[ Psychotherapy may end, but the popularity of this topic may well not. There’s a follow-up to this post, which you may wish to read: Leaving therapy – so what’s the problem? (2009.01.15) ]
Everything ends eventually, including psychotherapy. A grace-full, well managed ending is ideal, but, in reality, ending psychotherapy – leaving a psychotherapy relationship – is a problem for some individuals. Mental health professionals would do well to acknowledge this more often, and respond with some specific suggestions for our clients, before they start wondering whether it’s time to stop, and then how to do it.
PSYCHOTHERAPY AS AN INTIMATE RELATIONSHIP
Intimacy takes many forms. Most intimacy in life is familial. Some occurs in the context of friendship. And some occurs in psychotherapy. In all cases, it is true that intimates know things about each other not generally known by other people in their life.
Intimacy is not always between peers. We may know significant details of the life of our First Family (President, etc.). It’s unlikely that they know anything of us, as individuals. Mothers know more about their children than the children know of them. Psychotherapy relationships are similarly unequal, for in them therapists know more about their clients than clients about therapists.
INTIMACY AND VULNERABILITY
Intimate knowledge creates vulnerability. Where intimate knowledge is asymmetrical, vulnerability is also. Whoever is known most about is usually the vulnerable one, for multiple reasons. In psychotherapy, this vulnerable one is the client.
The specific vulnerability I want to address here has to do with the likelihood that leaving a psychotherapy relationship will be a distressing time for a client. I want to consider the possibility of reducing this distress.
WHY LEAVING PSYCHOTHERAPY CAN BE DIFFICULT FOR YOU
There are so many reasons why this may be so. Here a some of the reasons most immediately obvious to me:
- You may never have done it before.
- When the issue of leaving occurs to you, you may not feel finished with therapy.
- Your therapist may not talked with you yet about leaving, at the time you begin thinking about it.
- You may have real conflict about leaving.
- You may not be the one who brings the issue up.
- You may be aware that your therapist is more engaged in working with your problems than you are, and you don’t have any idea what to do about this.
- You don’t want to hurt your therapist’s feelings.
- You may have no idea how to justify your leaving.
- Other people in your life who matter to you may want you to stay in therapy.
GETTING YOUR THINKING STRAIGHT ABOUT LEAVING
I want to take up here each of challenges I listed above, and possibly a few others that come up as I work things through.
You may never have done it before. First-time therapy clients have a lot of “firsts” to work through in therapy. Leaving is certainly one of them. If this is not your first therapy relationship you’re more likely to have some knowledge of the challenge of leaving, even if you don’t yet quite know how to do it well. If this is your first time leaving therapy, you really ought to talk about it with your therapist. They, after all, are not first-timers, relative to this issue, and just might be able to help you. If you find it a difficult topic to bring up, then the difficulty you’re experiencing needs to be the first thing you talk about. That difficulty may well be a legitimate “therapy issue”.
Your therapist may not talk with you about leaving before you begin to feel like the time is close. If we therapists don’t take up this problem and make sense of it, what chance do you have if doing it at all well? We’re interested in getting you into therapy, and keeping you there until we can get some real work done. And then what? We seem to have little to say about this.
When I brought up this topic to my very capable faculty adviser during my internship in graduate school, his reaction was that this concern was not for us to address. “The client determines when therapy ends”, he said. OK – there’s a very good idea in that sentence, but the problem remains. (And I suspect that if I’d asked the question better I’d have gotten a better answer!)
We have many ideas to offer you. How to leave therapy well seems not to be among them. I’ve never heard this issue seriously discussed in a professional context. We seem not to think about it. We should, because it’s too often a source of distress for our clients. As a client, you cannot fix this problem, but you can realize that part of the problem for you is that too often you’re on your own with the problem. You shouldn’t be, I think, but you usually are. There is a remedy for this, however, and it’s under your control.
You will probably not feel finished, when the issue of leaving comes up. It is rare for a person to have addressed all their problems when they leave therapy. There really isn’t a need to have done this. It’s better to take up focused issues, make progress (any progress at all is better than staying stuck), leave, and then return later if this seems called for. It is realistic to see life as a series of ongoing challenges – and to accept that you’re not going to run out of problems. Do you really think psychotherapy is going to fix this? I wish!
You may not be the one who brings the issue up. If you have to deal with “managed care”, or have a seriously limited budget, you know that external factors and people can have a real say about when therapy ends. Or…your therapist may be moving, or retiring, or going on vacation. Your situation then is one of feeling unfinished but having to leave anyway (see the paragraph above, concerning this). This can be difficult, but it can also be talked about, and learned from. See that this is how it gets handled in your case.
