When Therapy is Long Does Your Therapist’s Patience Grow Short?


Some phrases never grow old, never become routine. “I love you” is one.” So is “I don’t want you anymore.” It is not that we’ve never heard the words before, but that they are so powerful and fraught with significance (or so hard to say or mean so much) either to the one who utters them or the one to whom they are delivered. In therapy the dread-laden expression is different: “I can’t do more. I need to refer you. Treatment has been long. The lack of progress means we must stop.”

Yes, perhaps it is said differently or becomes evident not through language, but impatience or facial expression or indifference. Where once enthusiasm and intensity bloomed, now the counselor seems to be enduring you, too conscious of the time, growing weary of your moments together. Two of my readers, Claire and Rosie, asked me to write about what permits a therapist not to take this dreaded path, the one leading to his desire to dump you — hoping you “never again darken my door” even if he doesn’t say the precise words I just used. Thanks to them I will try. I speak for myself, but know many therapists who would agree with much of what they will find below.

  • I like people. I like stories. I like individuals, not groups. I try to provoke meaningful conversations even with friends, not small talk. The time I spent with my patients was the perfect environment for me to look into a person’s history, history being a favorite subject from my early school years on.
  • I learned to notice small signs of progress. Sometimes we advance in microscopic steps. We reach a plateau on the mountain climb of treatment and then must catch our breath or wait for the storm to pass. The old Chinese saying tells us, “A journey of a thousand miles begins with a single step.” Therapists measure their work in moving toward a goal, not reaching it in quick time.


  • The work is gratifying. Where else do people come to you, rather than requiring your travel? Watching others grow — helping them grow — generates good feeling on both sides. You receive thanks.
  • The work is an honor. New counselors find the responsibility almost overwhelming: another person places his well-being in your hands. A wiser, more experienced, older doc should know (or remind himself) of the implicit tribute his patients give him by their consultation and expectation of his help.
  • I received payment for my effort. It was easier to be patient with patients in the knowledge some of my compensation came in a material way. That said, in a handful of cases, long-term clients were thousands of dollars in debt to me before the sessions ended and they achieved the life they wanted. Yes, they did then pay me, usually over time. Healers must not be so self-sacrificing that they become resentful of those they treat.
  • The patient’s life was not mine or that of my spouse or children. While clients sometimes wish to be closer to their doctor, the therapeutic distance created by him makes it possible to put treatment still-points in perspective. I am less calm and understanding with my wife and adult children than with those who sought my professional skills. I cared about the people I treated, but (usually) not to the point of a disruption of my equanimity. Thus, I tended to be patient with a lack of movement, thinking of such episodes as a rather commonplace experience not usually requiring a desperate and immediate remedy.
  • I was responsible for making therapy fresh. A therapist’s job is to bring his intense focus to every session. He must also reflect periodically on whether he has missed something important. I reevaluated my patient and my approach, made course corrections as needed. A therapist who is often bored or unable to change perspective and look anew at the client is in the wrong profession. I kept it interesting both for myself and for those who put their trust in me. A patient is not your entertainer. The counselor should be emotionally and intellectually engaged on his own
  • Of course, if you aren’t putting in the effort, you might wear the therapist down. If you are simply paying for a friend, buying his time because you have affection for him (or using him to replace a missing social life) then he should recognize this and talk to you about it. So long as you rededicate yourself to “the work” of therapy, no ouster need be expected.


