How long is the therapeutic process?

Although my belief is that therapy should be a brief moment in one's life, of course the actual length of time will vary enormously and will also be function of the length of time you have lived with the issue and its severity. An anxiety problem which was left unrecognised or untreated during childhood will be more difficult to tackle in adulthood. Why? Because your personality developed around the anxiety core and you found - sometimes very subtle - ways to get around having to confront the object of your anxieties, hence avoiding having to feel anxiety altogether! Paradoxically, the more one avoids feeling anxious, the more the anxiety disorder is reinforced and installs itself. This is because avoiding the aversive object (the one that makes you feel anxiety) brings a sense of relief (the "phew! I'm glad I got out of that one!" feeling). For the brain and the body, this sense of relief is associated to a pleasurable event and so the avoidance is positively reinforced. This is known as negative reinforcement in CBT lingo (the aversive stimulus is removed). You actually learn to avoid the aversive stimuli because it brings your brain and body a reward. Length of treatment will also be a function of your motivation and willingness to change. During treatment, we encounter resistence to change and this is a very normal part of the process. Psychodynamic theory can help understand aspects of resistence to change in the form of defense mechanisms and internal conflict. There may also be an underlying hidden benefit that we have to discover before being able to change. The role of the therapist is to help you find the motivation and the strength to change.

Another factor that will play a role in determining the length of treatment is your ability to carry out assigned tasks and activities between sessions. These tasks are not particularly time-consuming but they may entail a certain discipline in that they will have to be carried out on a daily basis for a given amount of time. For example, I may ask you to monitor your reactions to certain situations by writing your observations down on paper so that we can discuss them in the following session. Or, I may ask you to set daily relaxation moments once I give you the relaxation techniques to use at home. I may also ask you to think about a certain topic, such as your values in life, in order to stimulate the change process. Both the client and the therapist have an active role in this change process.