Therapy For Depression: Should I Stay Or Should I Go?

A client comes in to see me. When I ask how long she's been depressed, she replies, "Probably my whole life." The odd part is not the lifetime of depression. Sadly, I hear that more often than you might think. What's odd is when we meet a second or third time. I learn my client is considering dropping out of therapy, because, she says, "I don't think I'm getting any better."

Here's the thing ... while therapy is supposed to, and usually does, instill hope for the future, if you've been depressed your whole life, can you really expect to feel significantly better in a week or two? According to a recent book, 20% of the time clients drop out of therapy early, most often because they have unrealistic expectations. The most common is that dramatic, sustained change will happen after the first session, or two. The unusual and sometimes confusing nature of the therapy process itself can also drive clients away. It's my job to see to it that any questions clients have about the process are addressed, but I'm not perfect. Neither are my colleagues.

So, in case we fail to help you clear up any misconceptions, you can take charge. These are some of the things that drive people from therapy. I encourage you to discuss any that are relevant to you with your therapist:

1. How long will it take? 

This is a great question to ask, with one caveat. Don't ask me how long it's going to take before I've met you. Knowing you have anxiety, and spending 45 minutes learning about your specific anxiety, are two different things. After the session, in which I'll learn more about your anxiety, I can give you a much better idea of how long I think it will take. As therapists, you commonly are asked how long you think it should take, which is good information.

2. Why aren't I getting better?

You may see improvement initially and then hit a low point, or you may feel things are not changing enough. Therapy, like life, has its ups and downs. When you feel things aren't progressing, talking to your therapist about it can be useful. It may result in a change in strategy or a reminder that there's light at the end of the tunnel. Sometimes your therapist may agree that an impasse has been reached and a referral to another practitioner might be in your best interests.

3. How do I share my innermost thoughts and feelings with a stranger?

Of course it feels weird to bare your soul to someone you know little about. It's hard not to wonder what they'll think. Your therapist may explain that it's useful not to know much about them. Some therapists will ask what you need to know about then to feel more comfortable. Consider that you probably don't know much about your physicians, yet together you may face  life and death. In therapy, as in medicine, the focus is on you, not me.

4. What if I don't need to come back?

Sometimes people don't want to return because they feel they've improved. This is good to talk about with your therapist. I worry people will rush off after a bump up in their sense of well-being, but that is short lived. I like to talk to people about sustaining gains.

5. How will I know when I'm finished?

It's sensible to have your therapist help you quantify goals so you can tell when you've cross the finish line. Examples might include when you feel happy more days than not, haven't had a panic attack in three months or can talk about your ex without becoming hysterical or furious.

6. Are you going to be a jerk, judgmental, or aloof like my last therapist?

It's absolutely fine to tell your therapist all about your last awful therapist so they don't make the same mistakes. Telling your new therapist what you liked about previous treatment is also useful. I like to know what worked and what did not.

7. What if I didn't like what you said last week?

Please, tell me! Maybe you felt misunderstood, that your therapist was cold or that they're just in it for the money. All of these are valid feelings but they might be related to a misunderstanding of your therapist's intentions or your therapist failing to "get you" on some issue. Your feelings about your therapist can be addressed as part of therapy.

8. What are the sessions going to look like?

Many people are nervous about facing new situations. Asking about what you can expect or what you need to do to prepare for sessions is perfectly appropriate. Letting your therapist know how you'd like the sessions to look is helpful.

If you have any of these questions, ask your therapist. Like all relationships, the therapy relationship is dynamic, it grows and evolves and we each bring something to the table. Communicating about the process is extremely helpful, as it is in all relationships. With all of these issues addressed, you might decide it's time to move on, which is okay. Or, you might decide to continue in a constructive relationship, recently enhanced because you asked the hard questions.

Judith Tutin, PhD, ACC, is a licensed psychologist and certified life coach. Connect with her at drjudithtutin.com where you can request a free coaching call to bring more passion, fun and wellness to your life.