My father died when I was seven. I started therapy at eight. Family therapy at nine. A social worker at fourteen. By the time I left home at eighteen I'd seen more counsellors than most adults have seen dentists, and I was done with every one of them.
That's how I got in. Getting out kept happening on its own.
Because this is the pattern, and it ran for decades. Something goes wrong and I end up in a chair across from someone. The public system, or the insurance I had in the years I had it, pays for a fixed number of sessions. We spend the first few figuring out who the hell I am. We start getting close to the real stuff. Then the sessions run out. Good luck, take care. A year or five later, same issues, new office, back to zero.
So, why does therapy keep ending before it actually helps? A lot of the time the problem is the rationing. Public programs and insurance plans cover a set number of sessions, and that number comes from a budget, not from you. If what you're carrying goes back decades, eight or ten sessions can barely get the lid off. There are ways to push past that, though, and I'll get to them.
What the session cap did to me
I'll own my part first. I left home at eighteen and avoided any kind of support for years. Nobody was chasing me with appointments. That was me.
But when I did go back, I went back to everything. Therapy. Group therapy. Art therapy. Programs, some of them a bit cult-ish, some of them well known and popular (I'm not naming any). Every single time, the same cycle. A block of sessions somebody else was paying for, then nothing.
Here's what that does to you over enough years.
You tell the story from the top, every time. Father, therapy at eight, the whole thing. After the tenth telling it comes out flat, like reading a grocery list. Flat is great for not feeling it. It's useless for getting better.
You get good at being a good client. Say the insightful thing around session three, so it looks like progress. I could do that in my sleep.
And you never let anyone too close, because you know the end date. Why would you? They're leaving. For someone like me, who already tends to leave before I can be left, a therapy with an expiry date is basically fear of abandonment with an appointment card.
Through my 40s I quit on the whole thing. Well over a decade with no support at all.
What changed in 2022
The COVID years broke me. In 2022, in the middle of that breakdown, I got lucky and was assigned a social worker who actually gave a damn. They helped me get real support, got me to a diagnosis (Autism Spectrum Disorder (ASD), at 50), and helped me set up tools so I wasn't white-knuckling everything between appointments.
That one person broke the cycle more than any program did. I wrote about them in the social worker who gave a damn.
There was no magic technique. Somebody was finally tracking the whole thing, past the next session.
Is a short course of therapy always a bad thing?
No. I want to be fair here. Some therapies are built to be short and structured, and for a specific problem they can work well. I go through the main ones in CBT, DBT, ACT in plain words.
Québec's public system runs on stepped care. The PQPTM (Programme québécois pour les troubles mentaux) goes from self-care up through education, relaxation, cognitive-behavioural work and psychotherapy, according to Québec.ca. On paper that's good. The steps are supposed to let you move up when you need more.
The trouble is when nobody's watching you climb. If the block of sessions ends and nobody asks what's next, you don't move up a step. You fall off the ladder. That was me, for most of my life.
How do you get continuity instead of another dead end?
What I'd tell anyone starting, especially in Québec.
Start at the public door. Every public health and social services establishment in Québec offers mental health care for free. Go to your CLSC or call Info-Social 811, option 2. It's free and runs 24 hours a day, 365 days a year. Someone assesses your situation and points you to the right level of help. Expect a wait, and ask how long.
Ask about the end on day one. Out loud, in the first session: "What happens when these sessions are done?" Ask for a plan that goes past the cap. Who follows you after? What's the next step if you still need it? Can they refer you on, or write down what worked so the next person doesn't start from zero? If I'd known to ask that at twenty, I would have.
Know your insurance. If you have group insurance, find out how much it covers per session and per year, and whether it covers only psychologists or other licensed psychotherapists too. Then plan the sessions instead of burning them in a panic. I break down the money side in what therapy costs in Québec.
Ask about lower fees. Some psychologists will lower their rate if you ask. The Ordre des psychologues du Québec also points to university clinics where supervised students see clients for less.
Mix it up. A group plus a few individual sessions goes further than either one alone. Group was hit and miss for me, but some of it stuck. More on that in what group therapy is really like.
Keep your own file. One page. Your history, your diagnoses, what helped, what didn't. Hand it to the next person. It saves you three sessions of grocery-list storytelling.
Go back before it's a crisis. My pattern was to wait until everything was on fire. Don't copy me on that one.