You may have real conflict about leaving – feeling like you want to leave AND you want to stay. This is very common, for many reasons. The best thing to do is to take up the matter of the conflict(s) you feel with your therapist (do you notice a theme in my remarks, here?). Such conflicts arise from the fact that our mind virtually always holds multiple points of view about critical issues. These conflicts are part of being human, so talk about it. It’ll help, and it’ll often work to actually resolve the conflict.
You may be aware that your therapist is more engaged in working with your problems than you are, and you don’t have any idea what to do about this. In a sense, this shouldn’t happen, but it often does, anyway. First of all, it’s probably generally true that your therapist experiences a degree of fascination with your problems – dealing with them is his/her chosen profession, after all. You, on the other hand feel something other than fascination, and in this there is an essential imbalance.
Nevertheless, the rule is that the client leads. We may invite you to go certain places, but when you indicate disinterest, that settles it. It’s YOUR opinion that counts. I hope your therapist doesn’t forget this, but if they do, you still shouldn’t. If your therapist appears to need to engage with your problems, they have matters to take up with their therapist. This kind of problem is actually common in psychotherapy. Freud talked about it, and we’ve been talking about it since then. What you should know is that it’s OUR problem, not yours.
Therapists are people, and they do have problems, at times, but that should not be your concern. In psychotherapy, you’re expected to be self-centered, and you should maintain this focus right on through the time of your leaving. Your therapist can take care of themselves. They have access to excellent resources for doing this.
You don’t want to hurt your therapist’s feelings. I see this issue come up most often with young women, who are often deeply in contact with their maternal side. Such instincts are one of the glories of humanity, but really don’t belong in the psychotherapy relationship. Your therapist does have feelings, and you likely will be missed. Your therapist also has experience with this problem, and can take care of themselves.
It’s good for you to notice that your therapist values you. You do have value, and we all need to know this. However, children leave home, clients leave therapy, and we all leave life, at some point. It’s the Way of Things. If this is a persisting problem for you, you owe it to yourself to bring this problem to therapy. Doing so is an excellent idea.
You may have no idea how to justify your leaving. Many people in therapy have a history of being disrespected, and thus have some trouble respecting themselves. They often feel defensive or in need of justification. Try to understand that this is a developmental problem which you don’t have to have, and really should not tolerate. If you DO have this problem, take it into your therapy as a topic.
The best reason to leave therapy is a very simple one: you want to. I teach assertion, and I’ll say it plainly: Your feelings are your best justification for anything. (You do well to see that your feelings are based on correct perceptions of course.) If you find this difficult, then you’ve just identified and area in which you need some work, and definitely some practice. Assertion skills definitely have to be practiced. I look for opportunities to practice mine. You should too.
Other people in your life who matter to you may want you to stay in therapy. Who? Parents, spouses, children, friends, employers…did I leave anyone out? While sometimes therapy may be mandated by a judge, in all other cases, it’s your call. People can have any opinion they want. It’s a free country. And you need to keep your own counsel. Participation is your decision. When someone else has feelings about your leaving therapy, take it up with them. Understand that THEY are having a problem. Talk with them to see what’s at the root of the problem (it’ll usually be some fear which isn’t well enough identified). This will help your relationship with them, and may even give you some useful information.
SOME THINGS I WANT YOU TO KNOW ABOUT LEAVING THERAPY
You may not be the only one distressed by the idea of your leaving. We often come to truly like and enjoy our clients. I know that in mine I virtually always see the essential problems of all of us as human beings. I usually develop a strong sense of compassion, and come to care significantly about each individual I work with. How can I look casually upon the prospect of coming to the end of our meetings? I don’t know how to do this, and I’m not sure I want to learn. So, that your distress is likely shared is a very good reason for taking up leaving as a topic, with your therapist. You both should talk about it with each other. Very often the problem is one of dealing with loss – and that’s a problem that challenges all of us, in various ways.
Some therapists are as puzzled by the “leaving” problem as you may be. Not all therapists grasp that clients will leave with some of the problems they brought into therapy. I can recall our being confronted with the necessary “unfinished client” problem, by one of our teachers in graduate school. I was already familiar with it, but some of my fellow students had not thought of it, and found it troubling. If your therapist has not grasped this reality, and the fact that it’s not necessarily a problem, you still can. You must, in fact, because everyone leaves unfinished. We’re all a work-in-progress. You think this is a problem? Wait until you face dying, unfinished! (You’ve been warned – so now you have some time to prepare for that one…)
Loss is one of the great themes of everyone’s life – you do well not to turn away from it. Some people, when the time comes, simply run from therapy. It’s the only way they can handle it, but it’s not a good response. Losing your therapist is but one of many losses you will have in your life. USE the experience to address the issue of loss and what it means to you and how you handle it. It’s an excellent chance to add to the benefit you get from your therapy.
Your therapy is about you and what’s good for you. This may seem obvious, yet concern for others and a desire to take care of others, sometimes in inappropriate ways, is common, especially in psychotherapy clients. Your therapist, if she/he has a lick of sense, has done psychotherapy work themselves, and has taken up the issue of loss in the course of that work. He/she comes to their work prepared to handle the eventual loss of clients. You don’t need to be worried or concerned about them. Your attention belongs on you.
