Therapy

Don't Ghost Your Therapist

Ending therapy well can be a valuable part of the treatment.

Posted Oct 23, 2020

Once, last year, I sent a text to a patient of mine about copayments, and the outcome surprised me.  She hadn’t paid anything for two weeks in a row — not at all unusual — and owed me a few dollars, something well under $100. So at the end of an ordinary text thread in which we scheduled another session, I reminded her of the amount she still owed. Her response was immediate and surprising: She promised to send the copayments but would also be canceling all future sessions. I wrote back to ask what had prompted this decision, which seemed very sudden, but that was it: I never heard from her again. Our therapeutic relationship ended just like that, with nothing even faintly resembling closure.

Flickr / R~P~M
Source: Flickr / R~P~M

Obviously, “ghosting” one’s therapist like this is not the recommended way to end treatment. In the mental health vernacular, bringing therapy to a conclusion is known as “termination” — a dubious term that has wrinkled quite a few brows over the years. (I recall hearing about a young therapist who, in the days leading up to her last session with a favorite patient, had recurring dreams about Arnold Schwarzenegger, as if her unconscious mind was engaging in a little word-association humor.) Nevertheless, the ideal end of therapy should be, in the considered opinion of those who have studied such things, integrated into the treatment from the outset.

That’s right: Termination isn’t something to stumble over as a treatment reaches its conclusion, but can be discussed right away, as you enter into a course of therapy. It’s not uncommon for people to fear that their therapists will expect them to stay in therapy for the rest of their lives, or to warily ask how long the treatment will last; a little communication early on about termination can dispel any mistaken notions, and should properly set the frame for a course of therapy.

I’m also reminded of another example: the case of a young man with whom I worked for almost five years until he reluctantly told me he’d been wondering if our therapy should come to an end. It soon occurred to me that the most therapeutic thing I could do for him — a man who had once been so hesitant and uncertain, whose therapy had focused on enhancing his ability to speak up for himself, and who had gradually become more independent over the years — would be to stop being his therapist. It became clear that the termination of our therapy wasn’t just a stopping point; it was an additional facet of treatment, a jumping-off place from which the patient would take new steps he’d never attempted before.

In general terms, then, the goals of your treatment should inform the termination plan that you and your therapist establish. For instance, if your goal is to discontinue a compulsive behavior, the two of you can agree that therapy will conclude after the compulsions disappear. If, however, you’re seeking therapy for a less specific reason — to process your emotional reactions to the world around you, to gain insight, or just to feel seen and fully understood by a fellow human being, you and your therapist can agree to continue until you decide to make a change.

Of course, other factors do sometimes end treatment prematurely. Insurance companies can limit therapy to a set number of sessions; other times, patients may change jobs, or move to a new city. And sometimes, it’s the therapist who needs to terminate prematurely* — if, for example, they are in training and know they will be moving on after a specific date. In all of these cases, you and your therapist should talk about ending treatment before the end is nigh.

In the end, psychotherapy always benefits from honest and genuine participation, and the same is true about any treatment’s conclusion. Don’t deprive yourself of the valuable opportunity to consider termination together and to gain insight into what it might mean. If you do this, you’ll never need to “ghost” your therapist, because your expectations for closure will already be set.

*Therapists also have an ethical obligation to discontinue treatment under certain circumstances. If, for example, you and your therapist discover that you’re somehow connected through a third person, you should have a candid conversation about the ways in which this could affect your treatment. It may be that the dual relationship compromises your therapist’s ability to empathize, or to treat you with impartiality; you, too, may have difficulty relating to your therapist in quite the same way. If the treatment cannot proceed with objectivity and empathy, it may be better to discontinue it and to accept your therapist’s recommendation of another provider.

To find a therapist near you, visit the Psychology Today Therapy Directory.

References

Barnett, J. E. (2016, October). 6 strategies for ethical termination of psychotherapy: And for avoiding abandonment. [Web article]. Retrieved from: http://www.societyforpsychotherapy.org/6-strategies-for-ethical-termination-of-psychotherapy