This is the last blog in my series inviting readers to examine: recognizing when someone might benefit from going into therapy, various types of therapy that are available, appropriate expectations with regard to healthy therapy, and recognizing therapists who are unhealthy, ineffective or even unethical.
Today we will look at why, when, and how to break up with a therapist and end the therapeutic relationship. In addition to my own personal experiences, I’m drawing from a number of websites with excellent information so I highly recommend you check out some of the linked sites to get more information than I can provide here.
According to an article entitled “How Long Does Therapy Last?” on the website Good Therapy: “The treatment methods the therapist uses, the goals of the person seeking therapy, the symptoms he or she has, and the history of those symptoms will all determine the length of therapy.”
The author of this article, Cynthia W. Lubow, MS, MFT, shares the following: “When people have been repeatedly traumatized, abused, neglected, or shamed as a child, without loving adults to help them handle these traumas, they generally need several years in therapy, or even more. When people get hurt in relationships that are supposed to be close and trustworthy (like parents), it takes another committed and consistently trustworthy person to help repair those wounds over time. When people have been badly hurt, especially when they were children, repair is generally a slower process of developing trust in the therapist and transforming childhood ways of coping into more effective ways.”
According to Joseph Napoli, MD, associate chief of psychiatry at Englewood Hospital and Medical Center in Englewood, New Jersey on the website WebMD “The job of therapy is to make the therapist expendable…. Just as you grow up and leave your parents,…so should you be developing the necessary tools to leave your therapist and live your own life.”
From the same website, Dr. Norman Rosenthal, clinical professor of psychiatry at Georgetown University in Washington states the following, “If you’re thinking of leaving therapy, ask yourself why: Are you not getting much out of it anymore? Or, on the other hand, have you accomplished what you set out to do? Do you feel that the world and your relationships in it will be manageable on your own? “
Sometimes therapy ends because there is a prescribed number of sessions allotted for this specific therapy. For example, EMDR therapists often have a prescribed number of sessions typically anywhere from 6-12 sessions. Sometimes therapy ends because insurance will only pay for certain amount. Or a client cannot afford to continue. Sometimes a client is not experiencing new awareness, growth or healing and therefore is dissatisfied with the therapist’s approaches. And noted on the Good Therapy website, it depends on the specific needs, issues and diagnoses of clients. The more complex, deep-seated, and long-term someone’s issues are, such as is true for people with PTSD, the more complicated and long-term therapy probably needs to be.
Both the client and therapist need to be careful not to extend therapy beyond the time when it would be good to end the therapeutic relationship. It can be tempting for a client and sometimes for a therapist to want to remain in the therapeutic relationship when a deep sense of connection has been created. You do not want to continue with a therapist who has overstepped their boundaries, creating a high degree of dependency, or one who just provides advice and approval rather than being nurturing and empowering. Any time a therapeutic relationship goes on for many years with a client who does not have a severe and complex set of issues, it is time to consider that one or both have become co-dependent and are struggling to end their therapeutic alliance.
Ending a therapeutic relationship can be painful and even traumatizing, especially when the therapy has lasted for months or years where the client has formed a strong bond with the therapist seeing them as someone who freed them from pain, and has become someone they genuinely like or even love. As stated on the website Society for Psychotherapy “For some clients and psychotherapists, psychotherapy termination is also theorized to trigger a re-experiencing of past losses and unresolved grief.” If a very strong, warm relationship as formed between a client and therapist, a certain degree of grief will occur for one or both people when the relationship needs to end.
Some good news about ending the therapeutic relationship comes from the article previously cited from the Society for Psychotherapy: “Termination appears to be viewed as a positive transition by most clients…For most clients, rather than eliciting unresolved losses, the research suggests that the final stage of psychotherapy is characterized by a sense of accomplishment, pride, calmness, and health for both psychotherapist and client.”
According to Society for Psychotherapy, it is clients who initiate discussions of ending therapy about two thirds of the time. But sometimes the therapist suggests that a client might benefit from a different kind of therapy after they have experienced the particular approaches the therapist used. Sometimes both the therapist and the client conclude that their time together and goals were accomplished. Or instead of having an abrupt ending, the client and therapist decide to meet fewer times and finally end by saying that the client is always welcome to have a check-in session as needed.
Each therapeutic relationship is unique. There is no specific exact formula for forming a therapeutic relationship or for ending one. Having some of these principles in mind can serve as a guide if you are considering therapy.
Invitation for Reflection
- What new awareness or understanding do you now have regarding why, when and how to end a therapeutic relationship?
- Is there anything that you need to explore to make it easier and healthier for you as you move through processes of ending a therapeutic relationship?
- How might you use the information in this blog or previous ones to assist anyone considering therapy or needs to end therapy?
Diane Wagenhals, Director, Lakeside Global Institute