The end of the psychotherapy relationship is a difficult phase of therapy. Perhaps the second most difficult one, next to actually making the decision to try out psychotherapy in the first place and pour your heart out to a complete stranger (albeit a professional).
Therapists call the end of therapy “termination,” which doesn’t help in the “let’s give this a warm, fuzzy-feeling name to make it sound as least scary as possible” department. In everyday society, we typically “terminate” bugs or contracts, not relationships. But that’s psychology for you, always promoting psychobabble when simply calling it “ending therapy” would’ve sufficed.
Ending any relationship for most of us is not something that comes easily, or is second nature. In fact, ending a relationship may be one of the most difficult things we do in our lives. Many people simply don’t know how to handle the feelings accompanying the loss, and so it can be a very trying and stressful time even under the best of circumstances.
Most psychotherapy relationships end mutually, however, which makes them a little bit easier to handle. But not much. No matter what reason the relationship may be ending — the natural end of a course of therapy for a specific mental disorder, you or your therapist moving, a change in insurance coverage — here are some tips to make the transition easier for you.
10 Tips When Ending Psychotherapy
1. Understand The Process.
While many therapists are good about explaining the termination process, some are not. Termination starts with a discussion about whether it might be a good time to end therapy. Although it’s usually begun by the therapist, sometimes clients will get the ball rolling too (especially if they feel like they’re no longer “getting anything” from therapy).
After the discussion, if both parties have agreed to end therapy, a date is chosen, usually many weeks out. In the sessions between the initial decision and the chosen end date, the therapist spends time discussing how the client is feeling about the end of psychotherapy. Goals of therapy are discussed, and the progress made on those goals. The therapist will also often review the techniques learned in therapy, and strategies to ensure the client can rely on those techniques and tools in the future without the therapist’s help. A final session ends the process.
2. Bring It Up Early.
Most experienced psychotherapists are trained to start the termination process early — far earlier than most clients are probably used to or even comfortable with. Some therapists may start talking about it as far out as 10 or 12 sessions from the end (especially for longer-term therapy). This is a good thing. It gives you time to get comfortable with the idea, and it gives your mind time to get anxious — anxiety that can then be dealt with in your continuing psychotherapy sessions.
3. Pick A Final Session Date.
This is connected to bringing it up early: Your therapist should work with you on picking the date of your last session. It’s best to choose this date together, to ensure it’s not too early (for you) or that it doesn’t interfere with some other commitment either one of you may not know about. Such a date also acts as a mutual goal the both of you will work toward in your remaining sessions.
4. Let It Out.
Ending a psychotherapy relationship is just as difficult as ending any relationship in your life. That means you’re likely going to experience mixed emotions about the end of your relationship with your therapist. That’s fine, but it’s even better if you find a way to express those feelings to your therapist. Sometimes the end of therapy brings up a new issue that hasn’t yet emerged in session. This gives you time to work on these things — if work is needed — while there’s still time.
5. Anger And Anxiety Are Normal.
It’s perfectly normal to feel anger, anxiety, or a host of other emotions after your therapist has suggested it might be time to end the relationship. Express them. Write them out. Twitter them, or post them on your Facebook page. Whatever works for you, find a way to share these things with your therapist (and if not your therapist, some other outlet that gives you a sense of relief).
6. Ask Questions If You Have Them.
Sometimes the end of therapy brings up questions about the future. What if I relapse? Who do I call? Can I start therapy with you in the future if the need arises? Any books or support groups you recommend to help me with everyday coping? Can you give me a referral to another psychotherapist you recommend? Sometimes we get flustered or feel embarrassed to ask such questions at the end of therapy. Try to find a way to ask any questions you might have, since this may be the last chance you have to have a mental health professional’s opinion or help with them.
