The Psych Central Report
The Patient-Therapist Relationship,
Part 3: Knowing When to End the Relationship
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Editor's Note: This is Part 3 in a series of three articles on the patient-therapist relationship. The first part deals with specific kinds of therapists and mental health professionals available. The second part looks at how to determine and find quality mental health professionals. The third part discusses knowing when to end a patient-therapist relationship.
In the last issue, Part 2 illustrated the professionalism of the therapist, and how it could help or hinder the well-being of the patient. This third and final part discusses ending the patient-therapist relationship, the termination of the relationship. How does a patient tell whether it is time to end the relationship? Some signs are:
Sometimes the patient questions whether more sessions are needed because the therapist is genuinely concerned, or that the therapist wants the money.
- When the patient feels that therapy or therapist is not working.
- When the patient feels that he or she is 'well' enough to be on his or her own.
Throughout this article, the word patient always came before therapist as in 'patient-therapist'. There is a reason for that. The patient's health and well-being takes priority. If the patient strongly feels that continuing therapy will not change anything, and it is just wasting time and money, then it is time to commence the termination of therapy.
The patient should listen to his or her instincts - his or her gut feelings. These feelings are often right; however, it should be kept in mind that should something happen in the future, the patient has the option to see the therapist again, or find another one.
The most important thing in this article is that decisions, especially whether to stay with a therapist, depends on the patient. Patients should try to listen to themselves. If something does not feel right, even if there is nothing specific, then it is time to move on to someone else or stop therapy altogether.
Terminating the therapy is not easy, but it may be for the best.
When Therapy Is Not Working Out
In many cases, the patient does not know that therapy is not working until after many sessions. This is partly due to the fact that the patient often enters therapy during a crisis, and the initial sessions are usually helpful. As well, the patient-therapist relationship and therapy should be given the chance and time to see if they work.
Signs That Therapy Is Not Working
- The patient is dissatisfied. His or her goals or needs, and support are not met, despite many attempts to rectify the issues. Both the patient and the therapist need to try to work together on this.
- Personality clash.
- Many disagreements over the perspectives of issues and how to handle them.
- Disagreements regarding the type of therapy and treatment.
- The patient may feel that enough time has been given and feels that he or she is 'stuck' on a plateau.
- The patient feels the therapist is being unethical. (This topic was briefly discussed in Part 2 of "Patient-Therapist Relationship - Professionalism")
There may be other reasons why the patient (or even the therapist) may feel that therapy is not working out. Regardless of the reasons, it is very important that they both discuss his or her thoughts and feelings with each other. If neither can come to an agreement on how to deal with the situations, then it is time to start the termination process.
As mentioned earlier, another reason for termination is when the patient feels that therapy is successful, and he or she is well enough to be on his or her own.
Therapy Is Successful
If the patient feels that he or she has reached the point in therapy where further sessions are not beneficial, and that he or she can handle life on his or her own, then it may be time to terminate therapy. The therapist can also bring up the issue of termination if he or she feels the patient has gone as far as he or she could.
A termination date can be set in the future to allow time to explore the issues that might arise, such as the loss of support from the therapist, dependence, abandonment, or guilt.
Another way of terminating therapy is to taper the sessions - for example, from weekly sessions to every other week, to monthly etc.
The termination period allows the time to review and summarize the journey from when the patient attended the first session to the last. Many issues may be discussed, such as anticipating situations that might be difficult to handle, which coping mechanisms to use in case of a relapse, as well as understanding and acknowledging what can or cannot be changed.
One of the most important things to take away from the last session is that if the patient needs help in the future, it is not a sign of weakness. Some therapists make it clear that the option to return to therapy in the future is there should the need arise.
How To Go To Therapy: Making the Most of Professional Help (2003). Carl Sherman. Random House Inc.
Knowing When to Call it Quits in Psychotherapy (2004). J.M. Grohol. Online at www.psychcentral.com/library/therapy.html