Posted by fallsfall on December 16, 2004, at 12:34:36
In reply to Length of CBT treatment, posted by dawnfawn on December 16, 2004, at 10:01:28
I think it is wonderful when CBT can cure a severe depression in 1 - 2 years. Unfortunately, it does not always work, and that is why I ended up in longterm CBT. In hindsight, I probably should have changed therapists after 4 or 5 years, instead of waiting 8 1/2, but there were a number of different reasons that the change didn't happen.
I started therapy in Jan. of 1995. I was overly dependent on my best friend, and starting to drive her crazy with my obsessiveness. My GP referred me to an experienced, competent CB therapist. She said at the end of our first session that she would see me 6 - 8 times and things would be better. She also recommended that I go back to my GP and get medication (which I did).
Over the first couple of months, it became clear that my obsession with my friend was a real problem, so clearly I wasn't going to be "cured" in 6 - 8 sessions. We extracted me from the obsessive relationship, but that caused me to start to be suicidal for the first time in my life. So, we needed to work on skills to keep me safe. By August I was hospitalized. I saw her twice a week for a year (?) after that and became more stable as far as suicidality was concerned, but also became more dependent on her. The CBT response to dependency is to force separation so that the client can learn that they are able to stand on their own two feet (at least that was the tact she took). This was excruciating for me.
In the next couple of years we did significant work on self-esteem. I left my husband after 19 years of marriage. I contemplated other very significant changes in my definition of who I was. And the dependency continued. So, during this time I *was* making progress in many areas (including the dependency, well, I learned not to call and to survive until my next appointment). There was no point where I was "stable", when it would have made sense to stop - I always had major things going on.
I was out of work on disability for 5 years, but was able finally to go back to work fulltime. I worked for 2 years, and reduced sessions (I actually had an appointment scheduled for 3 months!!!), but after 2 years I crashed again and wound up back in the hospital. So we did try reducing therapy while I was doing better (with some success), but then, since I was suicidal again, stopping therapy didn't seem like a very good idea. It was hard to even *talk* about stopping, or about changing therapists because I was so attached to her. This was probably a red flag - she couldn't even bring up making a change because I would freak out. So she kept trying to reduce sessions, and that just made me panic more.
After about 8 years things started getting worse. I was caught in a transference where I felt that she was angry and disappointed, so I tried harder to please her. Every session was excruciating because I couldn't please her, and I would work between sessions trying to figure out what to do. I finally became so suicidal that I figured that if I kept doing what I was doing I *was* going to die, so thinking that I *might* die if I left her started to look more attractive. Because that meant that if I left her, I might *not* die.
To make a long story short, I switched to a psychodyanmic therapist. Within 6 weeks I was back in the "he's angry/disappointed in me" transference, and within a couple of weeks we came out the other side of that transference.
So, why did I stay 8 1/2 years? Because I *did* keep learning stuff. Because I *was* making changes in my life. Because I adored her. Because she *IS* a good therapist (it is just that after a while I needed something different). Because I was scared to leave and she was scared to throw me out. I probably should have left when I crashed after working for those two years, but I felt too vulnerable to make a major change like that.
That's my story. If I had been cured after 1-2 years, I would have gladly ended therapy. But CBT is not always successful the way it is "supposed" to be. She accepted me as a patient because in the beginning it looked like I was a fairly "normal" depression patient. By the time it became clear that CBT wasn't doing it for me, I was in deep enough that it was very hard to get out.
P.S. When I did leave, and was interviewing new therapists she did make a comment, sort of under her breath, "And did any of them say anything about the fact that you have been in therapy for EIGHT AND A HALF YEARS??". Clearly this wasn't the norm for her, either.
poster:fallsfall
thread:430242
URL: http://www.dr-bob.org/babble/psycho/20041210/msgs/430295.html