THE LONG AND THE SHORT OF IT: Is therapy forever?

by Velleda C. Ceccoli Ph.D. on April 23, 2012

I had planned on writing a post on collaboration, something that has been on my mind quite a lot lately. Then, Sunday morning I woke to a New York Times article that got my blood boiling – In Therapy Forever? Enough Already (click link to view):

There are many reasons why it stirred me into action. For one, it begins with descriptions of bad therapeutic behavior, which all of us who practice therapy would agree is unconscionable- yet many things can sound that way when they are taken out of the context in which they occur. But ok, bad behavior is bad behavior and there is no excuse for it. However, the author uses such bad behavior to corroborate his idea that the longer a treatment goes on, the less helpful it is. Really?

Yes really, and this is substantiated by research which while published in scholarly journals, tells us none of the details of the population studied, its size, diagnosis, issues, treatment modality, etc. It just tells us that a whopping 88% of patients got better after one session! Imagine that. I find this insulting to both patients and therapists who spend many hours in dialogue with painful memories, behaviors and issues. One session? Not psychotherapy. Not in my book.

But here is the biggest issue I take with this psychoanalysis/ psychotherapy bashing article: it privileges the therapists’ authority over the patients’. While the author gives lip service to the notion that different therapeutic approaches work differently for different people, and at the same time suggests that there are relatively few “severe” treatment issues which would justify a longer treatment (take schizophrenia, he says, as an example!) – your ‘average’ depression or anxiety can be cured and addressed in one to ten sessions, and here is the kicker: a therapist of his ilk needs to aggressively confront the patient, give his opinion and advice as to what the patient should do, all while proposing a structured action plan for changing his or her life. We clearly have different views about what constitutes therapeutic authority. And therapeutic action. And how transformation and change come about. So here goes.

Almost 15 years ago the brilliant psychoanalyst Stephen Mitchell turned his keen eye to the issue of authority in the treatment setting  (see: ) attempting to clarify what psychoanalysts’ could legitimately claim expertise of. As one of the founders of Relational Psychoanalysis, Mitchell approached the psychoanalytic encounter as a complex matrix of interpersonal exchanges aimed at arriving at multiple understandings of human experience. Within such a view, psychoanalysts have an expertise in how meaning is made and arrived at, in the process of self-reflection and the ongoing organization and re-organization of experience. This is because the mind is understood as a series of self-interpretive constructions- a complex and dense theater comprised of many voices, events and relationships.

Those of us who work and think relationally, respect the fact that people need a sense of personal history and motivation to “knit their world together”. As psychoanalysts we study the way that those systems of meaning come together and are constructed- we are experts at following narratives, spotting omissions and gaps, and co-constructing such histories into useful and perhaps transforming narratives with our patients. Thus analytic authority is not based on my opinion or advice about something, but on my understanding of my patient, arrived at through numerous mutual, interpersonal exchanges which transmit experience and meaning relationally- through our subjective experiences of each other. My expertise lies in being able to sift through these experiences and put forth questions, ideas and feelings which may lead us to answers and perhaps more questions, but which are lived together through the therapeutic relationship. That is ultimately the way meaning takes shape-relationally.

Contemporary psychoanalysts believe that there is never one truth, but rather many, and in treatment, the issue is more about what becomes entrenched in our narrative(s) of ourselves as the truth. What shuts out other possible versions of truth and meaning and reduces our choices in life. What prevents further truths to be explored. Such analysts are experts at holding many versions of one ‘self’, and alternating between varying selves and self-states. Some would say that this is the art of psychotherapy.

Psychoanalysts can also claim expertise at reading and understanding affect and emotions.  In her research on psychotherapy sessions, and what is curative about the psychoanalytic encounter, Wilma Bucci ( concludes that psychotherapists have more emotional ‘schemas’ from which they can identify emotion and work with it. The language of affect is a natural part of the therapeutic encounter, and psychoanalysts have expertise in the labeling, containing and understanding of emotions on a wide spectrum of intensity. Often, it is the language of affect that requires words to be processed and understood, and this takes place in ongoing dialogue with one another.

Perhaps the issue of authority is murkiest due to the unbalanced nature of the therapeutic relationship. Often patients’ ascribe greater authority to the therapist than they do to themselves. This is inevitable and even necessary. After all, patients’ come to us because they believe us to be experts in our field, and the analysts’ authority is built into its asymmetrical nature. Yet, if the process is to work at all, it requires a collaborative relationship, which will likely need to be negotiated through many ups and downs, and will always question directives and opinions that shut out possibilities and choices.

The very asymmetry of the psychotherapeutic relationship lends itself to abuses of power such as the one implied in the NY Times article, and presented as  “what patients need”.  Furthermore, while psychotherapists can provide a structured ‘action plan’ I have rarely found this useful except for purposes of insurance and billing, as it reduces the complexity of the clinical hour to a heuristic hypocrisy. Such is not the nature of human beings or human minds. Interpersonal situations are complex actions in which consciousness comes into being through interactions with another and/or through self-reflection on those interactions. This means that events in the patient’s mind are knowable only through an active process of composing and arranging them -which happens in relationship to another.

