are for treating mental disorders for their problems but those medications dont work within their bodies due to allergies, or matabolism rate. like no one loses weight the same way people react differently to the same medications. what works for you may not work for others.

I know quite a few people who have only needed two or three therapy sessions and were able to get on with their lives and manage their mental disorders and daily problems and I have known many people who's files tell me they have been in therapy for decades.

there is no set deadline for how long a person should or will be in therapy. its all individualized for what each person needs.

and no it isnt unethical for therapists to be seeing their clients for years. whats unethical is shipping the client out into the world if therapists know that client still needs help. you see this topic appearing a lot where people are in the news for committing crimes that their mental disorders may have been a contributing factor and sometimes their treatment providers end up under investigation for not notifying appropriate agencies that this person may be a danger to himself and others and needs intensive in patient or outpatient treatment in order to continue being safe with their self and others.

If you think you have been in treatment too long you can get a second opinion, just tell your treatment providers you would like a psychiatric evaluation and refural for a second opinion regarding your mental disorders, problems and length of your therapy program.

The discussion is about whether it is unethical to keep a patient in therapy for years--that was the title of your thread. The discussion is not limited only to talk of psychologists who are not ethical and competent. Could it be you have already decided that patients in therapy for longer than 3 years have therapists who are unethical? If so, I wonder why you asked for others' views if you have already made up your mind? My own view is that some people have problems that take longer than 3 years to work through (e.g. significant childhood trauma). Most people don't take that long, but some do.

................

I don't think anyone is 'kept' in therapy. At least I hope it is always clear that being in therapy is a choice unless legally obligated.

There are different kinds of therapies. Some very specifically teach skills and some are ongoing explorations of one's self that includes depth work and seeing how new things that come along, as they do all through one's life, affect us.

I haven't had an experience with an unethical or incompetent therapist, and I wouldn't be able to judge a therapist's ethics or competency without knowing all of the facts, which only the therapist would know.
I think it could be easy to misinterpret dedication and desire to heal with something else, and something like a high degree of distrust or suspiciousness by the person interpreting could influence the conclusions reached.

I think it very much depends on the individual issues one has. For instance OCDs can be successfully treated in a relatively short period of time, and someone who needs support through a life changing crisis may be adequately helped by a short course of therapy as well. But there are many disorders that require a longer term of therapy, such as anorexia nervosa, DID, and BPD.
Personal history also influences the length and type of therapy required. For instance someone who has experienced a sexual assault in adulthood but otherwise has been well adjusted and trauma free will likely require shorter term therapy than someone who experienced a sexual assault but also has a long term history of childhood sexual abuse. The damage caused by ongoing childhood abuse is developmental - it pervades every aspect of a person's being. It damages self-esteem, the ability to trust, the ability to relate successfully to others, sexuality, to mention but a few things that need to be worked on in therapy. No three month course of therapy can 'fix' a lifetime of abuse.

I say the duration of therapy depends on a lot of different variables, including the presenting problem(s) of the client and the therapeutic approach. Certain types of cognitive behavioural therapy are not designed to be long term. Psychodynamic therapy takes longer. Are there unethical therapists? Sure. However, it's impossible to put a time table on therapy actually takes.

Are all problems/symptoms treated with psychotherapy curable? I don't know, perhaps managed might be a better word, as other health care professionals do with other chronic illnesses.

People go to therapy for all kinds of reasons. I know I personally have several reasons that I choose to go to therapy for. Note that I said "I choose" - this is a personal decision on my part. I assure you my therapist is not unethical by anymeans. He has helped me make signifigant changes in my life, he has helped me work through many crisis situations, he has helped me look at things from different perspectives, and sometimes he is just there for me to have a safe place to go and just purge - I love that he is unbiased. A friend is never unbaised. A therapist gives a unique insight into your life. There have been times where I have gone to therapy frequently and times I have not gone frequently. It just depends on where I personally am at. The reason I started therapy is not the reason I have stayed so long. I have found that I am on a journey of self discovery and change and he is there to walk alongside me in my journey by my request. I would never consider someone who has responded positively to my request for support as unethical.

I've been wandering the same thing myself. Does long term therapy do more harm than good? At some point is it like the law of diminishing returns that applies to just about any product or service?

Wawryzn,
I think it directly applies to the diagnosis of the person in therapy and their level of functioning. I know for myself personally I have a serious mental illness and I am not able to live a healthy functioning life without therapy and medications. It is tried and true. When I am in supportive therapy and medication management I am able to be a contributing member of society, hold down a full time job, not be abusive to my family, etc. If I were not in therapy I do not believe I would be able to have that level of functioning in my life. It would be unethical to deny a person like myself the psychotherapuetic resources that are needed to manage our mental illness.

