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Natural Awakenings Bucks and Montgomery Counties PA

Nixing the ‘Quick Fix’: In Defense of Long-Term Therapy

by Karen L. Smith

If you could have changed it any other way, you would have already. If willpower could be successfully leveraged against the issue you have struggled with year after year, it would be a non-issue now. If a well written pop psychology self-help book could have fixed the issue burdening you, it would be fixed. If a weekend skill development workshop could shift the issue that plagues you, it wouldn’t still be a burden.

There are many short-term psychological/social/intra-psychic/relational interventions that can radically change our lives. Sometimes even a walk in the woods, a well-timed song and, of course, conversations and community can shift and awaken us in a way that brings about core changes in how we see ourselves, our worlds and our relationships. Sometimes these interventions are hit or miss, but even then, well worth it. The self is inherently growth and change filled, and the activities we place in our lives are what will dictate the direction and shape those changes take.

But some of our struggles are particularly stubborn. There are certain issues that we feel helpless to change after years of effort. That is because these are issues embedded in the core recess of our psyches before we had full functioning as thinkers or were creators of our own destinies; namely, childhood.

For instance—the debate about the cup half full or the cup half empty. That world view isn’t about personality or disposition or even choice. It is a direct reflection of whether or not we experienced the world, as an infant, as a place where our basic needs were going to be met. It is a reflection of how long we had to wait to be tended to, with feeding and changing and cuddling, and whether when tended to we typically received enough of what we needed or only some of what we needed.

So if we are someone who didn’t really get tended to in a generous way in the first few months of life, and then that pattern repeated over and over through childhood, we are living with a narrative “truth” that is so deeply embedded in our psyches, that it is not enough to tell ourselves a new narrative. No amount of positivity training books and workshops and suggestions is going to shift that perspective.

The person that views the world as unlikely to meet their needs can learn a new reality. But it takes time, and relationship. Long-term therapy provides a context and opportunity for this kind of deep, core change. In the container that is the therapy relationship, we can identify the many experiences that built our narrative. We will encounter the moments in our childhood where we learned the cup was half empty, and that we were not going to receive enough to have our needs met. In the containment of the therapeutic relationship, we will grieve those moments, and the resulting induction into a world view that served to limit the joy we were able to see and take in as adults.

As we successfully grieve the absences of our childhood, the psychotherapist will be able to help us note post-childhood experiences in our lives, including with the therapist, when the world and its relationships provided enough. Over time, just as in childhood, the repetition of these new experiences and new awareness will help us write a new story.

Once that work is in place, we’ll find that everything else we do—whether it’s a one-day retreat or a jog on the beach—will fill our cup.

CS_FullLiving_KarenSmith_0316Karen L. Smith, MMS, LCSW, is the director of Full Living: a Psychotherapy Practice, which serves the Greater Philadelphia area. For more information, call 215-494-7818, email [email protected] or visit

May 2017