Termination: 10 Tips When Ending PsychotherapyThe 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 …

34 Comments to
Termination: 10 Tips When Ending Psychotherapy

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  1. 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

  2. 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

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. 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)

  9. 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.

  10. 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.

  11. 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!

  12. 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.

  13. 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.

    • I’m very sorry for you and completely can relate. I’ve been out of therapy for three weeks and its been most difficult. I was in weekly therapy for a year and seven months. I mourn it. I find myself sad and crying. I will admit the first two weeks I felt like a knife went through my heart. This week a bit better but I find keeping busy helps. Face it…you trust this person like no other and you can express anything without being judged but unconditionally loved. I pray for the best for you. My belief is everyone should. Go through therapy. It refreshes your soul. I would of liked to continue for life coaching. As I spoke to him about everything. He was “my angel”and I miss him so much♥

  14. 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

  15. 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.

  16. 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

  17. 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.

  18. 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.

  19. 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

  20. 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.

  21. 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.

  22. thank you for your post, jacki

  23. 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.

  24. 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.

    • Kathy,
      I just saw your Oct 8, 2009 entry and am wondering how you are doing.
      bating

    • Kathy G
      Just saw your comment and am so concerned. I think it was irresponsible for your therapist to allow you to continue in therapy, dependent on her for so long. I pray that you found your way.
      KKnATL

  25. i’m rather surprised at the level of involvement folks have with their therapist. is that how therapy is supposed to work? i can understand cases where there is a genuine need for extended therapy and support from a professional… i’m worried for folks who are capable of learning techniques to depend on themselves but are instead staying within their comfort zone of a therapist. i thought therapy was a professional relationship and that there is a line between therapist and patient, but am surprised to see the level of dependency. maybe i’ve got the idea of therapy all wrong. i personally see a therapist when i feel overwhelmed, but i go with the end in mind – to get a grasp on the problem and get pointers to go do further work on my own – so its pretty clear off the bat that i’m the one who’s gonna do the ending, unless the therapist is able to articulate to me some compelling reason for me to continue.

    i’m genuinely sorry if i’m coming across too blunt.

  26. Yes! I believe dat everything dat has a begining must surely has an end. Termination phase is truely a difficult phase between the client and the therapist because the therapist will make sure that the client is responding or has attained mental health before announcing termination to him he cannot announce it when he does not see a change in him.”MASTER” my question is will a therapist announce termination when a client is under resistance of all types?

  27. I am also currently going through a very difficult time in ending my therapy. I have known my therapist for just over 5 years now. Initially I started, because I was training to become a counsellor myself. I only needed 36 sessions per year, so only saw her for those sessions in the first 3 years. 2 1/2 years ago I had an abortion and finally with a lot of post (taking the pill and wearing a contraceptive implant) trauma to deal with, my body and mind were overwhelmed with feelings of depression. I started seeing my therapist regularly once a week. At the moment I really feel therapy is not helping anymore. It feels as if we have come to a dead end. I have also started taking anti-depressants for the first time (although very low dose). I really want to stand on my own two feet, since not feeling that we are going anywhere, but also feel scared to end therapy. Any advise from anyone, who had similar feelings or circumstances? I don’t want to be more dependant and in therapy for longer!!!

    • Hi Richarda, I hope things are going better for you. Last week I just finished up with my therapist after 8 years. I also felt that I wasn’t getting as much help as I needed during my sessions, and thought about stopping for a few months.I finally realized that I needed to decide what was best for me. It was hard, really hard to bring the topic up- but I have confidence in myself now, and she was so understanding and helpful. Part of me loves her still, and part of me knows it was just a professional relationship. I have both feelings inside & thats ok.

      We agreed to end after 3 – sessions one month apart. That gave me time to make sure I was strong enough to stand on my own. I am still grieving the loss a little bit since thats what it really is. But its a healthy reaction and I know I’ll be fine. She saved my life, and helped me to stand on my own and I’m so grateful. And smiling, and whole. Finally. My thoughts & prayers of graceful courage are with you.

  28. I am not sure why some therapists allow clients to continue with them until they feel that they (therapists) are not doing anything for them. What about referrals to care with a professional who would be able to recommend care within the institution for short periods? Or, am I missing something here as being the reason for allowing the (paying) client to continue?

  29. Good Evening. I have just been terminated from therapy after weekly sessions for one year and seven months. I was thrilled when it happened recognizing my growth, only to find myself fall into a depression, crying and yearning for it NOT to end. Its been three weeks since our last session, email or text. I miss him. I liked him, I hated him and I love him. I never had a chance to ask if I needed him again after termination may I call and make an appointment. Why is termination so difficult? Why do I find myself in tears missing the one person I allowed to know me to a complete? I want to be strong but I’m sad. I feel like I’m mourning a death. Is this normal? Will it ever pass? And does your therapist go through this also after termination? Please help me …ty kindly.

  30. Thanks! I’m writing a paper for my pre-practicum class and you would be amazed how little information there is on how to terminate.

    This gave me a near step-by-step springboard to wrap my project around.

  31. A “termination period” assumes a sweet candyland where all therapists are ethical, unselfish and not threatened losing their clients.

    Unfortunately the termination threat ignites some therapists into the counselor’s version of the controlling, wounded spouse, exploding in rage, and employing every manipulation in their arsenals to impede client abandonment. And because the client has been lulled into viewing these jerks as wise “authority figures,” the lies and contradictions can inflict untold damage.

    Unqualifiedly counseling ALL clients to have a sweet face-to-face goodbye, regardless of circumstance, damage or ethical violation, is irresponsible counsel. Some therapists don’t take losing their devoted sycophant, income stream or woman-on-the-side well.

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