Mind Over Matter

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To End or Not to End Therapy: That is the Question

Am I ready to fly solo?

To End or Not to End Therapy: That is the Question…

In my last blog I promised to address this question and continue the discussion about how one knows if they have had “enough” therapy.

Some general questions to ask are:

  • Has the problem I sought therapy for been resolved?
  • Am I where I want to be in my life?
  • Do I have the tools to deal with things and people more effectively and consciously?
  • Are my moods stable and reasonable to the situation at hand?
  • What are my present goals for continuing therapy?

Therapy does not erase life’s inevitable stresses. But the key is how we deal with them. So when “stuff” happens, do you feel more comfortable with the way you handle it? And if there are still remaining things that haven’t been resolved, is your life in a “good enough” place for you? That is a question only the patient can answer, not the therapist.

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Even when the time is right to end therapy, conflicting emotions may arise. Along with feelings of empowerment and excitement, there also may be some sadness at the impending loss of the therapist who has been a significant person in the patient’s life. Unresolved feelings related to former losses, fears and dependency issues can be triggered and resurface. The termination process provides an excellent opportunity to further resolve these issues on a deeper level. A month is a typical amount of time for termination of a long term therapy, although sometimes people decrease to bi-weekly, then monthly to check in. My feeling about the best way to handle termination has evolved over the years. Similar to my belief that there is no “one size fits all” approach to therapy, recommendations need to be based on a person’s history, present circumstances and what the patient feels would be most helpful to him or her.

There may be times when a patient feels “stuck” in the therapeutic process. They may feel like they are not where they want to be, even though they have been in therapy for a while. They may genuinely like their therapist and feel that he or she has helped them in many ways. However, there are remaining unresolved difficulties causing them distress with no change or movement in sight. Sessions are canceled, reasons for not coming in are found - “too busy at work, not enough money”, instead of discussing their dissatisfaction with their treatment. They may be fearful of hurting the therapist’s feelings, fear an angry response or fear that the therapist will try to talk them into staying when they want to leave. Resentment about “having to pay to discuss the whole thing” is sometimes felt.

In effect they are indirectly “ending” therapy without having to state their true feelings and take responsibility for what they want (and don’t want) in their life. They avoid dealing with uncomfortable feelings and situations in a direct, proactive manner. This is often related in some way to why they began therapy in the first place. Being able to openly and honestly discuss concerns is a sign of improved mental health and an opportunity for further growth.

Decision Making Process

  1. Talk about your feelings with your therapist including whatever concerns you might have about leaving, staying, the therapist, or your treatment. This might sound like a “no brainer”, but is sometimes difficult for patients to do.
  2. Evaluate therapist’s reactions and subsequent actions. Have changes been made that have addressed your concerns? Or do you just feel like you are being “blamed”, and the therapist is being defensive?
  3. Sometimes a patient and therapist might disagree about whether it is the appropriate time to terminate. As honestly as possible, try to determine if you are getting close to some uncomfortable feeling or realization that is making you want to stop prematurely. Ultimately, it is your decision. If in doubt, seek further consultation with a different therapist.
  4. A therapist might suggest a patient work with someone else to get a different approach or perspective.

A successful therapy and termination brings forth feelings of accomplishment, pride, happiness, and some sadness for both patient and therapist. Yes, we have feelings too and can miss those we have worked with and wonder, how is he or she doing?

Robin Zarel, LCSW, is a New York-based therapist. She has been in practice for 30 years.

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