You can come back. Surprise! This doesn’t occur to many people. You can think of leaving as an experiment. Do it and see how it goes for you. You can return, if you find that you’re not ready. I’ve had a number of clients return, virtually always for only a short period of additional work. Some have come back 2-3 times. One came back four, and the fourth time was the one where she really got down to work. I was thrilled, and I think she was as well. You can simply take things as they come, just like you have to do with the rest of your life.
SOME GOOD WAYS TO TALK ABOUT LEAVING THERAPY
I want to offer here some little “mini-scripts” which may help you deal with leaving.
(To your therapist) – “I’ve been thinking that I’m about finished with therapy. What do you think about that?”
(To anyone at all) – “I’m feeling about ready to leave therapy. It’s been a challenge/good experience/disappointment/real puzzle to me/a life changing experience (pick one or more). I’m ready for a rest.”
(To yourself) – “I feel about ready to stop. I want to respect that. I can come back if I want to, or go elsewhere, later. I will always have many options.”
(To your spouse) – “I’m graduating soon from therapy. I hope you’ve been keeping up, because your life is about to get really interesting!”
(To your therapist) – “Thanks for the challenges, for the patience, for information, for the compassions and caring. I’m not who I was when I came here. I know I’ll keep growing after I leave, and what’s happened here will help to make that good growth. I’m grateful. I hope you think of me from time to time. I know I’ll think of you. Maybe I’ll send you a postcard.” (I always like to hear these sorts of statements. Expressing gratitude is something I very much value. I will often express a lot of it back – I do admire the courage and humanity of my clients. I always am inspired by it. Rarely, I think, do they realize how much they enrich my life. I want them to have some small sense of that. And I always respond positively to the idea of that “postcard”.)
CONCLUSION
I wrote this originally in one sitting, while thinking particularly of one client of mine (who reported finding it useful), but always had in mind a more general problem, involving many more individuals. What I have written seems incomplete, and unfinished, and I hope to revisit the topic and revise it further, but for now it’s time to go. This, too, is a work in progress.
(revised 2008.06.03)
Thanks. That was very useful. I’ve been in therapy for two and a half years, I’ve made enormous progress in many areas, and feel ready to fend for myself out in the world. My fear is that my therapist will likely not agree, and will suggest that I remain in therapy. Tricky. I trust her and she has brought me so far, but I also need to trust my abilities to exist therapy-free in the world. I can’t help thinking if it was up to her I’d remain in therapy for years and years tweaking away at progressively more obscure issues that I’d like to learn to navigate on my own. The problem is that if she doesn’t support me leaving, it is hard to have absolute trust that I am doing the right thing. I should mention that I am a fully functioning person with no serious chemical issues who basically suffered from childhood wounds, moderate depression, low-self esteem, and a history of abusive relationships. I’m now single, I’ve got a stellar job, loads of friends and a rather wonderful life.
Obviously I’ll bring this up with her. I should also mention that there is no financial incentive to keep me in her stable. I live in Canada and her services have been provided to me through the health care system.
Thanks again for writing this article. It is an issue worth discussing, and I’d love to get more guidance.
I apologize for being very slow to notice your comment. Things get very busy for me in the winter!
Thanks for your positive reaction – and for sharing it. I’m delighted to read that word “useful” in your comments. That was exactly what I was hoping for.
I encourage you to trust yourself. What’s the worst that could happen if you decide to leave (assuming you really want to)?
It’s important to know what while therapy is, in my opinion, full of potential to be very useful, one doesn’t have to be in therapy continually. Doing it in cycles probably makes more sense.
So…consider trusting your judgment a bit more, and simply engaging in the little experimental living! Best of luck to you.
I announced I wanted to leave therapy to my therapist a week ago. I’m glad I’ve made that decision, and we’ve talked about leaving since then. However, I have felt a bit apprehensive and some of the questions and concerns you mention in your article. I found reading it reassuring and helpful – thanks for putting this on the web!
Tom
Thank you for the article – I have been writing a similar article from the client’s side, as I am debating leaving my therapist. I know it is not time for me to leave, but perhaps to change. I am a rabid information gatherer, and I am doing research to understand how to rebuild the therapeutic relationship and regain the trust in order to continue, and have been searching for the right issues to bring up over the next few sessions in order to see if I feel comfortable staying, or should find someone new. I have added many of your recommendations into my article (with attribution of course) and I am glad I found your site.
My site deals specifically with dissociative identity disorder and PTSD secondary to repeated sexual assaults, and I started the blog to share the research that I had been doing for myself and my therapy, since I haven’t seen similar stuff on the web and thought others might benefit from it as well.