  • Progress isn’t linear. I once asked my money manager, a professional analyst of financial markets, what he expected in the near term from the stock market. He answered, “It will fluctuate.” What he said was funny, but his comment acknowledged that no one predicts economic busts or booms, much as many people claim to. Therapy doesn’t move in a straight line of ascent from start to finish, anymore more than the stock market goes straight up or down in perpetuity. There are bursts of change, but more often, periods of little movement. I didn’t expect patients to be elite prodigies of self-analysis and courage, sprinting to psychotherapy’s finish line, so I wasn’t desolated if treatment took its time.
  • The therapist discovers value in challenges. If therapy were always smooth sailing, counselors would become bored with it.  They would learn nothing new because no greater progress could be made by doing so. Since I lacked a magic wand, I had to continue to consult colleagues, read books, and attend classes. Those who posed therapeutic dilemmas generated some of my growth as a counselor and a person. Why would I wish to cast aside people who were, in effect, helping me to do better?
  • Elite athletes are useful models for clinicians. Baseball players grind out a 162-game schedule from April through September, longer if they reach the playoffs. Successful athletes learn to put today’s failure behind them, lest they worry themselves into being unable to perform well tomorrow. I was better than many in my capacity to go home and think about other things, relate to my loved ones, and set the therapist hat on a closet hook. To do otherwise would have burned me out. I was not available 24/7, nor did I guarantee rapid responses to email or phone messages. I made sure I didn’t get used up. A doctor who takes good care of himself is less likely to get tired of you.
  • Buddhists provide yet another excellent example for therapists. You know the frustration of a long static line: a line where there is but one indolent checker or ticketing agent taking care of all those in the queue. You have places to go, people to see. Yet your reaction to just this type of setting — one seemingly out of your control — might determine whether you lead a satisfying life: 1) You can be frustrated and make yourself miserable. 2) You might jump to the line’s front and complain, which will not usually make the line shorter or the ticket agent more efficient. 3) You can reframe the experience. A Buddhist would say, in fact, you should be grateful for the line and the plodding employee because they are giving you the opportunity to learn patience. A lengthy term of treatment where every inch of progress is dearly won offers the same opportunity.
  • My job was a gift. I performed work that was not always “work.” A summer job during my school years in the 100-degree heat of a metal-stamping factory taught me how soul-killing “work” can be. I later came to make a good living in clean, climate-controlled surroundings as a psychologist. My patients helped me become more patient, more thoughtful, more loving — more grateful. I was my own boss and I took meaning from the relationships and the privilege, the stories and the intimacy. I used my brain, one of my favorite body parts! Living this professional life and remaining (mostly) grateful defused many frustrations.

The task of a therapist is not to say, “You’re fired,” but to find a way through or around, under or over; whether running, crawling, pushing, pulling, cajoling, asking questions, waiting, reconfiguring, staying silent, or getting his own help. Much as some of our patients worry about being put into a dumpster, we are working to get them out of one.

Rest easy.

The top photo is called Doraemon by istolethetv from Hong Kong, China. The second is named I’ll Miss You Dad by Cecilio M. Ricardo, Jr., USAP. The final image is a highway Sign at the Truth or Consequences, New Mexico Exit taken as part of an August 24, 2009 road trip by CGP Grey.

If Therapists Have Problems, How Can They Help?


I’ve never met anyone without problems, in or out of therapy. Some are more serene, optimistic, or luckier, but no one escapes the downside of life: frustration, heartbreak, and aging. What then, despite those troubles, enables such a person — aka your therapist — to help?

Part of his capacity to relate to you is the very fact that he can’t escape either. The counselor and you are members of the same species, no matter how different in significant details. Basic experiences are common to each of you: learning, making a living, finding love, communicating in words, inhabiting a fragile body, losing people, and facing your own demise.

He is also damaged, if not necessarily as severely as you; and ideally, not suffering acutely in the moment he treats you. Yes, there is a point beyond which the one treating needs treatment before he can assist others. Perhaps his own demons are triggered by what you say or do, even how you look. Maybe he will be unreliable or poorly trained, using outmoded theories or failing to keep up with “what works.” A counselor can also be overwhelmed by his own life circumstances and lack the energy to help while he is trying to stay afloat himself.

These concerns excepted, you will still be dealing with a flawed person. Best if he is not also either too young or too old. A youthful counselor is inexperienced by definition. He brings enthusiasm, boundless effort, and (we hope) knowledge of the latest research, but hasn’t spent enough time in the trenches. Still, he must learn his craft somewhere.

Caution also applies to seasoned doctors who just go through the motions or have run out of gas. Too often they are tied to routine ways of thinking and are no longer “alive” to what it means to be in the springtime of life. They, too, should be avoided, perhaps even more than earnest young people who will, at least, invest themselves in you.

