As often as people ask a question about how to begin therapy, folks don’t seem to ask how they will know it’s time to call it quits.
Psychotherapy involves a relationship between two people and ending any social or professional relationship can be difficult. Therapists are trained to know how to successfully end a therapeutic relationship in a healthy, positive manner. Despite their training, however, sometimes the therapist doesn’t know exactly when to end therapy. This article is meant to help you understand and learn to look for the signs of when it may be time to end your therapy.
Setting the Expectations in Psychotherapy
Some people go into therapy thinking it’s a lifetime commitment. Unless you’re Woody Allen or otherwise well-off, most people do not stay in therapy for more than a year or two. In today’s practice of psychotherapy, clinicians focus on helping people solve their issues in a time-limited environment. Managed care has had something to do with that, but it also makes a lot of sense. Most research shows that for the most common mental health concerns – such as depression, anxiety, and bipolar disorder – cognitive-behavioral approaches work effectively in short amounts of time.
What exactly is a “short amount of time?” That depends not only on the type and severity of the problem, but also the client’s personality and coping skills. Additionally, more skilled and experienced therapists tend to have slightly quicker and more robust positive outcomes than less experienced clinicians. Research shows that many people for many common mental health concerns will begin experiencing positive gains in therapy in as little as 6 to 12 sessions. At one session per week, that translates into two to three months.
In practice, however, gains often take longer because people are usually a little more complex (and therapists a little less focused on only problem-solving) in the real world. In the real world, you can expect gains to take up to three times longer. You should definitely start seeing improvements in that first two to three months. But long-term improvement and long-lasting gains may take from six to 12 months to fully realize with an experienced therapist.
Remember, these numbers are just averages for common problems such as depression, anxiety and bipolar disorder. Psychotherapy is rarely conducted in a vacuum, which means the messiness and complexity of life can often interfere with treatment. The best treatment also usually involves a combination approach of psychotherapy and medications.
There are two common reasons people leave their psychotherapy – they’re done working on the issue that brought them into therapy in the first place, or they’re finding they cannot work with their therapy any longer. You can usually tell that it may be getting time to leave therapy by looking for some telltale signs.
You’re Done Working on the Issue
If you’re done working on the issue that brought you into therapy, you’ll notice by looking at your behavior while in session. You may feel more bored than usual in session, or find that increasingly you have little to talk about. You and your therapist may spend a great deal of more and more sessions talking about daily activities or things that have little to do with the reason you’re seeing your therapist. Running through a laundry list of activities you did in the past week since you last saw your therapist is often a sign that therapy is winding down. (Sometimes going through such a list may be beneficial or a part of therapy of the problem is related to time-management, anxiety, or such. But if it’s just a recounting of your daily activities with no special focus on anything, it’s probably just a time-filler.)
Sometimes people will notice they begin talking about more existential issues in therapy, or get more philosophical or political in their discussions. If these are not the issues that you came into psychotherapy to discuss, it’s likely that you’re using them as time-fillers. I believe it is fine to have such discussions in therapy, but only if they occur infrequently or as a tangent off of the issue that brought you into session in the first place.
Therapy can also often evolve into something different than what it started as. That’s also okay as long as both the client and the therapist are aware of the evolution and are okay with it. What may have started as a focus on a client’s depression could turn into some discussions about death, dying, and the meaning of life. That may be completely legitimate and a useful focus for therapy. Just as long as the client is relating the discussion back to their issues or to their own lives with an emotional connection. Academic debates or discussions are best left to university classrooms or dinner conversations.
Leaving a Therapy Relationship that’s Not Working Out
People may also want to leave psychotherapy because they find they are not accomplishing positive things with their therapist. This occurs more frequently with a new therapist. You can usually sense it’s not working with the new therapist because your personalities clash, your ways of dealing with issues differ significantly, or you don’t find the therapist supportive of your needs.
The key here is to acknowledge the reality as soon as you realize it and accept that it’s not working. Then you have to bring it up to your therapist in the next session. This is easier said than done, since a common part of the problem is that you may find it difficult to talk to a therapist that’s not working out. Sometimes it helps a person to write down their reasons for it not working out on a piece of paper and bring that into session with you. You can refer to the paper when you bring the topic up. Try to do so as soon as possible in the session – do not wait until you have 5 minutes left. You need time to discuss the issue with your therapist, and hopefully to get a few referrals from him or her.
Therapists sometimes have a difficult time with a client who wants to leave early, especially if it’s over an issue where the client doesn’t like or doesn’t feel supported by the psychotherapist. That’s their problem, not yours. Listen to their concerns or questions. Sometimes it may have just been a simple misunderstanding (especially if you’ve only seen the therapist once or twice). But if you are certain about your decision and have given the therapist a thorough chance, be firm in your resolve. Some therapists may try to argue you out of your decision. Be prepared for that and simply answer them with your feelings and beliefs – that you don’t feel working with them is working out or beneficial any longer for you.
Making a Clean Break
Whether you’ve spent only 2 sessions or 20 with your therapist, it’s always easiest to make a clean break from therapy. It goes most smoothly if both the therapist and client have agreed upon a set date beforehand – “Three session from today will be our last.” Be prepared! The last session is often difficult and can be emotionally draining. Sometimes clients will feel a sense of achievement, but others may feel a sense of loss. Acknowledge your feelings in session and let you and your therapist work together one last time.
Don’t be tempted to make a follow-up appointment for a month or three down the road just to “check in.” In some exceptions, this may be necessary for especially long-term or intensive psychotherapy. But for most people, the end of therapy (therapists call it “termination,” a term that seems a little harsh to me) should just happen and then it’s over. No follow-ups, no phone calls, that’s it. Congratulations! You’ve successfully ended your therapy.
It is all right, however, to send a thank you note or card if you feel so inclined. Therapists are often thanked for the work they did with a client at the end of therapy. But most of the credit should, of course, go to the client who does the vast majority of the work. Change is hard, and changing the way we think or our behavior over the years can be especially challenging.
Remember that seeing a therapist is just like seeing a doctor when you’re sick. Leaving therapy once doesn’t mean you’re set for life. Changes do occur in our lives and there may be a time when you may need to go back into therapy in the future. Just keep that in mind that the psychotherapy resource is available to you in the future if you need it.