I hope to have my article up in the next few days at
http://emilyfirstgirl.wordpress.com/
Thank you
Emily
Emily – I’m looking forward to reading your thoughts on the subject. I can see from your site that you think and write carefully, and that delights me. Good luck on your writing.
[…] Cloyd T (2007).End times: Coming to the end of psychotherapy, Sleight of Mind blog, accessed from https://sleightmind.wordpress.com/2007/08/01/end-times-coming-to-the-end-of-psychotherapy/ […]
I just found this – with my final session with my therapist tomorrow. It’s not my choice – I’m out of the number of sessions it was deemed I should have. Trouble is, major issues have surfaced during therapy (abuse related) and I have nowhere to go with them. Endings have always been difficult for me (long history of abandonment) and this just feels impossible and outside of my control.
I’m struggling to know how to approach the session tomorrow. most of all I want to avoid, to run away, to have it happen without me. I’m fighting that, but it is so so hard. So much of what you wrote rings true for me – and it helps to know that endings are a problem for others, not just for me. Sometimes it feels as if people expect me to just be able tos ay “goodbye” without it mattering. But how do you say goodbye when you really don’t want to leave?
Some thoughts about your situation: A forced termination from someone with whom you’ve been working successfully, and with whom you wish to stay connected, is not a happy story. I’m sorry this is happening to you.
While the ending of this relationship seems beyond your control, how you handle it is not, and you seem to have some awareness of this. Good.
I suggest that you work seriously to find a new therapist you can afford (some do have a sliding fee scale), AND who can work with attachment, abandonment, and (ideally) ego state disorders. I suspect all three of the frequently interrelated perspectives would be useful for you to be engaged with.
Secondly, and more immediately: Your meeting today with your soon-to-be former therapist is a loss situation. Because you value the relationship, losing it will be disturbing for you. There’s no avoiding this. But there’s another side to all loss and grief: celebration of the good. While you can talk with this therapist, express your gratitude – clearly, strongly, and specifically – for the benefits you’ve had from the relationship.
Why do this? Because gifts of these sorts tend to stay with us, and because while we may not have had all we want, that we had any at all is a very good thing. Acknowledging and celebrating the positive aspects of a situation which has passed from our lives will virtually always help to stop our clinging to that which we must release. Try it – many people have found it quite helpful, including me.
It’s also telling yourself the whole truth. That’s an important skill for any adult person. And here’s another “whole truth” to grasp: howsoever wounded one became as a child, as an adult we have also acquired competent, capable aspects of self which can guide us through challenges and crises. There’s always more to us than the wounded child, although this is easy to forget when that child part of us is having a bad day. People with wounded child parts benefit from practicing their adult strengths – we all do, in fact!
So, this may be a hard day at times. But work to see that it’s also more than that. It can be. I hope you can achieve this. As an adult you can work at doing what was simply not possible as a child: taking good care of yourself this day. Be aware of what you’re feeling as you let go of this therapist. Keep breathing, and just let things flow. The feelings will just pass on, like a wind that comes and goes, and you’ll be OK when they’ve passed. This is good and vital work. Embrace it.
Thank you for this response.
What you wrote tied in so much with what my therapist and I tried to do (I didn’t see this reply till today) – that is very reassuring. We did spend time celebrating, recognising the positives. I was afraid I would not be able to put this into words, (though I did, in the end, manage to say much of what I wanted to in terms of thanks) so I emailed her before to say the things I appreciated. She also said very positive things about having enjoyed our work together, which touched me deeply.
I’ve been working very hard to find a new therapist and saw one for the first time today who feels like a good match. She has the experience (in many of the things you mention) and also works on a sliding scale – and there is no fixed limit to the number of sessions. All good.
I really appreciate the time you took to respond, and thank you particularly for the last paragraph. I’ll continue working at embracing this. Thank you.
Hi. Am in the process of cutting back to eventually terminate therapy. Have been seeing my psychologist for 5 years.(Chronic PTSD) I’m already finding that I am grieving between sessions, even though therapy hasn’t ended yet. I’m finding it really difficult to carry on seeing my therapist, being open and honest; whilst simultaneously letting go (in between sessions.) I’m going to miss her tremendously. She’s been such a valuable person in my life over the past 5 years. You talk about sharing the positives with ones therapist, and yes there are plenty of those; but what about the losses, the sad feelings? Is it appropriate to discuss those too?
It all sounds so logical and reasoned. I feel furious. I’m starting a psychotherapy course and they insist you do therapy with one of their ‘approved’ psychotherapists. Since my therapist is highly qualified and experienced I hoped they would approve her, now , with the course about to start they tell me they won’t, and it is too late to apply elsewhere. I hadn’t anticipated how hard it would be, nor how furious her accepting approach (you’re ready, you will make the right choice etc ) has left me. Your reasoned measured tone doesn’t match how I feel, maybe I’m not as ready as she thinks?
