It Takes Time

One of my clients tells me that I should have a neon sign on the wall behind me that reads, “It takes time.” She says I could simply flip a switch and turn it on instead of saying those words myself, which I obviously do quite a lot … for example, when someone asks me, “How do I learn to deal with these feelings in a better way, then?” It takes time. Any kind of meaningful growth takes a long time. I don’t think I’ve ever had a client who liked this answer, but most of them come to accept it.

I have a friend, an accomplished tennis pro, who once told me that in order to become a highly skilled tennis player, it might take ten years of lessons. He didn’t see anything unusual or objectionable about that. In order to become highly skilled at anything, you have to work hard at it for a long time. I spent four years as an undergraduate and six years in graduate school. After earning a B.S., a would-be surgeon then spends four years in medical school, followed by a long internship and residency, in order to qualify. You’ve probably heard about the 10,000 hour rule: it takes that many hours of practice to become expert at something.

In my experience, it also takes many years in psychotherapy to learn a whole new set of emotional skills — ones that are usually acquired under the guidance of your parents throughout childhoood — and to become “expert” at them. I don’t view therapy as re-parenting per se, but surely a big part of the goal is to make up for one’s deficient “learning experience” as a child. Reasonably good parents take 16 or so years to teach you what you need to know in order to get by in life; why do we expect therapists to do their repair job in six months or less? The short answer, of course, is that it can be expensive and insurance companies won’t pay.

It’s appealing to believe a drug could rectify a chemical imbalance, or that CBT could teach us skills that would make up for the lack of emotional capacity we should have developed under the guidance of our parents. Those interventions have their value, and many people find them sufficient. For people who would like to enlarge their understanding of themselves (and other people) while developing new emotional capacities and skills, there’s long-term psychotherapy … many years and a lot of money. Nobody thinks it unusual to spend eight years and tens of thousands of dollars to earn an advanced degree, working extra jobs and sacrificing other sources of gratification to get there. Why do people object to making a similar investment in oneself and the chance to lead a fuller, more satisfying emotional life? The years and money I spent on my personal analysis were the best investment I ever made. How do you put a price tag on the quality of your life?

The fact that psychotherapy takes a long time doesn’t mean there are no rewards or benefits along the way; the “payoff” isn’t deferred until the very end but comes at different stages along the way. Often the rewards take us by surprise; we tend not to see gradual change as it’s occuring; instead, something happens which makes it seem as if we have suddenly changed, all at once. As I often do in these matters, I find the experience of learning to play the piano a useful analogy.

I practice every day; in addition to the pieces I’m learning, I do scales, arpeggios and cadences, as well as technical exercises. For long periods, I will seem to be plugging along without making a lot of progress but I keep working. Then “suddenly” (it seems to me) I will take a big leap forward. Sometimes, it feels almost like magic. I recently took such a big step forward; I feel as if “all of a sudden” I have much more technical mastery in my fingers, more control over my tone, enough speed and agility to play my current Beethoven sonata without massacreing it. The way I describe the experience, I feel “happiness in my hands.” I’ve worked very hard and now I’m able to enjoy this sense of well-being and accomplishment.

Yesterday in session, my client Anita (who sings in a chorus) was telling me about her solo at their latest performance. In recent rehearsals, Anita hasn’t felt good about her singing; she hasn’t been able to feel fully present for the experience. At the concert, by contrast, she settled into herself; as she sang, she felt the resonance of her voice within her body and was able to hear her own sound clearly without being distracted by the other singers around her, as had happened to her before. That physical resonance felt very good to her (it reminded me of my “happy hands”). On a related matter, she also stood up for herself with the choral director; he responded respectfully to Anita’s complaint and she felt good about how she’d handled it, in contrast to other interactions where she felt she’d been a “diva”.

Anita later went on to tell me about a disagreement she’d had with a friend, one whose point of view normally over-powered her own so that she would come to doubt herself and submit to her’s friend’s perspective. On this occasion, however, she felt able to maintain her own point of view and to challenge her friend in a non-hostile way. The friend heard her and ultimately came around to seeing the matter Anita’s way. Throughout this session, Anita clearly felt a strong sense of satisfaction and well-being — the reward for all the “practice” she has been doing.

