To people in therapy long-term (10+ years): ever taken a break? Did it actually help?

I don't even know where to begin, I am feeling helpless and exasperated. I don't want this to get moved to the Psychotherapy forum because I want advice from long-term sufferers of depression and not another condition.

I will be 35 years old next month, and have been in therapy almost continuously since I was 17. Over the years, I have had moods ranging from a low grade "on the back burner" depression to a total breakdown. I have never been hospitalized nor have I made a suicide attempt. In 2012, things got very bad for me, I had to go on partial leave from work for 3 months, and I started seeing a new therapist. This therapist's orientation was more CBT/eclectic whereas my previous therapist was psychodynamic. I kept plugging away and I got a little better, however the episodes kept happening where I just wanted to stay in bed all weekend and cut off everyone. Around December 2013 I started Abilify and things got a lot better for me, I felt great and started to become engaged in friends and hobbies, etc. Ten weeks later I crashed again, and soon after my therapist suggested that I find someone else because she felt that she did not have adequate training to deal with my case. She said she wouldn't terminate me because that would obviously be unhelpful, but she kept strongly encouraging me to find another provider during each session that followed.

I found someone else (through a referral of a referral) and terminated with the therapist above 2 years ago. This therapist was able to highlight issues surrounding my adoption that none of my other therapists bothered to emphasize enough. The adoption story is too long to go into, but let's just say it wasn't a typical case and it deeply affected my identity and ability to trust people. I started a new medication a year ago and it was the same old story like the Abilify - worked for a while, and then right back to the bottom.

I don't know if anyone else gets what I'm saying, but at this point, I am really, really, really tired of being a chronic "patient" and am sick of the routine. I feel totally pathologized (for lack of a better term) and like my mental illness is becoming my entire identity. In the past, opening up to a therapist or to loved ones used to lessen my burden. Now I feel worse when I do it because I'm re-entering my world of pain. I feel sick just typing this out right now. For the last few months I have felt horrible after leaving a therapy appointment and I have to assume my terrific acting skills, because then I have to go to work like nothing's wrong. A recent series of misunderstandings with my therapist hasn't helped things either, but I feel like my mood has been getting worse anyway. I am leaning towards not seeing her again, but I feel like I will have to start ALL OVER with a stranger and I don't feel like I am up to the task.

My current plan was to have two more sessions, this past Thursday and the coming Thursday, and then suspend therapy for 3 months and contact my therapist in October with a decision on whether or not to continue with her. Obviously, my therapist doesn't like this, but therapists don't like the very notion of taking breaks anyway. I can't say I blame them, because they think they are providing a helpful service. I ran this by my psychiatrist and he wasn't opposed to the idea if I felt like it wasn't helping anyway. Also, I am dealing with a lot of dental problems and I could use the money elsewhere for while.

A wrench was thrown into this plan when my therapist called on Wednesday and said she injured her back and could not meet Thursday. I said I was sorry she hurt herself, but I was adamant that I did not want this prolonged into yet *another* week, and that this Thursday will be it before the break. She said she was sorry that I felt that way, but she understood that I really want out of this for a while and she didn't want to aggravate the situation anymore by trying to convince me otherwise.

The only ray of hope I have as far as treatment goes is that my psychiatrist filed an aggressively argued, detailed appeal against my insurance company (for denial of treatment) with the assistance of his colleagues at the American Psychiatric Association. I am at the point where I really feel like psychotherapy is junk science. I was in psychodynamic therapy, I got worse, I went to CBT, I was kicked out of there, went back to psychodynamic, and now I feel worse again. I even did art therapy for a spell along with psychotherapy a few years ago and I didn't get anything out of it at all, even though I work in a creative field. I feel like all of my problems are MY fault and I am intrinsically damaged, because if they weren't, I would've gotten better a long time ago. I can't do simple things that *could* help myself like take more Vitamin D (I am deficient) or get bloodwork done because I can't remember to do it and it's too much work. I can't get out of bed if I don't have to be anywhere, I have insomnia, simple tasks that were easy for me a few years ago are now almost impossible to accomplish, I can't keep my place clean, I am avoiding people, and my feelings are easily hurt.

Has anyone else had this kind of attitude that I have right now towards the entire mental health profession? Did a break and "reset" help?

Hi there With or without you,

I'm sorry to hear that you're having such a tough time with your therapist.

I haven't had very long term therapy, though I did have 2 years with a psychodynamic counsellor, other talking treatments I have had have been between about 6 weeks and about 9 months.

I found the psychodynamic counsellor, after an initial improvement in insight really served to get me from one week to the next until I decided I wanted to try independence, with no real long term benefits.