AJ71: I’m concerned to hear that you’ve been in therapy for “chronic PTSD” for years. First, the term “chronic PTSD”, while certainly a descriptor we use professionally in diagnosis, is a bit of an absurdity. Once you have PTSD, it’s always there until you resolve it yourself or get help doing it. There’s good reason to believe that if you don’t resolve it yourself within a year, you’re stuck with it until you get professional help. So, after a year, all PTSD is chronic. I’m sorry that this term is confusing, but it is.
But my concern is with this: unless one has Attachment issues associated with PTSD originating in childhood, PTSD treatment, if it’s really treatment and not just talk, should not take five years. I don’t know enough to know that something’s wrong here, but I can’t rule it out either. Hence my concern. Too many people end up with a therapist who sayes they treat PTSD but really don’t. Treated PTSD goes away. You don’t have it any more. A simple idea. That’s the outcome with virtually everyone I treat, for example, and I’m not alone in getting such results. I typically get these results in 12 weeks. I hope there’s a good reason why you haven’t seen such results.
In leaving a therapist before you’re ready, feelings of distress and loss will certainly arise, unavoidably. Such feelings are a part of life, for all of us. They will surely come to us on multiple occasions throughout our life. Learning to live through them is important. I definitely think you should bring such feelings front and center in your therapy at this point. It well may be that they are the most important things going on between you and your therapist, so of course you should focus on them – absolutely.
A sense of loss and sadness tells us clearly that we value something. It’s very important to see what that is. I lost a relationship once, and in the instant I knew that I had lost it I realized that my grief was about my valuing something positive, else it wouldn’t be there. I decided to focus on regaining the positive value that I wanted in my life. I think this is the only thing that makes any sense in such situations.
You can do the same, I think. Affirm what you value, and don’t let that value go. You may well have to get another therapist, but you don’t have to give up personally meaningful, productive, healing relationships, which can be found even outside of a therapy relationship. A part of all losses cannot be restored, of course. A child who dies cannot be brought back, but that doesn’t mean that we must give up children in our lives.
Thanks for your comment. I hope this is of some help to you.
Nessie,
It sounds to me like some part of you feels ignored. You are mad, but my piece is reasonable: a mismatch. You are mad, but your therapist is accepting: another mismatch. I hope your realize that my blog entry was written for a general audience. It cannot fit the situation of everyone who reads it.
It seems to me that if you’re angry, there’s a good reason. Anger is a defensive emotion, and it comes up only in the context of fear. Finding what it is that provokes the fear can be very very profitable, if one is ready to be aware of it. The problem is that sometimes we are brought into contact with ancient unresolved fear and anger by current events. Our feelings won’t particularly match well with those current events, UNLESS we’re aware of the bigger picture – namely that something in our personal history is being remembered at some level in our mind, and THAT is stirring up feelings. People who don’t know our history may think us “crazy”, but this is absolutely NOT true. They just don’t know the whole story.
This is all a bit complex, of course, but it’s still true. Having professional help untangling this, and setting things right, can be the subject of some very profound psychotherapy. I can say this because I’ve done this with clients, and have been a client in such psychotherapy myself (as have many therapists).
I, too, find it infuriating when insurance companies and managed care plans take people’s money and then tell them who they can and cannot receive services from. However, one rarely gets involved in such plans without knowing in advance that this is going to happen. I suggest that people pursue other alternatives, if at all possible. And if not, make the best of it. Life is seldom perfect. We often have to compromise. That’s just a fact of life.
It’s important to realize that your anger is coming from a part of you which is trying to take care of the rest of you. It’s essentially protective. Realizing this, the adult part of you can respond by actively seeking to be protective as well. You want decent treatment. Good. You should. Take thoughtful action in response to this desire, which is also protective. Merely taking strong action, well thought out, will help you feel considerably better.
If you have to give up your present therapist, you might want to use her to help you sort out these feelings in your final sessions. Let your feelings tell you about yourself, about how you value yourself and want the best possible outcome. Then work to see that it happens. That’s all any of us can do, ever, and getting really good at doing this is a long term project for all of us. We just need to start it, and then keep going. You can do this. You may be poor at it in the beginning, but stay with it and you’ll get better. That’s always the story. I hope for the best, for you.
Hi Tom, to make my situation clearer. I have a childhood history of having been neglected, then abandoned by a parent (my mother) when I was 3. I was raised in an emotionally, physically & sexually abusive environment. I no doubt would have been dxed with PTSD as a child. I learned to disconnect from my feelings/thoughts, emigrated to the other side of the world, put my past behind me and started a new life with my husband. I experienced another major trauma (surgical trauma) 8 years ago as an adult, and got so unwell and out-of-control, I eventually hit rock bottom and ended up in therapy. The diagnosis was chronic PTSD.