Part of my hesitation in recommending young therapists, however, has nothing to do with their limited patient contact. Rather, most have not been hurt enough. To be adequate to treat, life must have its way with us for a time. We need to find out who we are and what life is. Ideally, counselors also need a body beginning to show signs it won’t last forever — to be informed of their own mortality. A future therapist should be humbled by life and find a way to come back for more. His rebound approximates the journey you hope to make yourself, the one on which he will accompany you.

Consider the kinds of preliminary encounters the legendary conductor Bruno Walter thought necessary for making music. Imagine how his opinion applies to a therapist’s need for life experience. The language is fulsome, characteristic of the time he was born (1876), but the message transcends it:

“He who has not experienced the stormy sea with a feeling heart will fail to find the elemental force of expression essential for the Overture of Wagner’s Flying Dutchman … Beethoven’s Scene by the Brook (from the Pastoral Symphony) will sound empty unless the conductor’s own delight in a purling brook and a smiling landscape is joined to the musical soulfulness of (his) interpretation … (And) he who is a stranger to ecstasy cannot convincingly conduct Wagner’s Tristan and Isolde.”

Simply put, should you visit a shrink who lacks the education acquired by passing through times both rough and wonderful? Read Homer’s Odyssey and ask yourself how the hero, Odysseus, might have been changed by a 10-year war at Troy, returning home by sea, fighting the Cyclops, and the additional 10-years required to find his way back? Few therapists experience anything close to this, but do learn a few things down a less remarkable path.ulises

A shrink should be like The Velveteen Rabbit, who only became “real” by being worn from use and transformed by love.

Therapists and non-therapists alike are survivors. Indeed, we are all the offspring of shipwrecked fellow men who endured. A shrink without personal acquaintance with travail and romance would be like a Martian trying to understand mankind. Yes, your doc has his own “stuff.” Would you prefer a virgin psychologist, untouched by life as well as sex?

Yet, he must also be different than his patients. A professional combines his training and experience to form an understanding of the “full catastrophe*” of existence. His daily practice allows refinement of the technique required to aid others. Thus, a seasoned counselor’s personal hardships and learning meld with the experience of helping patients (from whom he also learns, especially by making the mistakes novices usually do).

The practitioner ought to know more than you do about the healing art. Moreover, he is useful because he is NOT tied to you at the deepest level. A therapeutic perspective is essential: the dilemmas of your life are yours, not his, nor those of his loved ones. He can keep his head because of this, even though he does come to care about you as a particular person with increasing contact. Therapeutic distance permits him to remain calm and thoughtful in the presence of your pain.

Perhaps, too, the shrink has been luckier than you, without which he could not lend you his hope. He knows good things can happen and the darkness is followed by the dawn, at least much of the time. You are better off for his self-assurance and clarity of mind. They enable him to see the dimly lit road out of the woods. You would not wish him to be looking for the breadcrumbs left by Hansel and Gretel.

None of this is to suggest the counselor is some sort of god. Rather, he is the master of a limited situation — the small chamber in which he does his work. He is also an illusionist, of sorts. If you observed him unshaven, in his underwear, without the mirrors and smoke, arguing with his mate, worried about his kids, upset because the newspaper delivery service keeps leaving him the Tribune instead of the New York Times, then you might think less of him.

The illusion is a necessary one. You overgeneralize and come to believe that he is a wizard everywhere and all the time. He doesn’t stop you, as if he could. You need to believe.

So, dear reader, we therapists are quite mortal. We’ve got our own issues and the bruises sustained on our part-way-completed expedition through life. If we are any good, then we are observant and sensitive. We’ve seen the world’s unfairness. Judgment is set aside for the most part. We are each, as Seinfeld’s George Costanza used to say, “master of our domain,” although in a rather different context than George intended.

Some of our imperfections enable us to help. When we have too many? That’s another story.

*The facetious phrase, “full catastrophe,” comes from the 1964 movie Zorba the Greek. It has become associated with the book Full Catastrophe Living by John Kabat-Zinn.

The first image comes from the 1954 movie Ulysses (the Roman name for Odysseus). The ship is a model, not a full-sized boat. An illusion, yes? The movie poster is from the same film. The title role was played by Kirk Douglas. Anthony Quinn portrayed “Zorba” in the 1964 movie and took a supporting role in Ulysses.