Surely there are cases of people continuing on in therapy when it is not needed. I have seen several blogs here on PC regarding this very topic. I am fairly certain that it has more to do with the complex emotions of ending the relatioinship for both the therapist and the client than it has to do with blatant unethical behavior. How difficult and different the therapy road is. It does not compare to anything else does it?

I know of a Professor in an accredited Masters level couseling program who openly advises his students "So long as you are able to keep your clients dependant on you then you don't have to do any promotion/marketing and you have steady, reliable income". He specifically targets clients with dependancy issues and/or personality disorders. His goal is not to heal but to maintian dependance and an income until he retires.

Ugh, how awful! Not only that he does this, but that he TEACHES this!
I wonder how common it is. I've heard of medical doctors ordering un-needed tests and just treating symptoms without providing a 'cure' when it is available. I guess we truly have to be the advocates for our own treatment, but that is much more complicated when dealing with mental illnesses that may affect our ability to advocate for ourselves.

My T uses CBT and actually recommends that therapy should't have to take more than 3 - 6 months. But she also specializes in eating disorders and trauma, which she realizes can take a lot longer to treat so I know she is not rushing me out of therapy.

I've been in therapy with the same therapist since 1998. It is very much my choice to continue to see her and to continue to pay her, as I'm still getting a lot out of the therapy.

When I first started seeing her I was in full blown crisis - dissociating a lot and having trouble functioning at work. So we initially focussed on stress management and grounding skills and day to day life skills.

Once I was more stable we started working on the underlying trauma issues that were at the root cause of many of my symptons. The way I look at it is, it took me 29 years to get this messed up it's going to take me more than 6 months to get healthy. We focussed almost exclusively on trauma work for 6 years dealing with the death of my mother, abuse and neglect - I stopped dissociating. About 4 years ago I admitted that I had a drinking problem and sought help for it. It's been an ongoing struggle so for awhile my T was simply focussed on helping me develop coping strategies to not drink. Now we're at the really tough stuff, interpersonal relationships and my strong tendancy to isolate and my absolute terror of intimacy. I have a lot of barriers that need to be chipped away at still.

At the same time, I am starting to feel like I am less reliant on therapy to function. Last year I dropped down from every week to every 2 weeks and that's going well. I still see myself as needing therapy for the next few years as I work on building skills and social connections which I am doing.

But yes I need long term therapy just as I will probably always need medication. With the two combined, I've become reasonably happy am involved in a number of hobbies and am able to hold down a challenging responsible job.

--splitimage

If the therapist is manipulating the situation to "keep" a client who otherwise may not need therapy, then YES the manipulation of the client is unethical and there is likely insurance fraud as well.

Duration alone does not indicate unethical practices.
Is it unethical for a client to keep going to therapy when they don't really get anything from it, just like going or have gotten in the habit and can't imagine stopping?
There is not a duration "litmus" test. Definitely there are professionals who disagree with the use of long-term therapy for nearly everyone - See Doc John's blog post on Howard Stern's therapy. Some therapists are very tightly bound to a school of thought - so it guides them to view long term therapy though that lens (Good! Bad! As Needed!).

BUT, like others have noted, there are plenty of people for whom long term therapy (3+ years) is considered the proper and appropriate treatment! I sure hope that the therapist and the insurance company are able to provide the care needed for as long as it is appropriate.

I'm coming up on the end of my 2nd year of therapy - 18 mo with my original counselor and 6 mo with current therapist. Both my therapist and I envision a time when I won't need/want therapy; it isn't now. But she said "You will know when you are done" and I agree.
It has been a super fantastic experience to change how I interact/react with the world.

I believe therapy is very hard work for both the therapist and the client and I cannot imagine staying in therapy where I didn't think I was benefiting (it's expensive and time consuming too) and if the client isn't working hard, I have heard from therapists that it is very boring or frustrating and I can't imagine being that bored for that long just for a bit of money (from one person).

It sounds like you are assuming there are some therapists who have multiple clients who don't "need" therapy in order to make a little money; I don't think most educated people would want to work at a job that wasn't enjoyable that long? Sit for 50 minutes alone in a room, not able to get up or "do" anything but listen and find a boring person you don't enjoy listening to and have them talk. Could you do that for years with multiple people?