This client has been working with me for years; she works very hard and especially of late, has been making particular efforts to take the lessons of her therapy and put them to use in her everyday life. For the past few months, she’s been struggling without a clear sense of moving forward, often with a feeling of discouragement instead. This past week, all of a sudden (it would seem), she could see the results of her hard work: a clearer sense of her own strengths, a greater ability to maintain that sense of self in the presence of others. Anita’s therapy isn’t over. We’re not finished yet, but along the way, there have been and will continue to be these gratifying moments when the progress is clear.

As for that 10,000 hour rule, it’s hard to calculate how many hours Anita has put in, both within and outside of therapy, practicing the lessons she has learned. Still a distance to go. Earlier today, I tried to calculate how many hours I’ve put in at the piano under the guidance of different teachers over the years. About 6,000 hours, I figure. Another 4,000 to go — six more years at the current rate of practice. Maybe I’ll be an “expert” player one day. In the meantime, I have this gratification that comes from application and hard work; I have a sense of achievement in playing Opus 10, No. 2 reasonably well, even if I will never have the skill of Alfred Brendel, that master interpreter of Beethoven.

Joe is the author and the owner of AfterPsychotherapy.com, one of the leading online mental health resources on the internet. Be sure to connect with him on Google+ and Linkedin.

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57 comments

    Wonderful post on just how excruciating the process of changing mindset. Granted, this mindset was cemented years ago and the inability to see the damage done is made harder b/c we don’t “see” the small, incremental gains in the way we see the number go down on the scale after dieting.

    Maybe this ability to have faith and openness about therapy is the deciding factor in who experiences sx relief, and those who remain impatient and stuck…

    Interesting idea. I do think the ability to have faith is important; it has puzzled me before that some people with truly nightmarish childhoods have the ability to hope for something better while others from less damaging backgrounds are less able. Some people can keep the idea of “goodness” alive even if they’ve experienced very little of it.

    It’s amazing to me that so many people seem to think self-help should be a quick fix or instant results and make that their sole criteria or at least their main criteria for evaluating treatments. We really are a quick fix society. It takes 20, 30, 40 years of faulty beliefs and bad thinking and behavior habits to get messed up, it’s only natural undoing years of damage can itself take years.

    I agree, but few people want to accept the reality. It’s much more appealing to believe you can heal quickly — an understandable, if false, belief.

    A couple of comments.
    1. We should keep looking for quicker and easier ways.
    2. We should be looking for ways to make the process joyous and enjoyable – then how long it takes doesn’t matter nearly so much.
    3. (Not so good at counting). I think the way psychotherapy is done is a big reason it takes so long.

    Evan, this is one of your terse comments where I want you to say so much more! Especially No. 3 — I imagine you have quite a lot to say about that issue.

    Hi Joseph,

    I guess I tend to the terse. I want to get to the guts of things quickly.

    re #3.
    For those with early trauma it is likely some kind of re-parenting is involved. I think it would be better if this could be done quite intensively rather than an hour a week (or less). Say daily sessions and a weekend once a month. Especially if it was done in a group perhaps. (Not sure if/how that would work.)
    I think the ‘hour a week in the therapists office’ can mean that change happens more slowly than it would in other arrangements.

    re #1&2
    I think it is possible to build the new within the old. That is, in this kind of situation, to be helping the person realise how capable they are and how much they are doing right, while dealing with what they see as problems (possibly quite rightly). To be expanding their skills while building awareness.
    I think it is possible to find ways for people to have an enjoyable time (or recall them) and then have them reflect on what was required for this and how they could get more of what is required in their lives.
    I suspect you already do this in your practise a lot of the time.

    The intensive part is very interesting, and I think might be incredibly useful, though prohibitively expensive. On the other hand, it might cost the same amount, only all at once rather than spaced out over years. Regarding your last point, yes, I do that, although it seems to come later in treatment rather than earlier. Not exactly sure why.

    Maybe we think it should be a faster journey because we are adults now – so logically we should be able to deal with it on an adult level. However, I know, when dealing with my childhood experiences it’s difficult to deal with the hurt that I endured because I guess it happened when I wasn’t an adult, things weren’t dealt with on a logical, rational basis – and there was so much deeper hurt when it was from people you trusted. I have too many things come up from those moments of emotional neglect, teasing, humiliating moments and sometimes I can clearly see them smacking me in the face – sometimes I can’t.

