In this installment of the Demystifying Psychotherapy series, I discuss the process of ending psychotherapy. Saying goodbye to your therapist is ideally an intentional and gradual chapter in your psychotherapy which has its own set of goals and outcomes. Let’s explore the many questions and issues involved.
The nearly universal question: How long will therapy take?
When you first meet with a therapist, you naturally want to know how long it will take to accomplish your goals. The somewhat frustrating answer is that it depends on many factors – your goals, the nature and complexity of the issues bringing you to therapy – to name a few. Under the best of circumstances, psychotherapy ends when your goals have been met. This may take three months, three years, or more than a decade. As long as you are actively working on issues of importance to you and getting something meaningful from the experience, this is a sign that psychotherapy remains productive and is worth continuing.
The question of how many sessions a person may need to address a given issue is impossible to answer accurately due to the fact that a brand new psychotherapy needs to be created for every client. Every human being is unique and brings to the psychotherapy endeavor their own particular history, traits, goals, needs, values, dreams, struggles, and strengths. What we can say with authority is that if the client contributes a robust sense of motivation to do the work (psychotherapy takes quite a bit of active work, contrary to what some may think!) while also experiencing a good interpersonal fit with their therapist, positive outcomes are bound to follow.
We will readily see that the notion of some prescribed duration of psychotherapy is flawed when considering that mental health can be viewed through an illness lens or a wellness lens. Both are valid. Applying the former lens, psychotherapy is initiated because there is an ailment – a set of symptoms – that inhibits the ability to live a good life, however the sufferer may define it. Thus, the client finds themselves in the therapist’s office because they want the pain of depression, social anxiety, panic, etc. to be alleviated. Once symptoms are no longer present, the treatment ends. But does it?
Here is where the wellness lens contributes a different approach to mental health. Mental health is not something you get to achieve, check off your list, and cease giving attention to. Just like it would not make sense to stop going to the gym because you went several times and now feel physically healthy, it is not realistic to proclaim that one has mastered coping with adversity, suffering, conflict, trauma, and all the other incredibly rich, complex, and difficult experiences that come with being human. Psychotherapy becomes a powerful space for ensuring that wellness and mental health are receiving the attention they need.
It is because of the never-finished nature of mental health that many people choose to be in longer-term psychotherapy. Also, some clients need months or years to address the suffering that has brought them to psychotherapy in the first place. The duration is ultimately determined by the client’s goals and needs. These may evolve over time.
How might I know I am ready to end psychotherapy?
I have already established that mental health is not something we can achieve and be done with. This does not mean that people should see their therapist forever. Ending psychotherapy is not predicated on having no difficulties whatsoever. It has more to do with whether you feel you have accomplished what you wanted to and are fairly confident that you now have the tools and insights to guide you when new stressors arise. Many people share that one of the ways they knew they were ready to part ways with their therapist was because they internalized their therapist’s voice and could imagine in difficult situations what their therapist would say and recommend. Others feel not only that they gained a sense of confidence about their ability to handle various stressful circumstances but have also developed a more robust social support network to lean on during those times.
Ideally, the process of ending psychotherapy – what therapists call the termination phase of psychotherapy – is a planned and collaborative endeavor. If you are starting to wonder whether it is time to wind down your therapy and your therapist is not bringing this up, talk to them about it. Discuss your thoughts and feelings and review your goals. Together you will be able to set the agenda for the remaining time together, establish how many more sessions might be needed to accomplish the remaining goals, and review and solidify your psychotherapy gains.
Winding down: What happens in the termination phase of psychotherapy?
In the last chapter of your work with your therapist, there are many things to accomplish. First and foremost, it is important to revisit your goals and discuss in depth how they have been met. You might discover that new goals have emerged in their place and to continue your work to attend to them. If goals have been met, this is a time to prepare for termination. Together with your therapist, you will reflect on all that you have learned and also continue to focus on generalizing your skills and insights to your life outside of the session. This may be a time to begin to space sessions out, perhaps meeting with your therapist every other week versus weekly. If new struggles emerge at this point, this will also be an opportunity to work through them. Additionally, you will make a plan for addressing any struggles that might resurface and hopefully emerge with a clear idea of what might be the warning signs alerting you to the need to consider returning to psychotherapy.
A key takeaway here is also that psychotherapy rarely is a one-and-done experience. It is not uncommon for therapists to see their clients at different points in the client’s life. A client who was first seen as a young adult might come back in their thirties after starting a family, terminate after a year of therapy, and resurface again a decade later. It is also okay if you choose to work with a new therapist rather than return to your old one – whatever feels right to you.
Saying goodbye to your therapist
Humans are wired to avoid pain. This can translate into avoiding saying a “real” goodbye to your therapist. Sometimes clients choose to gradually disappear, never showing up to that one last session in which goodbyes are said. Therapists themselves may be guilty of colluding in this avoidance. It is very important to have an ending – a good goodbye – that honors all that was accomplished as well as the intimacy and connection that have developed between the therapist and the client. Good therapy endings are bittersweet. Making room for both the joy of meeting your goals and the loss of the relationship that you and the therapist have come to treasure provides for a healthy, empowering closure. We do not have enough of those in our human relationships. Try to resist the urge to sneak out of the relationship with your therapist without saying goodbye.