7. Knowing If You’re Not Ready.
Some people may not be ready to end therapy. You should talk to your therapist sooner rather than later if this is the case for you. You also have to try to separate out the feelings of “I’m not ready to do this” vs. “This is making me very anxious, but it feels like it’s the right time.” Just because talking about ending the relationship makes you feel anxious or uncomfortable doesn’t mean it isn’t right. But if you’re not ready to end it — because, for instance, you believe you have more work to do or more to learn — say so. Most therapists will respect your sense of whether it’s “right” or not and continue working with you.
8. It’s Done Face-To-Face.
The final session, as with most psychotherapy, is done face-to-face. Although some clients end up canceling their last session (with the sentiment of, “Why bother? We’re done, so let’s be done with it already”), it’s best to stick with it and attend the last session even if you don’t feel like it. Like ending any (hopefully!) positive relationship, it’s usually best to have one last final goodbye. It helps with “closure,” as therapists like to say.
9. The Final Session.
There is no “normal” way a final session goes — each therapist has his or her own way of doing it. It may involve a sort of encapsulating the months (or years) of therapy spent together, and ensuring the client is ready to move on in his or her life. Especially long-term or close therapeutic relationships may end with tears and a hug (if both parties agree). Shorter-term, solution-focused therapy will often end more business-like, with a handshake and best wishes.
10. Termination Is Not The End.
Although the word suggests an ending, termination really is the start of a new beginning for you. You are once again on your own in the world without the comfortable and safe weekly check-in with your therapist. And while that initially may be a little scary or sad, it marks another stage or transition in your life that you can embrace if you choose.
As the old saying goes, all good things must come to an end, and that includes psychotherapy too. Rest assured, however, that if you need to return to therapy in the future, a good therapist will be waiting for you.
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When Depression Sets In | Life Management Ideas (5/31/2009)
24 Comments to
“Termination: 10 Tips When Ending Psychotherapy”
Hi John,
I read your article and wanted to add that for me all therapies should have a beginning, middle and an end.
As professionals I think we all know that good endings make for good beginnings.
“…ending a relationship may be one of the most difficult things we do in our lives…”
This statement is so true yet exposure to these difficult feelings and taking control over difficulties within relationships is a massive key to feeling significantly better within our own lives.
Therapy can and does teach us this ability.
Thank you.
Regards
Dawn Pugh
http://www.everytherapist.com
Doc John,
I have read the article and appreciate the excellent tips and advice.
I just don’t see and end to therapy for myself. I have been with the same psychologist for three years now. It is interesting that just the past few days I have been considering confronting him with issues I have with him…like when he says, I have known you for three years now and this is a pattern you have had all the time I have known you.
It isn’t that he has not tried to help me overcome problems/patterns of this kind.
So, what is my problem…from your distant perspective? Do I get out or continue?
I personally don’t see an end, but then I do wonder sometimes if it is just me not wanting it to end. He is truly the only person I have to talk to about the negative issues in my life and he has been there for me when I needed BIG help; i.e. suicidal thoughts/considerations and hospitalizations.
Thank you for being there and having PsychCentral,
Carolyn
I was telling a friend recently that I like to think of the relationship as being held in my heart. It didn’t end in a negative way. Part of the process of caring is about letting go and moving forward. But the therapeutic space that I shared with my therapist stays held in the room…and I keep that in my heart as part of myself now. So I can use the strength and confidence I found there with him in my other relationships. It is a way of remaining connected even though we are apart. The process has been very difficult for me but I know I’m stronger for having experienced it.
The process of ‘transference, is not inevitable. My therapist, while allowing me to be safe and to discuss what I needed to discuss, never gave me any hint I really was a wonderful person who just needed help. We worked at discovering what was causing my problems and to find the best solutions for dealing with them. We knew when we had gone as far as we could, and found no reason to keep on going until a date in the future where we didn’t need to see each other. When new problems came up or old ones returned, we got back together. It was business with goals to achieve and we did it. He told me in the beginning his job was not to make me feel good about myself by seeing him. He did the job.