    Sheila, your comment brought to mind that opinion I’ve so often heard, that “smart” people know how to deal with their problems because they can rely on their intellect to work them out. So not true. As you know, logic and reason have little to do with it.

    Some times it is challenging though, isn’t it? On the one hand we are told to change our thinking in order to get better, which gives us the impression that we should easily be able to “think” ourselves well. Yet on the other hand, the true experience is that thinking doesn’t always work.
    For me I analyze – too much, I’m told. But for me the analysis is always trying to figure out the “why” of my behaviour, not “why me”, but if I can get to the why then I can move myself to the “how”. How am I going to make the change now that I know where it’s coming from.
    Maybe that’s just me – prime example of “thinking” rather than feeling it.
    aaaaahhh – big sigh.

    Hi Dr. Burgo,

    I understand your piano analogy, having to work had to become an expert at something. But I can also relate to your clients impatience and unwillingness to spend so much time in therapy. To become an expert piano player, EVERYONE has to spend money and put in hard work and practice 10.000 hours. But it is different with the skills you need to get by in life. The ones with the reasonably good parents get them for free, and they acquire them along the way, growing up. When they are finished, they can move on to other things, start a family, build a career. The unlucky ones then have to dedicate a lot of the resources (time, money) the lucky ones can spend however they please to pay for therapy. I remember when a friend of mine called me one night during a personal crisis. She had realized that she needed to go back into therapy, although she had thought she was ready to move on and just have a happy relationship with her new boyfriend. I knew her background, how bad parenting had screwed up her life and how much time she had already invested at this point to correct her parents` mistakes, and the unfairness of it all nearly made me cry out of anger and sadness.

    It is completely unfair. Unfortunately, there’s nothing we can do to make it fair. It’s just the way it is; the only realistic option is to accept the facts — as unfair as they are — and make the best of what’s possible.

    Thanks for the link. Some of this I understand — especially the part about the way the arm is suspended from the shoulder … very much the way my own teacher wants me to play.

    Joe / One of your best yet . Tells it like it is!!! Such an obvious commentary but nobody ever says this !!! Thanks from both my Therapist part and my Been in Therapy Myself part .

    You’re welcome, Penny. I take these things for granted but sometimes, we just need to say them out loud.

    I concur – absolutely with your post. Very early in my ‘change of approach’ to how I dealt with life, I became aware that whatever length of time had brought me to where I was- an equal length of time would probably be needed to get me out of that way of behaving. So far this has been proven true.

    That’s a very interesting approach … and I suspect it applies to many people. Understandably, few of them would welcome your message, but that doesn’t make it untrue.

    Thank you for the reminder – indeed it takes time & I don’t believe it is linear. I’ve found myself going in circles at times, but come to realize that too is a pattern & feel confident I can come out of it maybe a bit faster each time. Mastering one’s emotions is no easy task but certainly rewarding! Not just for myself but all those who cross my path … Especially my children. I agree too that the change comes along the way, slowly but surely. The ripple effect to those I relate with closley is even noticeable to me.

    Patience does have its rewards! In our society of instant gratification, patience is in short supply, however.

    Thanks, Deb. I’m glad that people are responding well to this message … I was afraid there might be a backlash.

    I’ve tried the quick fixes – solution-based therapies designed to deal with a single issue. While helpful to a point, they’re somewhat akin to learning how to play Chopsticks and scales on the piano. Sure, you know which keys produce which notes, but it’s hardly music. Dealing with single issues while not addressing the underlying reasons for them hasn’t been very effective for me and I’m now in psychodynamic therapy. While I certainly hope that it doesn’t take me as long to change my behavior patterns for good as it did to get here (I’m 53!), I realized a while ago that it was going to take some time. I’m settled in for the long haul now and feel much the better for that.

    Another great piano analogy! And very apt. Thanks for that one (and I’ll probably make use of it myself one day!).

    It would be a luxury to take all the time you needed. Have you got “success” stories, so to speak?
    I’m sure from you’re side it must be a challenge as well. When you have a new client, does “everything” said mean something significant about their psych?

    After so long in practice, I’d better have some success stories! There are degrees of success, too. Some people get something important from the work in a matter of months but are hardly finished; others settle in for the long haul, make important changes along the way and still feel they have more work to do. I’m not sure that “everything” said means something but an awful lot of it does, in unexpected ways.

