The psychotherapeutic space is one where time is treated as a neutral factor that operates as a boundary for when sessions begin and end, how treatment plans are scheduled and adapted over weeks or months, and is a crucial element in how progress is measured. However, individual experiences of time are far less linear or predictable. In fact, for people experiencing psychotic distress, time fragments. This leads to the experience of the past collapsing into the present, events stretching outside their normative and accepted chronological order, and a future that feels unimaginable and out of reach. Known as temporal distortions, these altered states hold valuable information not just about biological mechanisms, but about how suffering is experienced and endured.
The common language used within therapeutic settings to describe trauma, depression, and psychotic episodes include “feeling stuck” despite efforts to change our external support systems. This use of temporal terms are also heard by those who feel as if they are reliving past events on a loop. Others report that time either feels so fast that they cannot join its flow or so slow that they can’t bear to withstand their present circumstances. From a medical standpoint, these experiences are seen as symptoms, but from a psychological lens, these breaks from temporal reality provide a unique opportunity to step inside the psyche to see how individuals experiencing this distortion organize meaning, memory, and identity.
The clinical perspective connects these breaks to the difficulty an individual is experiencing in integrating the narrative structures that impact their daily life. For example, individuals who experience trauma may reject weaving this experience into their narrative story. Instead of integrating traumatic experiences into their autobiographical identification of self, they may stand outside of a person as a fragmented, intrusive set of images that provoke affective mental, emotional, and physiological states. The risk psychologically speaking is that when an event in the past is not understood as a symbol of “then,” it can be experienced as “now” when an individual experiences distress over this memory. This indicates that it is not about memory, necessarily, but about the loss of distance from the event that allows the individual to reflect on the event instead of reliving it.
One aspect of clinical work that is crucial here is listening acutely to how a patient describes their experience of time. When they report that they “feel like I’m back there again” or “I cannot imagine my future,” they are letting you into their experience of altered states of time. Even more importantly, they are expressing how they inhabit time. This is vital information for the clinician about their state of hope, their grasp on continuity of self, and their sense of agency.
Though it is not up to any therapist to try to remedy or correct this experience, these moments provide clinicians with the ability to explore the patient’s sense of time, name their experience, and then gently explore their ability to reconfigure their proximal relationship to those events. Perhaps the most important work a clinician can do with patients in this state is to help them differentiate between the past and present. This may be achieved by guiding them to name moments when memory feels immediate as a means of developing narrative coherence. The hope here is that, with psychotherapeutic support over time, the individual will begin to assign these events their symbolic placement as past occurrences, signaling their grasp of temporal reality.
This work is often slow-paced and may not occur through direct insights. Integrating a temporal sense of time can actually be nonlinear, gradually experienced through safety and patience as they sync their experiences between “then” and “now.” The goal is that they will develop a sense of time to the point where they can articulate their remembered past, their lived present, and the future they believe they can have.
By understanding that expressions of temporal distortion are meaningful and should not be dismissed as hyperbole or unimportant, clinicians can access the interior world where patients suffer. In this way, time is not just about scheduling and treatment plans. It is, in fact, where healing takes shape.