Commitment In Psychotherapy
Posted by Dr. Vollmer on November 11, 2013
“Thursday at 2 pm is your next appointment,” I say, understanding that time set aside is a sign of respect and concern for the patient’s sense of well-being. Coordinating calendars is an activity which says “you are important to me,” As such, I have deep concern over the time-limited therapies which communicate that after a specified dose of psychotherapy, I will no longer be interested, or am no longer able to help you. Yes, these time-limited therapies then offer future referral sources, but the idea that my commitment to you, is from the outset, short-term, communicates that the patient is of limited value. There is something very important about the message that I will be here as long as it takes for things to improve; as long as we can agree to struggle together. Whether this translates into three weeks or three years is not critical, but what is critical, is the willingness to try, as long as need be. This, once again, brings us back to Winnicott’s “holding environment” where a critical therapeutic action, is the ability to be present, to hear what is said, and to show up again, and again, and again. When a licensed professional says “let’s make an appointment,” the meta-communication, is you are important, and we need to devote time to your issues. Likewise, when the licensed professional says “we are done with our ten sessions,” then the meta-communication, is I am no longer able to help you, sometimes leaving the patient to feel that they are hopeless. The therapist can say “you can get better, but I have to stop treating you,” and that could help the patient’s self-esteem, but my concern remains that the feeling of abandonment, triggered by the forced shut-down of limited sessions, can, for some people, result in a lowering of self-esteem, and a trigger for past experiences of isolation and betrayal. Yes, the therapist is being honest with the patient, but the patient could still feel that “if you really cared, you would not stop treating me.” I would say that this is “betrayal” with little “b,” meaning that it is a mixed message to try to help someone and then tell them that you are done helping, even if they are not done hurting. Limiting psychotherapy sessions is the future of mental health care for millions of Americans who will now have health insurance. On the one hand, it is exciting to see that the mental health needs for so many can be addressed, unlike before, but on the other hand, it could feel like one big tease.