I found more structured sessions with more input from the counsellor using different models including transactional analysis was more helpful, with some continued benefit afterwards and other sessions I had were to address a particular issue.

I'm still living with depression. Three years ago I "crashed" and have had limited response to medicine or talking treatment, but, diagnosed with BPD traits, I took part in Stepps, a course which focuses on coping skills to manage emotions which helped me to be more independent dealing with episodes of distress as well as insights into thinking patterns and anticipating and intercepting possible triggers. This has helped me communicate with people around me about what I need and to avert some points of conflict without anyone kicking off.

I think in my experience, after initially exploring childhood and developmental trauma etc., therapy has worked best in shorter courses focusing on particular problems with daily life.

I have been more ready to deal with different things at different times in my life (now 47) though if you find someone who can help you get through the weeks more easily where life would be impossible without, I would go for it, but possibly not weekly (if it is for maintenance), but adjusted to the time I felt I could manage independently.

The clear message from my psychiatrist is that he feels I need to learn to live as the person I am somehow ¯\_(ツ)_/¯ if my personality is part of the issue he may be right, much as I hate to admit it. The U.K. Health system is geared more toward shorter periods of intervention if possible, aiming for as much independence as possible, for better or for worse, so I have to pay for long term counselling type therapy myself.

I have an issue I am thinking of taking to a counsellor if I can't get past it by myself and we have also had some couples counselling which was helpful.
I suppose for me, I like to feel I have some sort of control and a therapist who will allow that. They all seem to think they can cure everyone, but I'm no longer convinced.
The key is to have someone you trust and that it is of benefit. Pain without gain is nonsense in my opinion, you probably have the best idea of what you need, and you still have the advice of your psychiatrist as your needs change.

I don't know if I have just muddied the water with my rambling, just a little of my experience living with almost lifelong depression (age 47)and the need to try to find a way to continue that is acceptable or at least manageable potentially for another 47 years.

Best of luck with your break, I hope it will shed some more light onto what you think you need going on into the future.

Kudos for continuing to work through all this! No one else can know how hard and how much of an achievement that has been for you.

Thanks for replying. I'm sorry if I sound difficult, but you never mentioned in your reply if you actually took a break for a while.

I last saw my therapist 2 weeks ago and we agreed that I would come back on September 8 instead of mid-October. I see my psychiatrist next week. So far I can't say that my mood is any different - not better and not worse. I am using all of the money I would've spent towards therapy during this time to pay down some major debt I have from recent dental work. I am journaling here and there, the last time I did I just wrote about every past hurt or misunderstanding I've had with someone that had gone unspoken until I got a hand cramp. The words "disappointment" and "projection" seemed to come up a lot. It felt cathartic because this is crap that I would never be able to vent in a session, I would run out of time. I just don't know, I'm just antisocial and I don't enjoy most people and find many of them boring. I know by saying this I sound like a rather mean person and I don't want to be this way; maybe I hold people to an impossibly high standard or I have a personality disorder of some kind. I have offered to my therapist that I suspect I might be on the spectrum (I know Asperger's doesn't technically exist as a diagnosis anymore) but no one has ever suggested it. Everyone I've seen just thinks it's outright depression and social anxiety disorder.

I had jury duty yesterday and I was just sitting there dreading having to go into the courtroom and answer questions from the judge and attorneys in front of everyone, and I beat myself up for allowing this to still bother me as a person in their 30s. Luckily we all got dismissed for the day without ever making it that far.

I have come to the realization that I only feel better during the actual therapy, when I have to step out into the world again I feel like a crushing burden has come back onto my shoulders after only 45 minutes. I also feel like it's time to accept that I probably will never be totally rid of this and should focus on more on the word "management" rather than "cure."

The UK system is actually not that much different from the US in terms of "shorter-term" care being preferred over the long haul. Obviously, the difference is whether or not you have health insurance in the US. Health insurance is supposed to cover behavioral health services at a reasonable rate, but those companies do backhanded things to try to get out of paying for some people. I remember seeing an ex-therapist who told me beforehand that my insurance company was going to call her soon to "check" on me to ask her professional opinion on whether or not I still needed therapy. Of course, she told them to get lost and they kept paying. However she eventually stopped taking health insurance altogether because their meddling and red tape made it impossible for her fees to get reimbursed everytime (this wasn't solely because of me, of course). My current therapist does not accept insurance at all. I have to pay an exorbitant amount out of pocket directly to her and then submit my claims to my insurance company on my own. This process is called an "out of network" claim and I only pay about $24 more than I would if this therapist actually were on the insurance label. I never get questioned by my insurance company about filing all of these claims.

