In our last blog entry we explored two indicators that psychotherapists and clients can watch for that suggest it's time to end therapy: 1) the therapeutic goals have been accomplished, and 2) therapy isn't working. We also offered some ways for clients to bring up the topic of ending therapy. Today we address two more reasons for ending therapy and some helpful ways to do so. Before we go there, we want to mention two important points. First, psychotherapists are ethically responsible for ending therapy in an ethical fashion. Second, the end of psychotherapy can be one of the more emotionally difficult parts of the relationship, for both clients and therapists.
Psychotherapy is rarely a total success or a total failure. There are peaks and valleys in the process-times when therapy is working (or failing) somewhat. Thus, many decisions are made in what we call the "grey areas," when some but not all goals have been accomplished. One grey area is when it seems like therapy is not working, but it really is. For example: You experience pain. You
don't understand why you're being asked to keep a journal. You've had no big breakthroughs in the past few sessions. But you have to ask yourself whether this is really the end of the line, just a temporary lull, or actually a precursor to immense therapeutic work and benefit.
At these time, both therapists and clients need to remember: Therapy is not a linear process. It's actually more like the stock market--you can count on some progress in the long term, but there will be short-term peaks and valleys. Unlike the stock market, however, you may not know whether you are experiencing a peak or a valley! Frustration and pain does not necessarily mean you're not doing some very good therapeutic work. You might want to stick with it and give your therapist a chance, trusting him or her to know what to do. On the other hand, your feelings might be an indicator that it is at least time to take a break from therapy. In either case, you have the right to initiate the discussion of suspending or ending your work. For example, you can start the conversation off with, "I've noticed that at times it seems like I take two steps forward and one back. I think I've learned some useful tools in our work together and I want to take a break from therapy. That will give me an opportunity to try out what I've learned." Ethical therapists will probably have been thinking along the same lines-at least, they will not be surprised nor offended by your statement.
Another time to end therapy is when your therapist has engaged in blatant-or not-so-blatant-unethical or unprofessional behavior. You may find yourself in a situation, whether or not therapy is working, in which there are too many "red flags" (behaviors that suggest the therapist isn't being professional). We see the following red flag behaviors as reason enough to end therapy:
- sexual advances or behaviors (even subtle ones)
- dinner invitations
- overt invitations to friendships
When these types of behavior occur, we say end therapy or "Fire your therapist!"
Some red flags are more serious than others, and present more gray areas. For example, you might find sexist, ageist, racist remarks, even if they're said in apparent jest, too offensive. Other people might experience those same comments as less offensive, but they might draw the line with a therapist who is sloppy in his or her work.
Some red flag behaviors may be even more subtle and insidious; it may actually feel like things are going well but they're really not. You may be feeling good about the therapist or therapy for the wrong reasons. For example, you feel trusted by the therapist because he or she tells you about their home life. Or the therapist has given you a gift and you feel special, not realizing that the therapist may be motivated by romantic, financial, or other non-therapeutic factors. Or sometimes you feel comforted when your therapist is giving advice and don't notice that what you need even more is to make your own decisions. These types of subtle red flags might be hard to nail down but if they are frequent occurrences and begin to make you a little apprehensive about what will happen next, it may be time to say "Good bye" to your therapist.
Sometimes, your existing relationship with your psychotherapist gets in the way of being able to judge whether red flags are real or if they're bad enough to end therapy. You and the therapist have come to know each other. When this is the case, one potentially useful strategy is to ask yourself, "Self, if I were going to hire this person as a NEW therapist, would I do so?" Or, "What if my therapist treated ALL their clients this way?" Sometimes a little informality that develops in therapy is fine-it's just the therapeutic relationship getting into good working order. However, if you find that you would not have hired this person six months ago if he or she had been behaving the way he or she is now, that's an indication that professional boundaries have been crossed and you may need to end therapy. You might also want to get a second opinion from a trusted third party, like another therapist, a professional association (many of which have ethics committees that offer guidance), or your state or provincial mental health licensing board.
When faced with unethical behavior by your therapist, we would encourage you to be as bold as possible and simply announce your decision not to continue. Here's a worst-case scenario: Your therapist gets defensive or aggressive. To get you to stay (or not to report the misbehavior), he or she may try to make you feel guilty, pin the problem on your pre-existing issues, and/or try to manipulate you emotionally, In cases such as these, the answer is ... WALK. Exercise your right to stop treatment, and realize that such guilt-tripping and belligerence is the therapist's problem and not yours.
This post was co-written with Mitchell M. Handelsman, PhD, whose blog is "The Ethical Professor" and who co-authored the book Ethics for Psychotherapists and Counselors.