To think it's unethical for a Psychotherapist to have a client for 15 years?

[canyoutellemehowtoget]

I've been looking for a therapist recently due to a trauma I experienced at work a year ago.

I had therapy when my marriage broke down a decade ago so I'm not completely new to it.

Had an assessment session with a private therapist recently to see if we were a good fit for one another. I asked him about his experience and - because he said he offers long term therapy as well as short term - for some reason I asked what the longest amount of time he's worked with a client is.

He said he'd been seeing a client for 15 years (weekly, not on and off - I checked).

I did like him, or at least could gel with him, but this just gives me weird vibes.

How can it be ethical to take someone's money weekly for a decade and a half? Surely the idea is to make progress and outgrow the therapy?

YABU

Some people use therapy as a way of getting past something and it’s for a limited amount of time.
I’d say the majority have a limited amount of therapy sessions.

But some people use it as an ongoing thing to help them deal with every day life.

I know someone who lost her husband in traumatic circumstances and every issue or milestone that her child has means it brings it all back up and she can’t cope so ends up seeing the therapist again.

I believe she sees them once a month and has done for years but that’s her way of getting through it.
I guess it’s almost like a substitute husband, as instead of discussing her worries about the child with her husband like many couples do, she discusses it with her therapist.

I get what you’re saying about taking money off them but I’m not sure I’d feel comfortable telling them I can’t help them anymore just because it’s been a certain amount of time.

Well, since psychotherapist is not a protected title, you could be seeing someone who a week ago was a trolley collector at a supermarket, (I am one), why does it matter?

I’ve only just seen this in one of your posts OP…

And he said well short term could be as little as 6 weeks then randomly gave me a potted history of his longest client, which I most definitely did not ask for.

The giving you a potted history of the client is a major red flag. That’s a confidentiality breach. We should not talk with our clients about any specifics relating to other clients we currently have or have had. I might talk about having worked with certain issues in a general way, or I might say “some people who experience x have said they often feel y” but I would never ever give any sort of details relating to any other clients I have or have had. I would suggest this is a much bigger red flag than the length of time working with the client.

A good friend of mine is a therapist who has now retired except for her very long term clients.

They are very, very damaged people who will never be 'cured', only managed. Their treatment is generally covered by insurance/government healthcare due to the nature of their trauma. For anyone else, she sets her fees so as to be accessible to people on low incomes who need help.

OP you are assuming that therapy 'fixes' a client's life. It's true that for many people with a specific problem, they may find a therapist who helps them reframe it and move on. But life throws constant challenges at us and if someone chooses to work on them via a therapist - a sort of weekly mental work out, for MH maintenance, like going to the gym every week, then why not? It can be a life long ongoing process because life is not static.

The idea that therapy is to 'cure' someone is both outdated and offensive

My concern is that if the client becomes very dependent on the therapist over many years in order to remain stable or to cope with life; what happens when the therapist retires, becomes ill or dies? The client could well end up in a worse place than they were before because they’ve lost their only coping mechanism.

Sorry for linkdumping, but this comedy therapist clip always makes me laugh. No chance of it taking 15 years with this guy:

When you eventually find a therapist you do want to work with OP, see what they make of you telling them how to do their job. I expect working through that will be quite a big plank in your therapy

After fifteen years I would guess it’s more emotional support now. Some people
unfortunately can’t or don’t have anyone around them that they can talk to.

This is extremely judgemental of me but I feel they can't be that good if you need to see someone for that long. Although maybe that person doesn't really have any friends to talk to in RL and they must be getting something out of it

I'm aware of that, I was paraphrasing what the OP was implying and disagreeing with her.

I've been in therapy for almost 4 years now. See my therapist on a weekly basis at £50 a session. The only time We've missed session is due to holidays or when I gave birth- after which I took 4 week break. Seeing her weekly is taking care of myself- it's part of my life. I don't envision stopping anytime soon and will continue as long as she does!

I’m seeing my counsellor, not a psychotherapist, for 7 or 8 years.
Without her support at certain junctures I would have sunken, but I’ve had a fairly catastrophic series of events happen in the last ten years. Before that I’d never have imagined needing counselling for so long but it’s something I think of as for me now: it is now about getting me over the worst part of PTSD into a more functional life and getting through a pending court case. Before it was getting used to life after a stillborn baby, failed ivf after that, the decision to take ivf, a pregnancy that resulted in my seriously disabled DD, family issues past and present, problems with work when I worked, my health, SA by my daughter’s doctor and the 3 years of shit I’ve had since then..
Its not a waste of money in my eyes

Hi op. My sister has been seeing hers for 8 years. People see psychotherapists for many different reasons as I'm sure you know. In her case she has functional neurological disorder and regular therapy (once a month but up to once a week if she has a flare up). She may always need this. We hope she won't. I'm in therapy atm too and expect to be for around another six months. But I know that over the coming years I can check in with mine. Self maintenance I suppose

Why on earth would it be an issue? Sounds sensible to me if it works

@canyoutellemehowtoget

Hello OP

I was interested in your words here:

What if they feel dependent and the therapist keeps taking their money instead of helping them to build their own coping resources?

I think this raises a real question of how does therapy help and how does someone build resources.

I agree with you completely that the end goal of therapy is to help someone manage better in their life.

After many years as a patient i have learned not to fear dependence.

I have understood that it is through (appropriate and boundaried) dependence that people can develop and grow to become more independent. And this makes sense doesn't it - after all that is how infants and children develop. At first there is total dependence on the parent - gradually if all goes well people internalise a good parent who is then always available internally to help them.

Those people we are around us who are very functional and very capable - they are not doing it alone. They have a good internal parent who helps them.

In a psychodynamic or psychoanalytic psychotherapy or psychoanalysis relationship people are helped to develop and grow, not by being "told information" nor even by having all their feelings totally validated all the time. Instead what helps is a safe setting where the patients dependency needs can be taken seriously as it's only through the meeting of those needs that a person can grow more independent.

Of course dependence is difficult and painful. Your therapist has holidays when you miss them so much. They have other patients of whom you are jealous.

Because it's so painful most of us have very powerful defence against needing anyone and are suspicious of any kind of dependence whatever seeing it as a problem to be avoided.

But it is the dependent relationship that heals - the painful feelings that come with it have to somehow be borne and if the patient can bear to talk to the therapist about it the therapist can help him to beat the painful side of dependence. The challenge for the patient is to allow herself to feel those feelings and not trample them down out of all experience. Because they hold the key to getting better.

If people have a history of abusive families then it is extremely hard to trust and depend on anyone and very difficult to have a strong internal good figure to help you in life.

OP I think your response to this consultation could be really good starting point for your next consultation if you have one. Your fears about exploitation, your fears about dependence, about trust and ethics.

Sounds like some part of you knows you need a relationship of this kind but at the same time it is really terrifying to make yourself vulnerable like this when you are used to depending on no one and managing by yourself.

Good luck