Acknowledging the inter-subjective nature of the psychotherapeutic situation allows us to maintain a healthy respect for the patient’s autonomy while putting forth our view and experience of them as a co-constructed ‘truth’ that can be examined together. Owning our influence in the therapeutic encounter actually protects the patient’s autonomy and actively invites their participation in self-creation. To use a dance metaphor: patients lead and we analysts follow.

This means that the psychoanalyst’s expertise lies in her understanding of what happens when her patient begins to express himself and reflect on his experience in the presence of a trained listener, within the highly structured context of the analytic situation. The psychoanalytic relationship is one of meaningful engagement in which understanding of the other emerges slowly and over time, and is embedded in the fluid, interpenetrating mix of the encounter and the ongoing impact on each other.

Years ago Mitchell portrayed the analyst as an expert in collaborative, self-authorizing self-reflection. Conducting and protecting the inquiry being one of the major features of maintaining the relationship ‘analytic’: where the analyst attends to his own internal experience and is also mindful of the bigger picture, taking on the responsibility for the navigation of the relational terrain. The context specific intimacy of the analytic relationship highlighting its difference from any other kind of relationship- the constraints that it poses making it possible to open up self-reflection, self-expression and intimacy in a way that cannot happen in other relationships in our lives.

This psychotherapeutic process necessarily takes time because it is built on a healthy respect for the complexity of human experience and the recognition that despite the fact that as psychoanalysts we are experts in many of those complexities, we do not hold the key to health nor are we the arbiters of mental health. My patients are all intelligent, articulate people with complex lives and dilemmas, varying degrees of pain and trauma, severity, crisis, etc. They come to treatment because they have thought of many possible solutions about their issues and yet still struggle. For me to think that I can somehow come up with a better solution for their lives is a total abuse of the power and trust invested in me, and a simplistic and reductionist view of what constitutes growth, transformation and the therapeutic exchange.

Articles such as Jonathan Alpert’s essay in the Sunday NY Times do patients and therapists a great disservice by implying that change can come about without addressing the very fabric of who we are and how we come to be who we are.

Perhaps this post is about collaboration after all.

{ 15 comments… read them below or add one }

Jeff Howlin May 21, 2012 at 1:09 PM

Though I didn’t read the New York Times article that you referenced in this post, I have read other misguided writings like it before. I enjoyed reading your article thoroughly. Thank you for taking the time to defend the complexities inherent in competent psychotherapeutic work.

Jeff Howlin
CA psychologist


Stephen Rittenberg May 3, 2012 at 4:00 PM

Jonathan Alpert/ideas, as twitter/ Shakespeare. As Wolfgang Pauli said, when asked to comment on a physics paper: “It isn’t even wrong.”


Anne Marie April 30, 2012 at 4:27 AM

Hi Velleda. There’s been a response to this article in the NY Times in my College from the Counselling and Pschotherapy students. Is it ok if I direct them to your article to continue this debate?
Regards, AM


Velleda C. Ceccoli Ph.D. May 7, 2012 at 7:34 AM

Yes Anne Marie, please send it on, the more of us weigh in on this, the better!


Kara April 29, 2012 at 10:41 AM

Great, thoughtful response to a pretty ridiculously uninformed op-ed!
The author seems to have no understanding or respect of the complexity of the unconscious or working with its processes in a living person. He simply sounds like an ego-based life coach.
Thanks for writing!


Chewing Taffy April 25, 2012 at 9:37 PM

One has to wonder if the reason this guy’s patients “recovered” so fast was because he was such a jerk. I don’t think I’d last more than a few sessions either!

Like many others, I’m sure, I’ve found that therapy has helped me to rethink my life story, and make significant changes that have enhanced all of my relationships. I think it’s probably the best investment I’ve made (and continue to make) in my entire life.


jane hall April 24, 2012 at 4:29 PM

very nice article!
thank you.


gibbs williams Ph.D. April 24, 2012 at 10:57 AM

I take personal and professional offense at the article you mention above. The best way for me to express my strong feelings in defense of long term psychoanalysis is to share with you the result of my 11 year psychoanalytic experience meeting three times a week with no insurance. Although I entered my analysis looking rather well the truth is I was a ‘mess’ internally. I suffered from panic anxiety, deep despair, a split self, low self esteem, shame and guilt, low frustration,and hyper self consciousness, and poor self esteem regulation to mention a few of my symptoms and complaints. At the beginning of what would have been my 12th year of psychoanalysis my analyst returned from his vacation gravely ill. Soon after resuming my analysis with him he died. The following is a summary of my experience of his dying and death and the affects it had on me both personally and professionally.

