Longer Observation (4): Dream of a Raging River: If a patient can’t cross a raging river in a dream, this can be the whole focus of therapy, and it may take many years for her to discover if she needs to and wants to cross and then how to cross and if she can. And then there is the crossing itself and, finally, the beginning of life on the other side.  These are difficult goals to explain to insurance companies.

They want therapy to end as soon as the patient feels better even if the patient feels better because she is standing on the bank and looking over at the other side and feeling optimistic.  Or they might think the whole process, from beginning to end, should take a few weeks instead of a few years.