    Another valuable post, Dr. Burgo. I’d like to add that, in addition to therapy taking a long time, it is often needed more than once in a lifetime. I’ve gone back several times when I’ve encountered difficulties and needed to do some additional tweaking. I suspect most people think they are done with therapy after the first time, and it can be hard for them to go back. But things come up during the course of our lives–or are brought up by new experiences, such as parenting–or we may just find ourselves ready to take on an issue at a deeper level given a different stage of life. My more recent issues are stress-related, due to external situations (the caretaking of a parent), but therapy is still helping me to take the pressure down a notch, which is a worthwhile goal in itself.

    Important point. Yes, it may take more than once. I’ve had clients who return years later for a follow up.

    Jul: Although I understand basically what you are getting at, especially the whole paragraph in context, I’m having trouble grasping this statement: “When they are “finished” they can “move on” to other things, like starting a family, and a career”. What I’m getting out of this statement is this: If one can make it to their 20’s, with a reasonably un-traumatic childhood, (and I’m not sure how many of us really did make it through childhood unscathed) life will be easy? Allowing for the fact that this is MY interpretation, (I’m in my 40’s) ..and others may have a different perspective, I’ll elaborate anyway…

    What about the traumas of adult life? None of us are going to escape loss and all the unexpected challenges life can bring. Adult life is hard, sometimes even brutal. Worry about the future, including death, can affect some of us as much as the difficulties that occur in childhood. Sometimes an existential crisis can arise. The path through life is not always linear and logical.

    I also think that part of the unfairness is about how some choose to become more aware , to fully engage in life, and some do not choose to develop self-awareness and it seems like those who do often carry the burden for those who do not. Self-awareness is a difficult path, and for me, personally, sometimes I take a step back for every step forward.

    I also wonder if there isn’t a way to have it both ways, with a little bit of creative thinking. Doing the work of therapy, AND engaging in/practicing a life passion/skill. One that takes time to master, is rewarding, and gives one a deep sense of accomplishment, something that nobody can take away from us or diminish in any way. Couldn’t these things compliment each other? What do we really want to spend our time and money on? (I don’t have an answer, I’m just putting it out there, thinking about this for a bit)

    Work in progress.

    I very much relate to your point about the people who have developed more self-awareness often having to shoulder the burden for those who don’t. I personally relate to it, but I also find with clients who have grown a lot over time, there comes this point where they start to feel resentful: like, all this time, money, hard work and growth means I have to be “bigger” than everybody else? This is the payoff???

    Hi Jules,

    oh no, I did not mean to say that life would be easy if one only had a reasonably un-traumatic childhood. And I certainly know that adult life is hard (I am in my 40`s, too).
    To give you one example of what I meant:
    A woman has a crisis connected to a childhood trauma in her early 30`s. She is so troubled for several years that she can not maintain a relationship during that time. When she is finished with therapy, it takes her several more years to find a suitable partner (the marriage market can be pretty tough for women over 30), and now that she finally is in a situation to start a family, she discovers that her fertile years are over.
    Two other people I know had so troubled childhoods that it was very difficult for them to develop self-awareness, to know their own needs, their weaknesses and strengths etc., so they constantly chose partners or career paths that were wrong for them, and to correct these mistakes cost them not only a lot of time and energy, but also money. They are financially not much better off than college students, even though they are close to 50.

    When I feel that I am engaging in the repetition compulsion – enacting the same old behaviors- and I become frustated with myself, then I think about what I have heard said more than once regarding the progress one makes in long term therapy/analysis, that it’s one step forward and two steps backward. Instead of being depressing, that notion actually is rather consoling to me.

    “One step forward and two steps backward” — that would mean therapy is a continual process of getting worse! I hope you meant two steps forward, one step back.

    I have experienced the same thing, and in regards to Dr. Burgo’s reply about one step forward, two steps back, I would add that for me too just the one step forward is consoling because while two steps back can be disappointing, that one step in the right direction is hopefully laying the groundwork for more progress.

    Yes, I agree with your insight regarding the ” one step in the right direction is hopefully laying the groundwork for more progress.” The two steps back can hopefully foster compassion for ourselves, though disappointing, as we realize how difficult it is to change our maladaptive behaviors.