Your article mentioned very specific steps toward ending a therapeutic relationship. For myself, about 5 years into our 7th year of therapy, I was already thinking about the “end.” My therapist didn’t set a date. I guess he just waited for me to say the final, “I think I don’t need to see you any longer.” It took a couple of years of more issues for that to actually happen, but when I did make up my mind, I felt ready to “conquer the world.” From then on, I never went back. If the entire world were to get therapy, I’m sure we would be having less problems.
All of this sounds quite healthy. I figure that my therapist called me out of the blue after 4-1/2 years to tell me that he was ending therapy (kindly giving me the suicide support line number just in case) as revenge.
I don’t think I’ll ever understand why every feeling that happens in the therapy room has to be referred to as a transference. I see the therapeutic relationship as more of a microcosm of sorts. It is representative of all of your relationships outside of the room.
I’m glad your therapist’s methods worked for you. The therapist has to find what works best for each client and try to work with them in the way that they need. That method would not have worked with me. Everyone is different and has different needs.
In retrospect my “termination” process was probably done too abruptly so it hit me kind of hard. I ended up going back to better express my feelings about it and have a proper good-bye. (Lots of tears and a hug)This was very helpful to me.
What is the point to this posting? Am I the only psychiatrist out there who cares and is invested in people being in therapy in the first place?
When therapists are embracing the “biochemical model” and telling patients who have the first signs of problems after starting therapy to go see a psychiatrist or see one sooner than next scheduled “to go on/up your meds” when it is flagrantly obvious they have psychosocial stressors that need to be worked on and handled, what the f— is this!? These past 6 months have been so demoralizing to see therapists in all avenues of mental health care(community/private practice/urgent care settings)just tell patients to seek out meds for treatment and then schedule the next follow up therapy appointment weeks later, I have to say psychotherapy is terminally ill as a profession.
I have decided it is time to retire my alias ‘therapyfirst’. Hereon, I am going by ‘Skillsnotpills’, as I am not selling therapy if I have few to no colleagues to rely on to reinforce the message that talking is as much if not more important than taking medication.
First insurance won’t reimburse for the services that are indicated for treatment, then professionals dumb down their abilities, and now patients just seek out pills like pez. If I had a crystal ball when I was in medical school, I would have smashed the f—ing thing and never looked at psychiatry as an option.
And I know that is truly a terrible thing to say.
Skillsnotpills (formerly therapyfirst)
Skillsnotpills (formerly therapyfirst, I am sorry to hear of your distress as a physician. I have been in therapy on and off since I was a teenager. My life, which began with an abusive bi-polar father, has been too many crisis, which many read as I just can’t get my life together, but that is not true at all.
Happily, I don’t have a therapist who believes in pills first, call me in a few weeks. I have been with him for three years now, on a weekly basis.
He knows I see a psychiatrist for meds-only (that 15 minutes update appt about every two months). I will say though that without the nortriptyline that was scripted to me while the Johns Hopkins psych unit the end of last year, I probably would not still be living on this earth.
What concerns me now is am I continuing my weekly visits out of habit or not? Something I will take up with him my next visit.
Skillsnotpills (formerly therapyfirst,) I am sorry to hear of your distress as well. Maybe there is a pill for that?
I have also had therapy for my problem with NO results. Talking has its place for certain problems like marriage therapy, life skills and the like, but I am very curious as to the “skills” you claim are bringing to the table. Mind manipulation? Getting one to “see” that their mother or some other past person, place, or event is the cause of very severe OCD or schizophrenia or some other illness YET to be cured through “talk” therapy?
Please.
One day, (and I hope it is soon) scientists will be able to prove definitively which combination of brain chemicals is making people have delusions, compulsions, and depressions. That day will be a happy day, so we can finally put to bed the notion that there is a difference between mental and physical illness and people can begin to maybe find a way to CURE some of these tragic life destroying diseases,instead of playing games by TALKING their way around them.
therapyfirst… The point of the posting is that the end of therapy is something anyone who ever has therapy has to go through. It’s not like changing family docs. It’s a lot more than that, and folks would benefit from knowing and understanding how/why it’s different and prepare accordingly.
