Therapy has rightly been destigmatized over the past two decades, and millions of people have benefited from it. But the conversation has tilted so far toward “everyone should be in therapy forever” that a quieter pattern has gone underdiscussed: long-term, open-ended therapy without defined goals can produce dependency that’s harder to recognize and harder to leave the longer it lasts.
This isn’t a critique of therapy itself, which remains genuinely valuable for many people working through real symptoms. It’s a critique of a particular structure — weekly sessions stretching across years without measurable progress markers — that the system tends to default into.
Indefinite treatment can substitute for change
Evidence-based therapies like CBT, ACT, EMDR, and DBT typically have defined treatment lengths and explicit termination criteria. The patient and clinician work toward something measurable — reduced panic episodes, improved sleep, fewer intrusive thoughts, better interpersonal functioning. Open-ended psychodynamic or supportive therapy can also be valuable, but the absence of clear criteria for what success looks like means it can continue indefinitely without anyone noticing the lack of progress. Patients describe finding it harder to imagine making decisions, processing emotions, or handling conflict without first running it past their therapist. That can be useful early in treatment. After several years, it can crowd out the development of internal capacity the therapy was supposed to build.
The financial and emotional structure favors continuation
Therapists have a real incentive to retain clients — it’s how their practice runs. Most are not consciously prolonging treatment, but the structure tilts that way. Insurance authorizations for weekly sessions are easy to renew. Cancellation feels like rejection on both sides. Patients who consider stepping back often interpret the impulse itself as something to discuss with the therapist, who is the only person they’re discussing it with. The result is an arrangement that can quietly persist past its useful life because no party in it has a clear incentive to stop. Researchers studying psychotherapy outcomes, including Bruce Wampold and others, have noted that gains generally plateau after a number of sessions; ongoing weekly contact past that plateau may maintain stability without producing further change.
Healthy therapy includes a real exit strategy
Good clinicians talk about termination from early in treatment. They name what they’re working toward, check progress against goals, and discuss how the patient will know when a different cadence — monthly, quarterly, or fully ended — is appropriate. They build skills the patient can use independently. They don’t treat the relationship itself as the therapy. If you’ve been in weekly therapy for years and can’t articulate the goals you’re working toward or the markers that would tell you you’re done, that’s worth raising directly. A clinician who responds well to that conversation is doing real work. One who treats it as resistance or pathology may be telling you something important about the relationship.
The bottom line
Therapy genuinely helps many people, and professional support is valuable when you’re struggling. The question isn’t whether to engage with therapy. It’s whether the structure you’re in is helping you build a life that needs less therapy or quietly settling you into one that needs more.
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