You are right when you say that no one else can know what I am living with on a daily basis. Most people will never know. This is a very misunderstood illness and many people out there think if you just exercise or something like that you will snap out of it. I tried to open up to my mom recently and she made a poor choice of words in her response, she said she was "disturbed" by some of the things I said, I believe a better term would be "upset". So I'm just going to revert back to my "everything's fine" answer.

Sorry I didn't make myself clearer, I have only had 2 years continuous weekly therapy (psychodynamic counselling)
This therapy really only helped me get by week by week and I stopped it. I also wanted to feel more independent.

Since then the breaks have been longer than the spells of therapy which have mainly been to address specific issues or a particularly difficult time (such as my husband being hospitalised).

It sounds as if you have answered your own question to a certain extent, your relationship with this therapist is not as therapeutic as it could be. I suppose the question is, could she (or someone else) help you as much with more occasional visits, eg. Monthly or fortnightly, do you feel you will manage better without contact for a longer time and return to therapy of some sort when you have a specific goal to work towards (a particular issue to deal with) for a more targeted type of therapy.

In uk there is something called Brief Therapy which is helpful for life events or particular problems but takes more of a problem solving approach rather than dissecting the past like "how can I deal with this recurring issue at work so my work life is less difficult to manage" or anything like that.

Some people find a CBT type approach helps deal with a specific problem.

My psychiatrist and care coordinator (before I was discharged) both said they thought I had had a lot of different talking treatments and have probably had what long term benefit I'm likely to get, so they don't even recommend I go privately to anyone except for maybe if there is a new issue that could be helped with some short term support.

I know other people who get a worker or therapist see them once every two weeks or every month for support and to help problem solve or keep an eye on them if they relapse, but not so much for in depth revisiting of past trauma on a long term basis.

I don't know if that makes any more sense, it is really just thoughts on what I have experienced and have seen other people do.

My cousin is a psychiatrist and she says, paradoxically some people after a period of therapy then do better on their own without being reminded of their issues and being "in the system" therefore labelled as ill.

It doesn't mean all is easy and they may need more input in years to come.

I would be interested, if you want to share it, to hear how you get on with your break over the summer and how it works out for you.

Once again, kudos to you for still holding down a job.
I have now had to retire on health grounds but am lucky enough to have an occupational pension and a husband who can still work so I am trying to find a meaningful role where I feel I can contribute to society within my physical and mental health limitations.

Best of luck. I'm sending all the encouraging thoughts and hugs I can, this is a difficult decision you are making and the process may not be easy, but I believe you will know what is best for you.



Ps feel free to send a PM if you feel it would help, to me or anyone else you feel could lend an ear.

This therapist is not keen on seeing people every other week. I tried to do that about 2 years ago because of finances and she told me that would be a very bad thing for me clinically. The one before that (the one who referred me out, like I said in my original post) did not like it when I had to go every other week for about 2 months because my car needed major repairs, she said it was not in my best interests to skip. But I did what I had to do. I don't know what the "variable" is here. Maybe when I go back, I will have found that stepping away for a while is what was needed. Maybe I need CBT instead. I just don't see the point of revisiting things in the past that are unpleasant, I've unpacked them all and the memories will always make me unhappy. Maybe I need to see someone else who is willing to see me only every other week. I just won't have the answer until I return in September and see how I feel after a few sessions.

I think my first practical goal should be getting into a routine of ADL's (Activities of Daily Living). I have been going downhill with keeping my place clean, remembering to do simple tasks, putting clothes away, things like that. But the depression makes it practically impossible.

Thank you for sharing your cousin's point of view as a psychiatrist. I think that is the first provider I have heard of who understands what I've been trying to say when I've told various providers that just the fact of seeing them over and over makes me feel damaged or something. they never get it.

Unfortunately I do not have a partner and do not want one, so I have to take care of myself. Maybe that is what's keeping me going.

I will let you know what happens as the break continues and after I return to therapy. Sorry for cutting this short, but I need to go to bed. Thank you for your support.

I have been in and out of therapy since I was in 7th grade. I am 49 years old now and I haven't been in therapy for approximately 10 years. I kept reaching the point where it was no longer making any difference in my life - good, bad or otherwise and stopped.

The reason I haven't gone back this time, and the reason why I always had trouble going back before, is because I feel it to be an enormous waste of my time - and especially (specifically) MY money - to have to go all the way back to my mother's womb when I have already moved on from all of that. To be fair, I understand why therapists need to see where I've been, to see how I got to where I am, to see where I need to go, yet I. Just. Can't. Do. It. Thankyouverymuch.

