Therapists Spill: How to End Therapy

By Margarita Tartakovsky, M.S.

Therapists Spill: How to End TherapyThere are many reasons clients decide to end therapy. According to clinical psychologist Deborah Serani, Psy.D, “Sometimes they’ve reached their goals. Sometimes they need a break. Sometimes the connection with their therapist isn’t there.” Sometimes they notice a red flag. Sometimes they’re about to face a new fear or realize a new insight, said Ryan Howes, Ph.D, a clinical psychologist and author of the blog “In Therapy.”

“Whatever the reason, it’s vital to bring it into your sessions as soon as you feel it,” said Serani, author of the book Living With Depression. Howes agreed. Wanting to end therapy is a critical topic to explore, he said. And it could be as simple as telling your therapist, “I feel like it’s time to end therapy, I wonder what that’s all about?”

Therapy gives people the opportunity to have a positive ending, unlike most endings, which tend to be negative, such as death and divorce, Howes said. An end in therapy can be “more like a bittersweet graduation than a sad, abrupt, or complicated loss. Ideally, you can have a satisfying closure to therapy that will help you end relationships well in the future.”

That’s because our relationship with our therapist frequently mirrors our relationships outside their office. “We often unconsciously recreate dynamics from other relationships with our therapist,” said Joyce Marter, LCPC, a therapist and owner of the counseling practice Urban Balance. “Processing negative feelings can be a way to work through maladaptive patterns and make the therapeutic relationship a corrective experience. If you avoid this conversation by simply discontinuing therapy, you will miss this opportunity for a deeper level of healing resulting from your therapy.”

Tips on Ending Therapy

Below, clinicians share additional thoughts on the best ways to approach your therapist when you’d like to end therapy.

1. Figure out why you’d like to leave. According to Jeffrey Sumber, M.A., a psychotherapist, author and teacher, the best way to end therapy is to delve into why you’d like to leave. Ask yourself: Is it “because I feel disrespected, stuck or incompatible or [am I] actually feeling uncomfortable dealing with certain things that the counselor is pushing me on?” It’s common and part of the process of changing problematic patterns, he said, to feel triggered and even angry with your therapist.

2. Don’t stop therapy abruptly. Again, it’s important for clients to talk with their therapists, because they may realize that their desire to part ways is premature. Even if you decide to leave therapy, processing this is helpful. “A session or two to discuss how you feel and what kinds of post-treatment experiences you may go through will help ease guilt, regret or sadness that often arises when wanting to stop therapy,” Serani said.

Plus, “Honoring the relationship and the work you have done together with some sessions to achieve closure in a positive way can be a very powerful experience,” Marter said.

But there are exceptions. Howes suggested leaving abruptly if there are ethical violations. He reminded readers that you’re “the boss” in therapy:

If there have been significant ethical violations in therapy – sexual advances, breached confidentiality, boundary violations, etc. – it may be best to leave and seek treatment elsewhere. It’s important for clients to know they are the boss; it’s your time and your dime, and you can leave whenever you want. If the violations are serious enough, you may want to tell your therapist’s boss, your next therapist, or the licensing board about them.

3. Talk in person. Avoid ending therapy with a text, email or voicemail, Marter said. “Speaking directly is an opportunity to practice assertive communication and perhaps also conflict resolution, making it is an opportunity for learning and growth.”

4. Be honest. “If you feel comfortable and emotionally safe doing so, it is best to be direct and honest with your therapist about how you are feeling about him or her, the therapeutic relationship or the counseling process,” Marter said.

When offering feedback to your therapist, do so “without bitterness or judgment,” said John Duffy, Ph.D, a clinical psychologist and author of the book The Available Parent: Radical Optimism for Raising Teens and Tweens. “After all, this person will be working with others in the future, and your thoughts may change his or her style, and help them to better serve their clients in the future.”

“A good therapist will be open to feedback and will use it to continually improve,” added Christina G. Hibbert, Psy.D, a clinical psychologist and expert in postpartum mental health.

5. Communicate clearly. “Your best bet is to be as direct, open, and clear as possible,” Hibbert said. Articulate your exact reasons for wanting to end therapy. Hibbert gave the following examples: “’I didn’t agree with what you said last session and it makes me feel like this isn’t going to work,’ or ‘I’ve tried several sessions, but I just don’t feel like we’re a good match.’”

