When Is the Right Time to End Therapy?

This post is part one of a two-part series.

The question of when is the right time to end therapy remains debatable. In some cases, the decision is easy to make, while in others, it's unclear both to you as a client and, in some cases, even to the therapist, whether the time has come.

The premature abruption of therapy has several undesirable effects. Swift et al. (2) point out that clients who prematurely terminate exhibit poorer treatment outcomes compared to those who stay in therapy longer or complete it. Sherman & Anderson (4) note that the decision to terminate early often leads the client to decide that therapy is not for them, thus depriving themselves of a broad and diverse range of approaches and specialists generalized under the umbrella of "therapy".

The opportune time for ending therapy

The easiest decision is when the client comes with a concrete problem, e.g., "Help me get through a divorce", "I need help with changing jobs, but something is stopping me", "I want to earn more, but feel that I sabotage myself", and so on. In such cases, recovering from the problems and reaching a concrete and measurable result - i.e., finding a new job, getting a divorce, earning more, and/or improving functional abilities, becomes the point where therapy can be completed.

Another straightforward decision to end therapy can be made when addressing issues like specific phobias, panic attacks, or anxiety related to a concrete current or future event (such as an exam or relocation to a different country), or sometimes even when processing grief. In such cases, unless these issues are found to be part of a broader problem like PTSD, progress can be measured objectively through standardized tests or subjectively through the client's reported satisfaction with their newfound state of calm.

Identifying the appropriate time to end therapy usually isn't easy and straightforward

Let's say a client comes with emotional symptoms (anger, guilt, shame, sadness) that have roots in childhood traumas. A few examples:

A high-achieving attorney deals with too much stress and has no idea what he genuinely enjoys. All his hobbies are about self-optimization and earning more. His family complains that he spends too much time at work, and he angrily retorts that he does it for them. A profound grief emerges, a sudden welling of tears when he realizes that his father died in unknown circumstances. Working has become a coping mechanism to gain control to avoid painful losses. Therapy, which had been about stress, changes direction and becomes about grief and control.

A successful executive feels a constant, hollow emptiness, numbed by alcohol and a series of draining relationships. She proudly describes her achievements as "finally making her mother proud," yet she feels no pride herself. Therapy, which began to address her dependencies, shifts irrevocably when she recounts her mother's venomous confessions: "I didn't want to have children" and "Your father left because of you." The work is no longer about quitting bad habits, but about excavating and reliving a childhood buried under a mountain of guilt and learning that she deserves a life of her own, not one lived as an apology.

An individual who has always been the "scapegoat" for the family's problems develops a strong, positive alliance in therapy, then suddenly quits without any explanation. However, they soon return to continue and explain the decision: "I felt safe that you will not punish me, no matter what I do." The new feeling of safety is so antithetical to their identity within the family that it created a crisis that they could only resolve by terminating immediately and unexpectedly, reenacting their core trauma of abandonment. In this case, terminating therapy is a part of therapy to exercise a free choice, not its end.

Oftentimes, when the client starts to feel better, the progress is accompanied by a fear that the symptoms will return. Here we are dealing with a basic mistrust in oneself and the world — a fear that the world will not let you keep what "it hath given". This fear becomes the new target in therapy. Even though the client might decide to graduate from therapy, it is highly advisable to continue in this case and to work with these newly found fears and what they connect to in one's life. (see my post on 6 common fears about starting therapy)

Read part two of this series here.

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