There is no doubt that for some, therapy is a long, even a life-long process. But for others, in fact for most, it does not have to be that way. In fact, it can be quite short term. For others till they can do a little now and do a little later . . growth can occur in short spurts.

There are certain people for whom therapy needs to build or rebuild their basic core functions-anxiety mastery, the ability to connect, impulse control and even moral development. Through the relationship and ‘outfit’ changes (that is, attempts to do things differently in the world) certain people can make great changes.

Most people who come for therapy are “neurotic” and can get to their issues and come to resolution in a shorter period of time. It is a matter of getting to the place where the ‘stuckness’ occurred. For most, re-living ones childhood in months of therapy is not critical.

Most people come in because for some reason or another they are stuck and/or unhappy. Most people too have been doing the same thing for years and have been getting the same results (the layman’s definition of insanity). For many it is a matter of willingness to do things differently. For others, it is a much harder challenge.

Jonathan Alpert’s article in the NYTimes in April ( makes an excellent point. Therapy can be and is often time consuming and largely ineffective. For one, many therapists are il equipped to deal with the patient. They know psychopathology and can cite research but working with someone requires a different set of skills. Jonathan is right, simply asking the patient how they feel (a gross exaggeration of his message) is overly simplistic and often not therapeutic. Working in the here and now is critical although references to the past are important only as they effect the here and now. The silent unengaged therapist of the past is not effective for most. People need to be engaged and it is the relationship that often leads to the change.

On the other hand there are those who stay with little change. For some it takes time to feel safe enough to acknowledge and then to share their inner most conflicts. What can a therapist do when a patient takes three months to share of their marital affair or a patient who takes one year to feel safe enough to share of their internal dissociation? Confrontation too soon often sends people away.

Jonathan makes a good point (although ihs data is too short term to be reliable)-therapy for most does not need to take a long time. He cites a U Penn study that found that traditional therapists will make a determination as to the efficacy of therapy after 22 sessions. I have long said-when pressed for time frames (usually by someone who needs it the most) not to make any determination until they have attended twice weekly for three months.