(“’Not being a “good match’ is a perfectly good reason to terminate therapy, since so much of it has to do with a good personality fit and a trusting relationship,” she added.)

6. Be ready for your therapist to disagree. According to Serani, “It is not unusual for a therapist to agree with ending therapy, especially if you’ve reached your goals and are doing well.” But they also might disagree with you, she said. Still, remember that this is “your therapy.” “Don’t agree to continue if you truly want to stop, or feel persuaded to keep coming for sessions because your therapist pressures you to stay.”

7. Plan for the end in the beginning. “Every therapy ends, there’s no reason to deny this fact,” Howes said. He suggested discussing termination at the start of treatment. “Early in therapy when you’re covering your treatment goals, why not talk about how and when you’d like therapy to end? Will you stop when you’ve achieved all your goals? When the insurance runs out? When and if you get bored in therapy?”

Again, therapy can teach you valuable skills to use for your other relationships. According to Marter, “Even if after expressing your negative feelings, you choose to end the therapeutic relationship, you can rest assured that you took good care of yourself by advocating for yourself in a way that was direct and honest. This is a skill you can bring with you to other relationships that are no longer working for you.”

How Therapists React to Termination

So how do clinicians take it when clients end therapy? All the therapists noted that having their clients share feedback on their experiences is incredibly valuable. In short, it helps them improve and grow as clinicians.

But, when there’s no official end to therapy, therapists are left with many unanswered questions. According to Howes:

When a client terminates via voicemail, fades away with a vague “I’ll call you for my next session,” or abruptly announces the end and leaves, I feel loss and am left with many questions.

What fell short in this therapy? What would have worked better? How could I have been a better therapist for you? What made you feel like you couldn’t discuss this with me? I’m left with no answers for these questions, and that’s difficult. I spend a lot of time reflecting on our work together, but I have no definite answers.

Serani and Marter echoed this sentiment. “Sometimes clients just ‘fizzle out’ without explanation, which has been one of the harder pieces of being a therapist for me because I am very invested in my work with my clients. It causes me to wonder if I did something that bothered them and wished that I knew,” Marter said.

Serani also talked about attempting to understand the client’s decision. “I always want to explore the reasons why. Was it something I said? Was it something I didn’t say? What has happened to make this decision so urgent? I often feel confused, and work hard to make sense of why this has happened.”

Hibbert tries not to take it personally. “Usually clients simply ‘stop coming,’ so it’s not easy to know if they’re just ‘done’ with therapy or if I’ve done something to make them want to leave. When this is the case, I just let it go. It’s their issue, not mine, and I don’t need to stress over it when I don’t know the reasons behind it.”

She takes a similar approach when a client wants to stop therapy because of personality differences. “Only a couple of times has a client verbalized a desire to leave because of ‘personality’ or ‘style’ differences. I can’t say it never stings, but I try not to take it personally. Like I said before, therapy, in large part, is a personality fit, and I can’t fit with every personality.”

When client and clinician are able to have a session (or two) for proper closure, it becomes a great opportunity to reflect on their work together. In fact, for Howes, these are often his most enjoyable sessions.

My goal is to help a client confront life head-on. If they have clear reasons to end therapy and we’ve had the time to talk about it and tie up the loose ends, ending therapy is a great time to reflect on our work, talk about the client’s future, and discuss what has been accomplished and what hasn’t. We can leave with a sense of closure, without lingering questions.

Some of my best sessions have been final appointments where we reminisce about our time together, talk about the client’s future, and I learn how to be a better clinician for others.

Serani described final sessions with mixed emotions. “This is usually an exciting but bittersweet time, where we both feel a loss about the goodbye, but know that leaving is part of the healing process. I’m always sad for me, but happy for my patient.”

Unless there are ethical violations, it’s important to discuss your desire to end therapy with your therapist, in person. As Duffy said, doing so with “respect and integrity will set the tone for other relationship issues you will encounter in life.” It also helps you process your emotions and figure out if you’re leaving too soon. And it gives your therapist valuable feedback that improves their work. In other words, with proper closure, everybody wins.

 

APA Reference
Tartakovsky, M. (2013). Therapists Spill: How to End Therapy. Psych Central. Retrieved on October 24, 2014, from http://psychcentral.com/lib/therapists-spill-how-to-end-therapy/00015513
Scientifically Reviewed
    Last reviewed: By John M. Grohol, Psy.D. on 7 Mar 2013
    Published on PsychCentral.com. All rights reserved.