The “ending” of my 11 year, three times – a – week psychoanalysis with my beloved psychoanalyst was a life defining experience due to the unexpected fact of his dying and eventual death. ‘W’ always went away for 2 months in the summer and would call to say he was back inviting me to resume my analysis. At the beginning of my 12th year W uncharacteristically failed to call. Checking the local hospitals I discovered he was a patient with a serious illness. He eventually called and we resumed the analysis with him notably weakened. Soon after we resumed W was clearly snoring. I spontaneously shouted: W you are asleep! Jolted back to consciousness he said in his remarkably professional manner even in this horrible state of being: ” if so: free associate.” I laughed then instantly in my mind came a traumatic memory of my mother dying of cancer when she was 40 and I was 15. For six months she was dying in her bedroom – a space I militantly avoided. I hated everything about the reality of what was behind the dreaded bedroom door. I only remember going in to see her about three times although it was probably more.
The importance of this traumatic memory was crucial to the eventual success and closure with my analyst personally and professionally.
I then felt the full weight of why I had shouted at him…..It was clear as a bell he was dying. I also knew I had committed myself to always telling him and myself the truth of what was on my mind. So I said how can I tell you that I think you are dying? He answered: ” I believe in the Truman doctrine: If you can’t stand the heat then get out of the kitchen”
This was at the end of this fateful session. As I got off the couch to leave his office he said: Gibbs I plan to be here for you next session. However if you wish not to come that is OK. I unhesitatingly answered: W if you are here – I will be here.
And so we met three more sessions. On the third I feel as if I had reached a degree of closure both of my analysis and my relationship with him. He died the day after my last session. He also gave me a photograph of Freud I had admired in his office. It is hanging in my office now.
I didn’t feel an expected grief reaction as I think we had done a lot of mourning in advance. For this reason I felt I didn’t need to seek out a new analyst. I was fine enough for the next six months. Then during the 7th month after his death perhaps brought on by a number of stressful events I suck into the deepest darkest depression of my life. I thought seriously of consulting another psychoanalyst but I quickly dismissed this choice as I was determined to ride this out on my own.
Most probably I connected with the repressed grief I never experienced when my mother died to say nothing about the deep personal loss I felt not having the pleasure of meeting with my wonderful psychoanalyst.

I feel as if I brought to bear all of the ‘lessons’ I learned during my successful analysis resulting in my ever so gradually experiencing myself working through this dreadful state of affairs. Finally emerging from this psychic darkness I felt as empowered as I have ever felt in my life. Clearly, at least for me, as a sample of one – I had irrefutable evidence that my analysis (our analysis) was an undeniable success.
I have often recalled this life defining experience in both effectively managing subsequently disturbing moments both personally and professionally. I figure that if I could successfully tolerate the death of my mother and my therapist and still feel empowered to continue to struggle with my own struggles (with powerful positive memories of at least my analyst ) then I could most likely look forward to a highly productive and gratifying life – which is in fact my experience.


Velleda C. Ceccoli Ph.D. April 24, 2012 at 8:39 PM

Thank you for such a personal reply. Yes, often analytic work blooms after the actual work, and certainly because of it!
It is as if many seeds have been planted, together by patient and analyst , and over time they come to bloom at different times in our lives, sometimes spurned on by particular events, other times, just on their own. Time is a most important part of our process of being. The relationship between analyst and patient is another. And the space to just be and just speak . You have captured this and so much more in your comment.


Helen Neame MClinSci April 26, 2012 at 10:23 AM

Thank you Gibbs, I cried as I read your post, it was very beautiful.


Eren June 9, 2012 at 8:37 PM

Yes! Thank you Maria. I’m glad somebody ageers with me about this article (and that it’s not completely a crazy rant). I think you also added some good points about why the article is upsetting. I agree with you that it doesn’t say anything new, and much of what it does say is obvious and oversimplified. Murphy’s argument is s a huge stretch, but that’s not even the main reason why the article fails. It fails more because it is poorly planned and poorly executed. How ironic for a piece of writing center rhetoric


Karen April 24, 2012 at 7:40 AM

Jonathan Alpert’s essay reminds me of a cartoon that I saw about Managed Care back in the 1990’s. The caption on the top of the cartoon said, “Managed Care.” The cartoon depicted a patient reclining on a therapist’s couch. The therapist is shown slapping the patient across the face and saying, “Get over it!”
Jonathan Alpert is just the latest “star” in the field of celebrity experts who has managed to curry the interest of today’s pop culture journalists. His kind of help doesn’t require any expertise. It can be gotten from an Ann Landers advice column.


Johanna Sartori April 24, 2012 at 7:22 AM

I thank you for writing this eloquent rebuttal to the Jonathan Alpert’s article. It illustrates for me the difference between behavioural “quick fix” therapy that is being pushed certainly in the UK by publicly funded bodies, and the richer, deeper, meaningful experience of a relational based therapy such as you describe. I don’t advocate dependency in a therapeutic relationship, and aim for my long term clients to experience a planned ending that sees them leave therapy when they are ready, feeling better than they did when they started. However, I fear that Alpert’s clients who have their problems fixed in one session, are those clients who leave feeling unheard, with the deeper problem still unknown and hidden deep within them. Hopefully these clients are strong enough to find their way to a relational therapist for real work.


Martha April 24, 2012 at 7:03 AM

The Times article pathologizes any client who chooses a process that reaches for more depth than a 28 day cure for symptoms.
There are many reasons clients pursue treatment – and many different ways to use, stay, or leave the process.
Thanks for this!



Michaele April 24, 2012 at 6:25 AM

Thank you for such an eloquent rebuttal.


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