I have worked through the PTSD stuff from the surgical trauma and the childhood trauma, but still obviously have some issues with attachment. My T is the first person I’ve ever really allowed myself to feel close to and I am having trouble giving that up, even though I no longer need her support so much.
So yes, I am losing something that I value – A safe, close, intimate relationship that has been a really significant part of my life for the past 5 years (a very healing relationship); and I have trouble imagining myself having that with anybody else. I kind of don’t want to let it go, but I can’t stay in therapy forever.
Dear Tom
Thank you for your excellent article. I have been seeing my therapist weekly for@4 years.
Over the past week I have wrestled with ending and have now reached the decision that I am going to.
My therapist and I have always got on very well and seem to have a lot in common. For a while now I’ve had concerns that the boundaries are blurred and the relationship has been more “friendly” than professional and our sessions have felt stuck as a result. She has also cancelled quite a lot of appointments at the last minute, mainly due to personal illness and family matters. The lack of continuity has been stressful, and I very much sense that I keep “rescuing” her.
I have emailed my therapist and expressed most of my concerns. She took on board what I said and recognised the trust issue and hoped we could work through it. I can’t really see anyway of us going back on what has happened.
I feel like I’ve been through a range of emotions this past week, anger and feeling let down re the boundaries & cancellations, guilt at feeling angry! And sadness at the inevitable loss of the relationship.
I do feel ready to stop now, and feel a sense of peace in making the decision. It could be now the time to step out and focus on living my life rather than focusing on the therapy process etc. It is a bit daunting but I’m think I’m ready for the challenge and kind of exciting!
Although we’ve had a few emails back and forth in the past 2 weeks, I haven’t actually spoken to my therapist, I don’t how that will be and am not sure how you actually go about finishing when something like this has happened.
Apologies for this being so long.
Thanks.
AJ71 – Thanks for the additional information. It makes complete sense to me that you’d have difficulty ending this therapy relationship. I want to underline that sentence three times! With your awful childhood – awful in multiple dimensions, and in ways that few people can really understand, I would expect that simply achieving a reasonable level of comfort and hopefulness in daily life would be a significant challenge. It’s also a very important goal.
Part of that goal necessarily involves establishing emotionally affirming and nourishing relationships with other people – the very thing you learned you could NOT do as a child, because those around you could not be trusted, either in the sense of not hurting you or in the sense of not allowing others to.
So here you have established a safe and nourishing relationship. However, since it’s with your therapist it’s unbalanced – your therapist knows you far better than you them. As you leave this relationship, I hope you understand how important it is that you not stop.
You must continue to seek out, establish, and maintain safe and emotionally nourishing relationships. You can engage with another therapist, at some point, if you wish. But that’s not where one lives one’s life. You can learn HOW there, but the actually living must be done elsewhere.
I hope you are a fighter. You probably are, else you wouldn’t have gotten to where you are today. Just keep it up. Your need to fight for yourself – against the highly distorted view of the world you grew up (most people are good, not bad, and that applies to you as well), and against the reflexive sense of discouragement and hopelessness that your childhood taught you was sensible and protective. The world you’re in now is probably not one where you can justify large amounts of hopelessness. I certainly hope this is true, and to the degree that it is, validate and affirm this.
Now is the time you work to make for yourself the basis of a good life, as a competent adult. It’s the most important thing you have to do, and you’ll be working on it a long time. Leaving your therapist places you in a position where you will need to consciously take better care of yourself, daily – hourly, even. Know this, embrace it, work on it. You are your own parent now, and that’s as it should be.
Work hard, have fun, look for sunshine to stand in, smile and laugh every chance you get, and acknowledge your blessings. Simple things to say, but ah so important to do. I do them, and from that experience I readily recommend them. Best of luck!
Ps The reason I went into therapy was because I had difficulties relating and trusting people (I grew up in strained atmoshphere, my parents were both unstable, particularly my Dad, who was an alcoholic). Regrettably one of my ways of coping was through self-harm, sadly the scars will remain which is embarrassing.
Mel: A few thoughts – First, you sound comfortable with quiting. That’s a good sign. Second, I think it’s very reasonable to think of doing therapy in stages, or episodes. Do some, then back off and live a while. Later, if you like, do some more. These “stages” often seem to coincide with the developmental changes we go through as adults, so this all makes sense. Finally, when you do meet up with your therapist again, simply be honest. Express thanks, if you feel it (that actually helps us to part from someone). Pass over problems, unless there a constructive reason to bring them up. We encounter – and make – a fair amount of garbage in the course of our lives. No need to hang onto it. Better to go looking for flowers…and puppies…and the like. Thanks for commenting on my post, and best of luck to you.
Thanks for your reply Tom, it made a lot of sense. I have arranged to speak to my therapist tomorrow and feel ready to express thanks etc.
Next step… to keep putting the garbage out rather than hanging on to it and live life more fully, accepting the challenges that come along the way rather than running away and hiding from them.
