If one is comfortable with their therapist and feels the therapist seems to know what they are doing, how much lack of improvement should one tolerate before deciding it's time for a change? I know it's impossible to talk about an exact time frame given different diagnoses and personalities and treatment progress, etc etc, but is there any indication?And if so, what should one do? Bring it up with one's therapist and see what happens, switch therapists, get a second opinion? ...I was in a situation where I made no progress after 40 sessions and 3 drugs, had no experience with other therapists, and didn't think the therapy was going anywhere, but my therapist seemed competent.
A second reason people seek treatment is because they have experienced an overwhelming stress and they feel they are not coping with it well: the stress has resulted in either subjective distress, an inability to function normally, or the stress has precipitated a full-blown psychiatric disorder (back to where we started). For the sake of discussion, we can lump these first two groups of people together as patients with specific symptoms they want resolved.
A third common reason for seeking psychiatric treatment is that the patient is unhappy with the course his life has taken and feels he has maladaptive patterns of behaving and/or interacting which interfere with his ability to love or to work to his full potential. Sometimes people in this situation have personality disorders. Generally, people do not seek psychiatric treatment if they are having normal reactions to bad events or if they have no symptoms and believe they didn't get their last promotion because of bad luck or something completely external to them.
There is often a huge sense of relief simply in the telling of the story and the hopefulness of finding help. If the medications work, the patient often wants to end therapy or to come less often. People who are by nature a bit anxious often feel that regular therapy sessions keep them grounded and prevents recurrence. I don't know that they're right ( studies on Maintenance Psychotherapy, anyone?), however in those with repeated episodes of illness, if they are seen frequently it is easier to catch an episode and intervene early, and the patients who want to continue coming between episodes feel greatly comforted by psychotherapy for reasons that are sometimes difficult to articulate. One patient described therapy as a "safety net", and that's about as good as I've been able to get.
What about the patient with a personality disorder who repeatedly foils themselves or views life in a self-defeating way? These patients typically find me because they have a co-existing Axis I disorder -- meaning depression or anxiety or bipolar disorder, as in the last paragraph. But when their symptoms resolve with medications, their problems don't. These patients often continue with psychotherapy for a long time, and the therapy itself (and the therapist!) grow to have meaning above and beyond the issue of Fix the Problem, Doc. The end point becomes foggier, the treatment is more of a process, the goals may be clearly defined, but perhaps unattainable. And the treatment may start with the idea that progress will be slow and even painful. The relationship with the therapist may itself become a focus of attention, and this all gets muddled with what is going on with the illness and the meds and things are often just not so clear. Sometimes, it's not all that obvious exactly what is being worked on in psychotherapy and then, for lack of something that better describes what we do, therapy is deemed a "holding environment." I hate that term, and I like to know we're moving towards something, but that's just not always the case.