I disagree that psychotherapy is “terminally ill” as a profession. I think it sometimes comes and goes in cycles, and while you may be currently experiencing a “down” cycle, I don’t see that across the board as a profession.
Therapy is just as important (and even more important in many cases) than medications, and there are many disorders where no medication is called for or appropriate (such as most PTSD and trauma-related disorders). Psychotherapy has a rich and robust research foundation that continues to grow weekly. I don’t see it going away any time soon!
My experience in psychotherapy was very positive and I believe has had a life-changing effect on me. I used no medications. Talk therapy worked very well for me.
Termination of therapy is enough for me to not venture into therapy again after this. Or perhaps not go as long as I have been. I am now into my 5th year with my therapist, tried to end on numerous occassions, yet have not succeeded, nor has she. I can honestly say that this “therapeutic relatioinship” will be a difficult one to let go of.
my Mother,Debbie Manka ,went off and married her Psychologist/therapist Matt Manka. It destroyed our family and my brothers mental health as well as mine. it also destroyed my fathers health as he and my mother(debbie)r were going to Matt for marriage counseling initially. Now Matt and Debbie are running Lifestream Solutions in Arizona.I personally do not think they should be allowed to counsel anyone ,as dating your client is against the rules,right? Any comments on all this? kris
As someone who is in the process of ‘teminating’ a relationship with a wonderful therapist who has quite literally saved my life, I read the post as advice on ‘letting go’ and let’s face it, the ultimate aim of therapy is being able to stand alone. A good therapist supports and nourishes the damaged person until they can stand alone. I suffered a multiple loss and was grieving so badly that I simply wanted to die. I wanted the pain to go away and if I could just have gone to sleep and never wakened up I would have been happy. BUT I have a daughter who really did not deserve to have to cope with losing me too and I wanted to stay alive for her sake. (Although at times even that was almost not enough reason to continue living.)
I was very fortunate in finding my therapist and we have established a warm and healing relationship over the past 10 months. I intiated a ‘trial termination’ by increasing the time between appointments. It didn’t work the first time. Within a few days I had a crisis but she was at the end of the phone and I went immediately to see her - Sunday afternoon!- About a month later we decided to phase out the weekly meetings to alternate weeks. This month we decided to move to meeting for lunch from time to time. We’re in touch by text as she continues to convince me that I can have a happy life and be a confident,successful professional woman once more. I was a wreck when I went to her and without her support I could not be considering travelling to speak at an international conference which I am currently preparing for.
‘Letting go’ is a sign that you have entered a different phase and that’s going to be different for each person. My advice is to take time to heal and use the skills of your therapist for as long as it takes. I should add that I have also relied on acupuncture for calming and general wellbeing as well as boosting the immune system and trying to regulate my erratic sleep patterns. I continue to have that weekly.
Good morning
This is the first time I have participated in an online discussion but this spoke to me. I have had good relationships with my therapists and it does seem with them that a natural ending came about as I became healthier.
I would like to share one story my father who I loved dearly and cared for till he died of kidney failure. He was on dialysis so hospice was not an option but my mom and I qualified for hospice couseling. A wonderful man came into our lives and helped us through the hardest time of our lives. He kept seeing us for two years. My mom had severe heart problems and was in early stages of dementia. My husband served divorce papers 3 months after my dad died and my mother became sicker. He was a life saver he taught me how to honor my fathers death to accept my moms condition and gave me good insight to survive a breakup of a 20 year relationship with a young child. My mom was eventually put on hospice care and the counselor became a regular part of our lives. 2 weeks into hospice a month before my mom passed away he took a new job. I thought I was going to die myself but all the wonderful knowledge he helped me with brought me through. It was a huge blow though and if I had any wish it would be i could of had his counel till after mom died.