I mentioned before that clients often share that they “carry” their therapist with them: they may remember what the therapist had said, what they might say to a given issue, and how the therapist made them feel. You should know you also have an impact on your therapist. I often think of clients I saw years ago, wondering if they are content and living the life they wanted to live. I almost always include my former clients in my loving-kindness meditation; this never ceases to fill me with gratitude for the privilege of being a witness and a guide to crucial moments in their lives.
What about ending therapy that just isn’t working?
I have thus far described ending psychotherapy as a collaborative, gradual, and intentional process that culminates in a good goodbye. Unfortunately, this may not always be possible: sometimes you have to make a unilateral decision to end psychotherapy. Psychotherapists are bound to “do no harm,” much like physicians. If your therapist fails to abide by the legal and ethical standards of their profession, you need to sever ties to protect yourself. Depending on the nature of their transgression, you might consider reporting the issue to the therapist’s supervisor/employer and, in the event of a grave violation, to their licensing board.
It is a well-known fact that psychotherapy works only if the relationship between you and the therapist is marked by a strong and positive alliance. This means the therapeutic relationship needs to be based in trust, positive regard, nonjudgment, transparency, genuine commitment to you and your goals, and healthy, clearly established boundaries. Note also that the bond between you and the therapist will develop over time. After all, much like in other relationships, trust is earned, not simply given.
It is important to allow the time to develop a strong alliance with your therapist and not expect that it will happen overnight. However, if it is clear to you that your therapist is not the right fit, seek out a different one. Do not give up on psychotherapy altogether.
It is also worth mentioning that there may be times when you or your therapist come to the conclusion that your therapist is no longer the right fit for you due to the specific expertise your goals require and which the therapist may not have. Maybe you first came in to address conflict in your romantic relationship, but now you want to focus on your low libido and you find out this is not your therapist’s focus area. In such instances, your therapist is actually obligated to refer you to another professional.
Lastly, there is a common experience that people have after working with their therapist for an extended period of time that may give rise to feeling that psychotherapy is no longer bearing fruit: it is called a plateau. A plateau is marked by a feeling of stuckness and thoughts of “nothing is changing” which then may give rise to questioning (understandably!) why you are continuing with the process. Plateaus may precede a major breakthrough in psychotherapy. At other times they are a sign of some unconscious roadblock that needs to be identified and addressed. Or perhaps you and the therapist are not on the same page about the goals of your work together. If you are feeling stuck in your therapy, do not hold these feelings back. Talk to your therapist about your experience so you can figure out together how to get the therapy moving again. We will talk in greater depth about plateaus in another Demystifying Psychotherapy article.
Be careful not to end prematurely. Carefully consider your reasons first.
When considering ending psychotherapy, carefully review your reasons. If you are finding that the therapist is not helping you in the way you expected, consider whether you have made your goals and preferences clear. The therapist may be trying very hard to help you while being unaware of what works and does not work for you. Perhaps you would like them to give you more feedback or homework assignments. Or it annoys you that they are focusing so much on your past. Or even worse, they keep saying things that either don’t make sense to you or that you disagree with. Before you decide to stop, talk to your therapist about how you are feeling. It is very possible that this will be just what is needed to re-energize your work together.
The same recommendation applies to any interpersonal issues arising within the therapy relationship that lead to ambivalence about continuing. Progress in therapy is made not only by discussing and resolving issues pertaining to your life outside of the session, but also attuning to how interpersonal patterns from your outside relationships may come to be experienced within the therapy relationship. For example, a client who grew up experiencing chronic invalidation and shaming responses to their feelings may grow increasingly distrustful and uncomfortable with their therapist as their shared level of closeness increases. A few months into therapy, the client might say that continuing is untenable due to the cost or schedule when in fact the real reason for wanting to terminate is the discomfort with getting close for fear of being hurt again. The person may not realize that this is what is happening, and the cost or time considerations may be real enough to seem like the central reason to stop working together.
In a different example, a client may have experienced the therapist as cold or judgmental in a particular session, and not having spoken up about it, is no longer comfortable with taking emotional risks in the session. It is possible the therapist has made a mistake in how they responded and knowing about it would offer an opportunity for repair. It is also possible that the client fears being judged so much or judges themselves so harshly that the idea that someone could be nonjudgmental feels impossible to accept. All these issues can be mined for valuable insight and become tremendous learning opportunities. The relationship between the client and the therapist is in itself a key vehicle for growth.
Ending psychotherapy is an important though sometimes overlooked chapter in psychotherapy. After years of saying goodbye to my clients, I still cannot say I enjoy that last moment when we part ways. However, I do cherish the experience. The words of A.A. Milne capture the sentiment well: “How lucky I am to have something that makes saying goodbye so hard.” I hope those who have the courage and the self-awareness to seek the support of psychotherapy get to feel this way when the time comes to say goodbye.