Long-Term Therapy in the Age of Managed Care: The Case of Don

Abstract

Despite a variety of pressures to limit psychotherapy to brief treatment, some clients can only make progress slowly. This is true not just for more impaired clients, but also for better functioning clients who have suffered significant early trauma. For those clients long‐term therapy is necessary for them to feel safe enough to reveal their underlying traumas and to resolve fully their unconscious conflicts. The case of Don, a man who was chronically unfaithful to his wife, is discussed in detail to exemplify the changes that occurred in the transference and in his life over the course of a 10‐year psychotherapy.

I am grateful to Robert Shilkret, PhD, for the discussions that led to the conceptualization of this article.

Keywords:

• Psychotherapy
• long‐term therapy
• control‐mastery theory
• brief treatment
• psychological safety

Notes

I am grateful to Robert Shilkret, PhD, for the discussions that led to the conceptualization of this article.