Thanks for listening
In trying to end therapy, my very poor therapist really showed his stripes. He erupted into sarcasm, denigration and threats in attempt to keep me as his patient. The Colorado ethics board ruled this acceptable practice. I wonder what this profession considers unethical.
Endings are hard, God bless those therapists who take termination seriously and prepare the client for it as much as they can and understand the sadness that can go along with it. In my view, those therapists are the REAL DEAL.
I am in the process of ending my sessions after 3 and a half years. I have been in and out of counseling over the years as needed, and always felt it was a good way to get help through tough times.
This last wonderful counseler is the first that actually got to the deep childhood problems that most likely caused many of the “hard times” I encounted throughout my lifetime. I am 62. I feel that 3years ago I was finally ready to take the time to work on me. My children were grown and had their own families, it was time for me to take back my life and live it, again.
She helped me deal with old feelings and fears stemming from incidents, that were never understood orhealed. We did talk of ending the sessions and at first it scared me, yet after thinking about it I realised I was ready, my life had become quite busy with doing things I wanted to do. It took that couple of weeks to come to terms with the loss of our friendship, and realise that I could walk alone again. Also know I could always go back if needed, made it easier. Your tips came right on time. I think it was a good idea to put them in writing, to help other’s see them. I did not need or use medication. I found that I had some disasociative issues that needed to be worked through. I now understand those free floating emotions. Julie is the best.
Helen
I wish i had therapy to end. I have been to several therapists and felt that they were no help at all. I prefer to see female therapists as i am a female myself and can be better understood. However, i felt that yawning in my face and eating and drinking were a destraction when these therapists did so. I pretty much do my own research and still wonder if i can handle being off meds and reasoning with my own negative thinking.
iferjn I wish you well in your search for help.
My therapist, who I refer to in my previous post, came to the profession after tragedy in her own life and I wonder if that makes her more understanding than most. She had counselling herself and as a result she decided she wanted to return to college and retrain as a therapist.
She makes me feel as though I am the only person she has to focus on, yet she has to cope alone with a teenage family and has many more clients.
I’m blessed I know but giving their undivided attention for the allotted time is the way true professionals should behave. It is discourteous to eat and drink during a consultation with a client, as for yawning in your face…
Perhaps you should investigate more reliable therapists to help with your negative thoughts. I found such destructive thoughts extremely difficult to cope with alone and needed another perspective to sort out my head and my heart. I would never have managed it alone so I hope you find help soon. Professionals reading these posts may be able to advise you.
thank you for your post, jacki
My therapist and I have mutally decided to finish up our work together. (I don’t like the word “termination.”) I have been seeing her for 2 1/2 years. We’ve talked about it in the past, but just yesterday, we decided that I have learned and utilized some very helpful coping tools. It is time for me to continue to put those skills into place.
We decided we will first switch to meeting every other week. She then took it a step further by helping me to set a termination date. That was somewhat scary for me, but we were able to come up with a mutually acceptable date.
This therapist has literally saved my life. How do you thank someone for that? It will be so very hard to say goodbye to her, but I know that it is finally time to do so. I also know that I will never forget her.
This will blow your mind but I have been seeing the same wonderful therapist for forty two years straight, two times a month. I am 56 years old and I started seeing her at age 15. She is about 12 or 13 years older than me and I love her like a mother. She told me the other day during a session that she is going to finally retire at the end of the year. (2009) She has been everything in the world to me. What concerns me is that I’m having fleeting thoughts of suicide and have in fact been trying to die already “by accident.” I am a diabetic and I ate 22 cookies the day after she broke the news to me and I left it up to Que Sera Sera as to if I woke up again or not. I am numb now. She says she will get together with me once every six months and that is wonderful of her but I don’t think I will make it thru this alive. I’m really worried about myself but will not tell anyone of my plans. Any similiar experiences would be appreciated because there is stilla part of me that would possibly like to go on living. Thank you.
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Last reviewed: By John M. Grohol, Psy.D. on 1 Jun 2009