    And therein lies two of the conundrums with long-term psychotherapy. Not only is it entirely unaffordable to the vast majority of the populace, but there’s no way to factor out change that occurs because of the therapy from change that occurs due to the ordinary passage of years. There is no doubt that massive change is possible without therapy. Data from the National Institute on Alcohol Abuse and Alcoholism, for example, shows that 75 % of alcoholics get better without any treatment. By the way, NIAAA is a federal agency, not an interest group.

    I guess I don’t particularly care whether change in my life comes from the passage of time, or my years in therapy. But without therapy, time would have stopped for me quite a while ago. I’m so grateful, and fortunate, to have excellent insurance that covers extensive psychotherapy, and a therapist who helps keep me in the game, while I wait/work for time and/or therapy to do something helpful. It’s horrible that the same resources aren’t available to everyone, but I’m glad long-term therapy is available at least to some people, many of whom feel helped by it, when they have not felt helped by other methods. I’m frustrated with how long it is taking me to feel better about myself and my life, but it means so much to me that there is a treatment and a person to provide me this time.

    That sounds like an interesting study. I may look for it on PubMed. Was in an individual study, or a systematic review based on multiple studies? Those are usually the most reliable. There was another study (studies) I wanted to look up about the efficacy of therapy based on rapport/connection with the therapist, (trust is HUGE) rather than the type/modality of therapy used.

    Having said all this, CBT is supposed to be “evidence based”, but that doesn’t mean it is for everyone, nor that the results are lasting. My conclusion (opinion) is that entering therapy is a highly personal decision. ( I don’t know enough about addiction or severe mental illness to make a statement) I admit I’m a little biased and prefer working with a therapist who makes a serious effort to really understand the human condition, (including his or her own) is intelligent, highly trustworthy, really listens and tries to understand ME, and is comfortable with paradox.

    It is kind of subjective. So how is “getting better” defined? When one stops drinking? When one becomes “indoctrinated” by their CBT therapist and is now thinking “correctly?” Who defines progress? And how the heck does one measure progress? For me, the only one who can decide what works best for me is myself, even after reading the stats. But I’m a bit odd. :)

    I appreciate this post. I also wonder about the issue that I have experienced, where upon the need is realized for longer-term psychotherapy, one finally begins to delve into complicated issues from the past, after a period of months of therapy when it seemed like the focus was on minor issues compared to the underlying “elephants in the room”. It is unfortunate that it takes so long to be able to build up trust and expose one’s self to vulnerability to get to that point, only extending the length of treatment.

    Yes, but you’re right — it often happens just as you describe it. Sometimes people end up working on something entirely different from what originally brought them in.

    Thanks for another fascinating post Joseph.
    I have a question: If you feel like you are not making progress over a prolonged period (say a couple of years), how do you know whether to persist? I doubt if my psychotherapist would ever tell me he does not feel that he can help me (after seeing him for a couple of years), but when I ask him he becomes very uncomfortable and seems to take it as a criticism. I like him as a person but am not sure if I find psychotherapy so difficult because of childhood problems and issues with trust, or whether he is not the right therapist for me.
    Thanks again for your thought-provoking articles.

    If you’re feeling that you’ve spent two years spinning your wheels, that’s definitely cause for concern. And if your therapist can’t talk to you about it, that’s also something to be concerned about. I’d keep trying with him and if you don’t feel you’re reaching some new understanding together, I’d consider moving on.

    “It takes the time that it takes.” that’s what I hear and I respond with “It takes forever!” Than I hear, “No, just the time that it takes.” It is a child-like game that I hate and that I find comfort in like so many child-like things that I still possess.

    I just stumbled onto this blog but found this post applicable to my therapy right now. I just started a 3rd year in therapy and would have never imagined at this point that I would still feel I have a long way to go. I promised myself when I started that I would stop when I felt it was right. Last week I told my therapist that I was quitting. My husband read an article in the NYT about how ridiculous long term therapy is and he started to get resentful and suspiscious about why it is taking so long. Money is also an issue (of course). I really did not want to quit and discussed it with my therapist (again) and am continuing. I appreciate your comments so much. I have spent a fair amount of money on my therapy but it is so clear to me the value (mostly…except when I get really pissed of or feel humiliated or it is really painful). What else could I do, buy a new car? Upgrade my cable? Remodel the house? Transforming my own life seems so much more valuable to me. I can feel the richness of the experience in my therapy down to my core. The excitement of a new car wears off in about a week. I guess my priorities are different from others. But I really do want to grow and transform and learn and hopefully become more compassionate and loving and happy in the meantime. Thanks again for the post. And thank God there are some good therapists out there!!!

