There does not seem to be an agreed upon definition of long-term psychotherapy. I have been a psychotherapist in private practice for almost thirty-five years. I work with children, teens, and adults. I believe that treatment lasting a year or longer should be considered long-term psychotherapy.

Who benefits from long-term therapy? Those who have experienced intense trauma in their lives as well as those whose traumatic experiences have made it difficult to trust others or even know how to enter a trusting relationship.

Examples of intense trauma are being a victim of sexual, physical, or emotional abuse; experiencing the death of a loved one; living through a natural disaster; experiencing parents’ divorce; losing employment; experiencing parents not accepting gender and/or sexual identity differences and living through a pandemic.

Clients reach out to therapists for multiple reasons. They may have recently experienced trauma and are having difficulty returning to work or school. They may find themselves crying a lot, having difficulty sleeping and having no appetite.

Others are tired of having difficulties with relationships. They feel as if their lives are without meaning and cannot seem to connect with others for more than a moment. They may be experiencing depression or anxiety that leads them to search the internet for therapists who may help them.

They wonder, and often do not share with others, whether the trauma they suffered during childhood has anything to do with feeling lost and hurt.

This connection is sometimes shared with the therapist in early sessions, or it can come out later once the client develops a sense of trust with the therapist.

 Benefits of Long-Term Psychotherapy

1. Working with a client for a long period of time allows the client/therapist relationship to grow.  Both parties can learn to work effectively with one another.

2. Healing from trauma takes time and working long-term with a trusted therapist allows that healing to occur. The issue of trust may be the most important element during treatment.  Trauma teaches people not to trust.  Major aspects of the work are to focus on the reasons for distrust and find ways to understand what safety looks and feels like.

3. The client could work through transference issues and share negative feelings about the therapist with the therapist. Transference happens when a client has feelings about the therapist’s interactions that remind her of her relationship with a significant person in her life. The goal of the client sharing negative thoughts about the therapist with the therapist is to discover that one can be honest without eliciting an abusive reaction.  The therapist needs to be very skilled in this area because the therapist’s feelings may be hurt, but must respond in a caring, thoughtful way that feels positive and safe for the client.

4. The client gets to practice her new skills out in the world.  She learns to deal with conflict in a direct way when it feels safe and avoid the person if it feels unsafe.  Through the therapeutic process, she learns what situations are safe and what aren’t.

5. The client finds her voice and learns to be unafraid about speaking her mind in personal and work situations.

6. The client learns that trauma is something that can be worked through and gives her confidence that nothing is unsurmountable.

7. The client begins to set clear boundaries and understands what she is and isn’t responsible for in a relationship. She learns to stop people pleasing and putting others first all the time.

8. The client learns that grieving losses is a normal part of life.  She no longer feels shame when experiencing sad memories.

9.The client discovers trust with a therapist and then understands/experiences trust with friends, family, partners.

10. During long-term therapy, the therapist often meets the significant people in the client’s life.  The therapist is available to provide validation to her feelings about these folks and help her work through issues connected to them.

Some of my long-term clients reviewed this blog and shared their insights: 

• Everyone can benefit from long-term treatment, not just trauma survivors. 
• Long-term therapy can benefit anyone who is looking to develop self-awareness and build a healthy relationship with themselves. 
• Long-term therapy clients can learn that many of their presenting issues stem from childhood.  One can learn to have a better sense of expectations of others and not expect them to take on the role of therapist.
• Long-term therapy can help clients recognize cues that indicate trauma is being experienced and when reactions are caused by or result from trauma and which responses are not from intense abuse.

In conclusion, long-term therapy can improve the quality of the client’s life through the work with the therapist.  The client can learn to be in touch with her feelings, learn to be tolerant of ambiguity and thereby develop patience to deal with the unpredictability of life.