Q: How do you know when you're done therapy?

A: When you have completed 8 sessions.

At least, that's the case around where we live. Oh wait - I guess I mean free therapy. And for the record, it's not just "floating around, find it on the shore of a beach" free, it's free to those whose doctors have decided the person is deserving of it, and who have been referred for it. I was lucky that way. It got me thinking.

Today, I had my eighth private counselling session, and I hit the jackpot - I get a bonus round. In other words, my counsellor is being as flexible as her workplace will allow, and is having me back in a month for a final check-in. I am so appreciative of her for doing this, because I know that she's under a lot of pressure to move me out the door and see someone new. No, really. That pressure actually exists.

I know this because that was my last job. I worked for the health authority, and whether we like it or not, they are a business, and they demand statistics and numbers. For those who work for the health authority, that means pressure to administer "short-term" therapy. In other words, therapy that is designed to work on a particular issue (such as a bout of depression, an addiction, and so on) and that can be completed in 6-8 sessions. To give the system credit, 6-8 sessions can be an effective time to treat ONE therapeutic issue, if done correctly. There are studies that have shown this, and if I was feeling more energetic, I'd dig them up.

One hiccup in this system is that not all counsellors are trained to achieve effective treatment in 6-8 sessions. Not all people are designed to see change that quickly. If the first 4 sessions are spent talking about whether or not the person wants to actually change, 6-8 sessions won't cut it. And it takes a lot of skill as a counsellor to get someone to a place of change in one (the first!) session. In other words, our system works if all counsellors and therapists are supermen and superwomen, and every person presents predictably.

For the record, if that actually happened, my job would have been dull as shit. And it sure wasn't!

Okay, second point. No system is a perfect system and like all others, ours is flawed. Sure, we live in Canada, so I will just get this out of the way: "at least your health care system is free!!" Yes yes... it is. Oh, but I pay taxes, so it's not. Which brings us to the next possible argument: "yes, but because your health system is socialized, it can be accessed equally by all!" For sure, it *could* be accessed by all. Presuming the GP who a person goes to see feels that the person (the case) is "worthy" for treatment. (Warning: sarcasm alert) But... GPs withhold all judgment, all the time. Right?

I'm lucky. I have completed 8 sessions with a compassionate, skilled counsellor. I was lucky to receive that referral. Presuming I had a one-dimensional issue for which I was accessing counselling, this would be sufficient. I didn't, but that's not to say the sessions weren't helpful and got me off to a good start, because they did. And I will run with that start, feeling grateful for the time I've had.

For some people, though, they won't have been lucky enough for their doctor to send them to the same public counselling program I went through. Why? Because many GPs still feel that if a person has a mental health concern and a substance use concern, that mental health treatment should not take place until the person has become clean and sober. Sure - rip that coping mechanism out before teaching a person how to cope. And other people may complete his or her 8 sessions, but it may not be enough, and he or she may walk away feeling... lost and alone.

It's not a perfect system. Since when, however, is that a good enough excuse?

PS