Update:
I have been back in therapy for about 5 sessions. A couple weeks before I went back, my psychiatrist asked me to take the Beck's Depression Inventory because my insurance company demanded it for my TMS appeal. I scored as Severe this time. My diagnosis has always been MDD, Moderate.

As far as returning to therapy goes, I think taking a break had a neutral effect on me (other than the effect on my wallet being a positive). I've been gradually cutting people off and becoming isolated, it's been creeping in since the beginning of this year. When I went back last month, I told her right away about aspects of my behavior that are concerning me - the outbursts and total indifference towards friends and family - and we have continued to discuss it. Wish I could remember what she said other than it's totally understandable given my level of depression and to be kind to myself, but it all goes in one ear and out the other. She tells me isolating myself is not doing me any favors, but I'm not interested in engaging with anyone. I think I'm pretty unreachable to any chance of therapeutic benefits unless I find some other medication solution because I'm pretty despondent.

3 weeks ago, the insomnia brought on by my MAOI dose finally broke me and I actually started having anxiety at such levels that it was interfering with basic daily activities. I had to reach out to my therapist for a "talk down" call. Not suicidal, but just feeling totally helpless and out of control and unable to concentrate. She talked me for about 25 minutes and then talked to my psychiatrist, who called in a sleeping pill prescription which did not work for me but I appreciated the try anyway. I saw my pdoc the next week and I asked to come down on my med because this side effect was becoming a quality of life issue. My sleep improved almost instantly after I dropped down. Unfortunately I am dealing with the bad timing of a back injury (due to lying in bed depressed all of these months on a bad mattress) but now if I do wake up, it's back pain and not the activating effects of my EMSAM. Also, I have no idea how long it takes to "right the ship" after 9 months of sleep deprivation but I'm dealing with horrible fatigue from the fallout of all of this.

Wish I had an update that was more conclusive.

Thanks for getting back.
I'm happy to know you're still on the planet but very sorry you're feeling so very depressed!!

I'm glad you had the therapist to talk you down when the anxiety got out of hand.

Sorry you didn't really come to a firm conclusion what was best to do and if the therapy can help.

I really hope you get some glimmer of light somewhere.

Thanks for replying again. Yeah, I haven't needed to talk to a therapist outside of a session in probably 10 years.

The only thing that helps is when night time comes around. I hear that's when your cortisol hormones are naturally at their highest. But I know lots of people don't like that it's getting darker earlier (I am in North America).

That's interesting, I sometimes feel better in the evening too.

Hi with. A lot of what you say deeply resonates with me. I've had therapy go on for long periods, stopped, gone back, etc.

IMO, it may be the case that, at this particular moment in time, you have exhausted what good you can derive from psychotherapy - for now. That's not to say that, at some future point in time, it might not benefit you again.

I've had so many of the same experiences that you are relating and have asked myself so many of the same questions. There were intervals of time when I would come out of a therapy session all wound up and feeling like I needed a few drinks to settle down. I would highly encourage you to take a break and used the money saved to pay down some bills.

Maybe therapy can be a godsend to some people at certain points in their lives. But for people, like myself, with chronically recurring depression, I think very long-term therapy is overrated. I did it for a long time. I came to believe that I was going because it felt good, while I was in the therapist's office, not because it was leading to any improvement in my life. So I stopped seeing a therapist I had been seeing for 19 years. I did go back, down the line, in therapy with other therapists.

I believe there comes a point where you can feel like you're really just spinning your wheels. There are times when what you most need to learn is something that can't be learned in a therapist's office. I think having interpersonal issues is a sign that you may be at that kind of a point. Somethings you have to learn in the laboratory of life.

A childhood trauma like your identity issue related to adoption is, I think, the ideal sort of issue to explore in therapy. But there's a limit to how much you can profitably kick that around. Your therapist, and possibly you, might feel like you could continue exploring that issue for months to come. And you probably could. But to what end? It might be something that you could profitably return to in the future. But you may have done as much as you can do with that issue for the time being.

I think a lot of therapeutic relationships go on way past the time that anything really therapeutic is being achieved.

I haven't been in therapy long-term, and I know you wanted this topic to be depression-specific, but after reading your post, I feel compelled to put this forth:

Have you ever been evaluated for ADHD?

Some things that make me wonder:

I know depression can cause this too, but my biggest source of failing at all those little responsibilities of life was my executive dysfunction (ADHD) rather than my mood. Particularly, initiation impairment.ADHD and Autism/Asperger's seem totally different if you look at the diagnostic criteria, but the problems faced by people with those conditions are weirdly similar, at least for the relatively "high functioning" forms of autism.

