I’m not exactly sure why, but the majority of my patients seem to require long-term psychotherapy (1 year or more of psychotherapy). On rare occasion (probably 20% of the time), treatment can be completed in less than 12 sessions. Perhaps it is the nature of the referrals I receive. The problems tend to be more complex and at a personality level. But perhaps it is that the prevalent paradigms for psychotherapy are not interested in the best possible outcome. I don’t really know yet what the answer is.

But I do know, that recent research1, shows that long-term psychodynamic treatment is the best approach for complex problems. And it also seems to me that a vast majority of my patients have complex problems. What I am uncertain of, is “Do I see problems as being more complex than other psychotherapists?” or “Do I see patients with more complex problems than the average psychotherapist?”

Regardless, what I do know is that I have done absolutely no advertising in a town of less than 10,000 people. One of my biggest referral sources is a bar in a town 45 miles away (that I have never been to). All of my recent new referrals have come from this bar. The comment from my new patients is, “I know you treated ‘Jane,’ she had a lot of problems. I thought to myself, ‘If she can change, I can too. I saw all of the changes that she made, and I was amazed.’” The patients talked to each other and started car-pooling to get to sessions with me. Other than one individual, their problems were very complex, requiring long-term treatment (treatment duration greater than 1 year).

So, on average, I’ve seen longer-term psychotherapy have great outcomes. Along the way, there have been a few short-term treatments with great outcomes. But on average, “Longer treatment is better treatment.”

On occasion, probably 10% of the time, treatment is a failure. The patient drops out without completing treatment, and continues to have problems. This percentage is fairly subjective, but I think it’s a fairly accurate representation. I’d like to get this down to 1 to 5%, and feel that this is possible if I can get better at my job. I think the main point I’m trying to get across to you, is that long-term treatment may be one of the best solutions to many problems that folks have.

1 http://www.sciencedaily.com/releases/2008/09/080930164454.htm