I hope this doesn’t offend anybody sharing this… I am a Christian and a couple of days ago this verse from the Bible sprung out to me: Isaiah 43 v18-20 “But the Lord says, do not cling to events of the past or dwell on what has happened long ago. Watch for the new thing I am going to do. It is happening already – you can see it now! I will make a road through the wilderness and give you streams of water there.” Gosh, just found it so relevant.
Many thanks
hello,
and thanks for this. there is very little written on this important subject, and i found your article useful.
i have been with my therapist for over 3 years and we have had a difficult time, as well as making progress in some ways.
when we have had problems we have managed to talk them through, but his recent misunderstandings and approach has made me question continuing. i am happy with what we have achieved, but do not feel that i can take things further with him.
however, he didn’t seem to like this and said i would “still be left with my anger issues” if i left him now, despite my disatissfaction right now.
i felt this was like some kind of emotional blackmail at worst – or at best making me into a pot that needed to be polished just right before being unleashed on the world by myself. his comments didn’t help really, nor did the charges of transference and countertransference – which i feel is becoming a bit of a get out really.
the fact is i am feeling more positive about things, and i feel he is dragging me down. i’ve told him as much, but he still seems to have this stubborn insistence that i should stay. but strangely i am feeling a little guilty.
i think this is unprofessional, at this stage, since what about my free will? I have a sneaky feeling he is tramelling on that ??!!.
anyway, thanks for your assertion that clients sometimes know what is good for them and need the right to assert this when they feel it necessary. and that ‘leaving’ is not the end – we are all unfinished business!
Jane:
A couple of thoughts: You may well be “unfinished”. In a sense we all are. One goes into therapy because of a desire to do a certain kind of work on oneself. At some point, you may no longer desire to do that work. YOU have to decide if your reasons for wanting to put your resources elsewhere make sense. No one else can do that for you.
It is common that we find that some of our personal “work” can be done with a given therapist, but not all. If you enrolled in college, would you expect to have all your learning from one teacher? The analogy isn’t perfect, but it makes the point.
Finally, you do have to live by your own judgment. It may be poor in the beginning, but it will only get better by using it and observing the results. There’s no other way. Start collecting those bloody knees! It may not be comfortable, but it’s very rarely fatal, in any case. And…it IS instructive. We all need that instruction if we are to improve in our living skills.
Thank you for raising such an important topic. I have had weekly therapy over a nine year period (!) with one break of about two years. From time to time I have raised the idea of ceasing therapy, but my therapist recommended that I instead have sessions twice rather than once a week. Therapy has helped me a lot but now I feel ready to leave. My therapist says I am opting out … that stopping therapy is a process that ideally takes some months … that I must have a hidden issue causing me to run away from therapy … and finally, she said if you go I need a month’s notice and expect payment for this even if you discontinue sessions right away (this is the first I’ve heard of this … I pay privately; when I asked why she hadn’t mentioned this before, she said terminating therapy and the conditions for it aren’t discussed at the beginning or during therapy). I now feel manipulated by someone I’ve always trusted and thought highly of. It doesn’t even feel safe to talk to her, which is kind of unthinkable after all this time. She knows all of my vulnerable issues and has pressed every button. I asked what would happen to me if I stopped therapy and she said “you will most likely regress”. It’s really depressing, because I feel so good, and that I’ve come such a long way. Surely therapy is about helping clients be independent and self-sufficient? I feel sad that such an important, long relationship is ending like this.
What a beautiful, beautiful piece. So much of it was relevant to me. I just experienced a mutual and emotional termination with the absolutely best therapist I could have ever hoped to have. He was soo good for me, helped me immensely, and helped me open up about some really painful issues in the safe comfort of his office.
Now I’m dealing with some very real sadness for not having him “in my life” anymore. It’s a separation anxiety of sorts…but mostly a sadness that someone who’s been so important to my recovery can never be my friend. It’s hard to resolve, but it’s something I knew would happen and I’m sure it will pass in time.
My therapist promised me that I would be welcome to come back and see him professionally at any time and that he really hopes I keep in touch in the future to let him know how things are going.
*sniff* I’m blessed to have found him, but very sad that it’s over.
thank you once again for your wise words.
kind regards.
hi again Tom
I wanted to update on my previous post. You are right that embracing the change and going with it helps. Three months on, the hurt is not so raw and what is left is a continuing appreciation for the work of my previous therapist – and a growing realisation that the move to someone else was absolutely right, given the constrains of the NHS. My new therapist does have the experience and expertise that my previous T recognised she lacked, and is also able to give me the long term commitment which (in light of childhood trauma and attachment “issues”) seems to be what I need. It’s going to be a slow process, but I have found I am able to move on. I think part of me will always miss D, but I am grateful for her honesty.