    I’m very glad you came to the decision you did. Sometimes it’s very hard to justify one’s commitment to long-term work in this era of instant gratification. I read the same NYT article and didn’t think much of it. The important thing is that you understand the value in your therapy and feel the money you spend is worth it. That’s all that counts.

    This is a bit off topic and might sound a bit, well, nuts, but I would be so interested in your insights and observations on this. Do you see physical changes in expressions and posture in your patients as their therapy progresses? In particular, the eyes. Having been very dissociative, and still working on it, I was fascinated when my own progress resulted in a remarkable thing. Suddenly, when I looked around me, everything seemed 3D and in full-colour. It was both sheer joy because it was so stunning, but also it felt a bit too much. I have read about others with the same type of experience and I think it is simply ending the dissociative phenomenon of the world seeming like a fog, flat. I wondered what causes this, physically, and I experimented a little, trying different things and it seemed to me that the dissociative fog, that flat, hazy way the world looks, is simply caused by an unfocusing of the eyes, partly that staring into nowhere phenomenon, but also just a general unfocusing of the muscles or whatever it is we have in our eyes (I’m no scientist but always curious). So if I am feeling dissociative and I make my eyes focus, if I straighten up, own my own face and expressions, so to speak, I get that 3D seeing again, though it’s hard when I’m overwhelmed. I’ve noticed that other people I know with traumatic childhoods and I suspect dissociative defense mechanisms, have a certain eye expression that I’ve had. Their pupils are up near the top of the eye, the top half of the pupil not visible., It’s not alway, but it is a default expression. I had this a lot when I was dissociative. It is hard to replicate, but I did it simply by just letting go of my “eye muscles”. It’s almost like a pre-sleep thing and it seems so appropriate since that’s in a way what dissociation is, not seeing, not being centred and focused. Have you noted this in patients? Are there other physial changes you see? Should therapy also include physical therapy, working mind and body at the same time?

    I have noticed physical changes in my clients, but not the one you’re describing. It doesn’t sound nuts at all to me — actually, it’s entirely persuasive and I’ll be on the look out for it from now on. I think there’s a lot of value in doing body work in addition to therapy, but it’s not for everyone.

    Thank you so much, Dr. Burgo. Your site and your responses have been having a quiet yet profoundly changing and strengthening effect on my journey toward healing. I am very grateful.

    I understand it takes time and my therapist is constantly telling me that but when at the age of 17 you’re completely supporting yourself, have already payed close to 13 thousand in therapy and still have a long way to go it makes it hard to hold on. I wouldn’t continue therapy for less than what I am paying now ( because I do own a business and understand why people charge the prices they do) but it only leaves me with the option to stop therapy all together. Especially when the man who made all the trouble in the first place is doing nothing to fix his actions and you’re left to rectify a situation you had no control over. I know I sound dark but it’s the reality of the situation.

    Gidday, I’m currently seeing a counselling psychologist and was wondering is there a difference between a counselling psych and a psychotherapist? She does insight oriented psychoanalysis but I’m still unsure if it is the equivalent to psychotherapy. I started seeing her through our EAP service as had a young person hang themself who I resuscitated. I’m a Youth Worker working with homeless youth. In sessions we have certainly moved on from that incidence and are now focussing on my experiences from childhood. I was hoping you could elaborate on the difference. Thank you :)

    I’m not sure about the distinctions between those two terms. In my experience, there’s no fixed boundaries in the field. Many people who are licensed as social workers actually practice psychoanalytic, insight-oriented therapy. Many people who hold a master’s in counseling psychology practice psychoanalysis. I think it depends more upon your therapist’s orientation and past experience than anything else.

    Even after spending several years with various therapists, I still have no idea what “good therapy” feels like or what “working hard” in therapy means. I talk, the therapist talks, fifty minutes later it’s over—next week we repeat: is that “working hard”? I really don’t understand … and therapists I raised that question with never explained what ” working hard” in therapy meant. Please forgive my ignorance

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