The Case Against Long-Term Therapy

By Marty Nemko

Every time I get a new client who says he has been in long-term psychotherapy, my stomach drops. Why? Because as I look back on my 2,000 career counseling clients, those that have undergone extensive therapy are among those least likely to land a good job or make a career change.

Of course, part of the reason is that the type of people that have been in long-term therapy are likely to have personal barriers that inhibit career success. But I’ve come to suspect that long-term therapy itself can damage one’s career.

Of course, psychotherapy, especially short-term therapy, has helped many people, and for severe mental illness, longer-term support may be needed. And at the end of this column, I’ll mention ways to get unstuck including how to make the most of therapy. But because long-term therapy is popular, I want first to alert you to its potential negative effects:

Long-term psychotherapy can encourage narcissism. It’s all about you. People who have had lots of therapy are often boring to be around. All they seem to care about is their own internal workings and too often whine in self-pity. That rarely improves relationships in or outside of work.

The eminent psychiatrist Karl Menninger was taking questions from an audience of fellow therapists. One question described the case of a depressed woman that the questioner had no idea how to help. Everyone in the audience expected Menninger to recommend even more frequent therapy. Instead, Menninger opined that this person’s problem is self-absorption, and that she should stop psychotherapy and start caring for someone else: volunteering, helping others at work, even getting a puppy.

Long-term therapy can create unhealthy dependency. More than one client has told me that they became so dependent on their therapist that they panicked when their shrink went on vacation. Such dependency doesn’t help a client function in the real world. Some therapists consciously or unconsciously encourage dependency because it feeds the therapist’s need for dependency. And all therapists have a conflict of interest: On one hand they want the client to be cured quickly, but on the other hand, they make more money if the client stays in therapy.

Therapy can rationalize inaction. Unless you’re a true star, landing a good job today requires assertiveness, even audacity. Procrastination is career death. Yet therapy can inadvertently encourage inaction. When a person procrastinates undertaking a job search, it often truly is laziness or unwillingness to push past one’s fears. But therapists usually legitimize the inaction by assiduously avoiding such words as “lazy.” Instead, these therapists offer inaction-inducing balms such as, “With your father having been so critical, it’s easy to see why you lack the confidence to move forward,” or “We need to work through your fear of failure and rejection,” or “Let’s look at the secondary gains you accrue from procrastinating your job search,” or “Your husband left you, so it’s understandable you suffer residual effects. “ Some clients use such information effectively, but many others ruminate themselves into analysis paralysis, a mental straitjacket, an inability to act.

Therapists also encourage inaction by resisting giving advice. Few therapists will say, for example, “You really should consider Option X.” Many people, however, can be moved to action by carefully dispensed advice.

A number of my clients have spent years in therapy yet remain chronically un- or underemployed, but giving them just one tough love lecture has shocked a surprising number of them out of complacency and into more rewarding worklives. Here’s a version of that tough-love lecture:

I’m going to pretend I’m not a counselor but a jerk: “You are a loser, an excuse-making, lazy loser. You have so much potential but you’ve pissed away your life by blaming everyone but yourself for your failures: your mother, your education, your boss. ”Or you say, ‘I’m just hard-wired that way.” You may be, but many people with your wiring have made a helluva lot more of their lives. Keep going and you’ll always be a loser.”

Now, as I said, that wasn’t me talking; that’s just what a jerk might say. What would you say back to that jerk?

Nearly every client has responded, “That jerk is right.” And many of them have been at least modestly more successful in his or her career as a result of just that one tough-love lecture.

Too often, therapy gives you insight into yourself but your life is no better. Please think twice before entering therapy expected to last more than five or ten sessions. If you’re already in long-term therapy, ask yourself: “Has the therapy improved my life enough to justify its cost? Has it made me narcissistic? Has it created undue dependency?”

If you’re looking for alternatives to therapy, ask yourself whether a tough-love lecture would help. Or find a good self-help book—so-called bibliotherapy. If you need human support, before running to a therapist, schedule regular check-ins with what Richard Bolles, author of What Color is Your Parachute calls “a loving taskmaster.” If that’s not enough, then perhaps sign up for a few sessions with a good career coach or with a therapist who specializes in brief cognitive-behavioral therapy. For a book on that subject, see San Francisco therapist Michael Edelstein’s book, “Three Minute Therapy.”