If you want to push the autism angle, the DSM-5's "autism spectrum disorder" diagnosis should still account for Asperger's. (It's not the that APA decided that Asperger's wasn't a real problem, but rather they decided it wasn't really all that different from HFA.) However, I've found that it's harder to get an autism diagnosis than an ADHD diagnosis, and it typically gets you access to less treatment than ADHD.Abilify is a dopamine agonist, so even though it's not normally used to treat ADHD, it theoretically could. However, many folks have problems with dopaminergic drugs only working temporarily, especially at low doses.

For whatever reason, ADHD is diagnosed more often in people who were adopted. (That applies more in certain situations than others; not sure if it's relevant to your history.) Plus, ADHD often goes unrecognized in females, especially in the past.

(And one of your past topics about financial problems.)

I don't know, I could be way off base, but it might be worth at least taking one of those screening questionnaires if you haven't already. I have ADHD and depression, and I have found that when my depression is well-treated but my ADHD is not, I'm still horribly sad (enough to get "moderately depressed" on the Beck Depression Inventory), just because untreated ADHD really sucks.

Sorry, I didn't see your post until now. I don't recall any professional ever suggesting ADD or ADHD in my life. I've always assumed it was depression and anxiety doing the damage. I have always been chronically disorganized and a bit of a slob, like you quoted in my previous posts, but I never thought that was a separate "clinical" thing because lots of people are disorganized and they don't have a mental illness. It has been more difficult for me to do everyday tasks in the past 3-4 years than it ever was before. I don't know if I'm making any sense in my response. Anyway, you have given me something to think about. Thank you.

I did not start therapy until I was in my late 30's to 40's. I wish I had started earlier due to many anger/depression issues that affected my parenting abilities. I have, pretty much, been in therapy most of the time since then. I have occasionally taken a brief break ( maybe a month) but usually life throws me a curve and I realize that I have made progress, but still need additional skill building.
There are times I get frustrated and feel like a perpetual mess( mental patient), but I realized as I was contemplating my response that I am gaining new skills to deal with my situations. My therapist knows me very well (we have been together for quite a while) so knows best how to deal with me when I'm being self destructive and uses my own logic skills to get through to me when I'm in a difficult spot.
I don't think break from therapy are a bad decision. Sometimes a bit of distance gives a chance to utilize the skills you have learned.
I hope my post helps a bit.

(((With or Without you)))
I've been going to therapy for 10years and I started going when I was 34. I'm 44 now. I've been with the same T for that time, however I did take a break or two and tried a different therapist as I thought my therapist didn't have anything else to offer. I tried a few other therapists. One was OK but she basically couldn't help me any more than my current therapist. The second therapist I felt a connection with but I feel like she pushed me too hard and she was really far from my home.

I decided to go back to my original therapist and I'm glad I did. She learned some new techniques (EMDR) and I've been with her since. Part of my reasoning for wanting to leave her to begin with also had to do with me having fear of feeling close to her and trusting her with my 'ugliness'. I have abandonment issues.

When I started seeing my T I had minor depression and 5 years ago I fell into a major depression and was in an outpatient program. That program helped me a lot. Since then I was OK for a while (3 years). The last two years have been not severe but not mild. This past August I started sliding back into a major depression. I've contemplated going into the hospital but going, inpatient. The only reason I've been able to stay out is because I'm almost never alone and I would never want to hurt my kids by killing myself. Another option for me is going outpatient but that is very expensive even with insurance.

I typically see my psychiatrist every month but I've been going every two weeks most recently as I've been feeling worse (downward spiral). Right now I'm seeing my therapist weekly and sometimes check in via phone or email another time during the week. Most recently I joined a free support group at the mental hospital and that helps me feel not so alone.

Not sure if any of this helps you but I feel your despair. For sleep I've been taking 100mg of Trazadone and that has helped otherwise I get no sleep. Abilify isn't something I've tried before but I'm going to discuss it with my psychiatrist. I'm also taking 100mg Pristiq and 300mg Wellbutrin. I'm not sure if I want to add another drug to my regimen. I am thinking about trying TMS (less severe treatment compared to ECT).

Please know that you aren't alone. Seeing your post has helped me feel less alone as I drown in this depression. I'm here.

I've been in and out of treatment for 15 years, and nothing has ever really helped me. I have been hospitalized before, and also recently tried a partial hospitalization program which was a disaster. If anything, I think I'm better off without therapy. I often feel more misunderstood because of therapy and as a result become more depressed, so yes, breaks have helped to a degree. I have also tried many medications with little to no effect, so I can relate to that frustration as well.