I am in a strange spot right now, and am hearing from you some of the same things my therapist is saying. My individual therapy is winding down due to a decision made by the managing therapists of the therapy clinic. They would like to give their individual time to new clients, and that means some of the old clients need to move on. I have plenty of insurance and would pay out of pocket if needed. Unfortunately, this change is coming at a difficult time of year for me, and I think that’s contributing to a feeling of despair I have over losing my individual therapist.
In a nutshell, I experienced years of chronic child abuse, a very difficult marriage that ended 2 years ago, and feel very upset that the person who has helped me most is moving on and moving me out. I am told my reaction is normal because I need a sense of control, and not getting that is causing me to be afraid, sad and angry. I am currently beginning group therapy at the same facility, but am so triggered at this point, that even walking in the building makes me want to cry. I know someone I could transfer care to, but sense that I need to process this with my present therapist. I’d like to just feel a little bit better about this, more hopeful, but I feel my therapist is nudging me toward the group instead of her, and it feels like rejection and abandonment. Things we didn’t get to in our work already due to much bigger things to conquer. I truly do not feel done with therapy, but I seem to have no choice in the matter.
Ann,
My apologies for taking so long to notice and comment on your response. There are times when I am simply unable to check in here, for extended periods.
As I have said before, therapy is often never fully “finished”, not any more than is one’s education. The exception to this, of course, has to do with distinct diagnoses which are treatable, curable, and for which treatment should be concluded in some reasonable period of time. There are many good reasons to be in therapy. Some can be addressed in a session, or a few, and some take several years (rarely!). I routinely treat and resolve serious issues in two to four months, and have for years. A few clients take much longer, but only a few.
I do not know of your situation, so my comments must necessarly be general. Seven years total therapy is a lot. I know of conditions where this would be reasonable, but for most it would not. Instead, it would suggest that therapy is not working, due to your condition’s being misdiagnosed or treated poorly.
I have said to others, taking a break from therapy is usually not a serious issue. I would, instead, be concerned about your not listening to the part of you which wants to leave. By all means bring up the issue with your therapist, BUT keep your own counsel, as well. It’s not their decision; it’s yours. When a therapist says that wanting to leave therapy is a sign of “resistance” or some “hidden issue”, they may be right. But they may also be echoing some really old thinking in psychotherapy. So, I advise that you simply look at the question for a time, then make a decision. Trust yourself. You really have no other option.
As for taking months to stop therapy’s – I don’t understand that assertion. Most of my clients terminate in about three weeks. The therapy ITSELF typically takes only months. That’s because we work for specific results, and stay focused until we get them.
The notion of your “having” to give a month’s notice – now that’s simply nonsense. I think that here your therapist is tipping her hand, as it were. I absolutely question the legitimacy of this. She may “require” it, but that has no legal force, and I urge you to tell her she’s out of order, if you don’t agree with the idea. Personally, I find it objectionable – and absurd, in most cases.
Concerning the idea that you’ll regress after you stop therapy, well, research has shown that that’s not uncommon. It’s also not usually a big deal, as the regression is typically small – if it occurs at all. Unless your case is unusual in some way (such as your having a tendency toward self-harm, seriously unstable emotional self-management, etc.) this is, I think, a non-issue.
You write “Surely therapy is about helping clients be independent and self-sufficient?” Absolutely. Enough said. Be independent, and start acting self-sufficient. If you want to engage in some consultation again, in the future. You surely can.
Shelly,
Thanks for sharing your experience. I’m glad for you that you had an excellent therapy experience – that’s what we all hope happens, certainly.
I assume you realize that your therapist cannot be your friend because [a] the relationship is very unbalanced – he knows a lot about you, and you don’t have the same knowledge of him; and [b] it’s important that he remain available to you as a professional resource. Other people are available to you as friends. When we therapists take this stance, at the end of therapy, it can be difficult for some people to understand, but it really is the best idea.
Now, I have a challenge for you: look back at this relationship, and think (and feel!) hard about what it was that meant so much to you. This will inform you of some of your core values. Finally, go see those values in some relationship which can be balanced (two-way) and enduring (and cheaper!). That’s really what you should be doing at this point. It will yield for you large rewards.
Best of luck.
Gail,
It’s understandable that you have become attached to your therapist. It’s very common, given that therapy relationships are typically intimate and hopefully productive, which tends to induce us to value them greatly.
As I’ve said before, there is more than one good therapist in the world, and experiencing more than one is virtually always a good thing. So, go get yourself another therapist, if you like.
Therapy is about you, not your therapist. The most important part of the experience – YOU – there is little risk of losing.
Your being nudged toward the group is probably an attempt to help you transition to a life without therapy. Not a bad idea, but the timing may well be poor.
The “rejection” I always worry about in situations like this is of US by OURSELVES. Be important enough to yourself to act to see that your needs are reasonably met, within the bounds of the limitations with which you must live.
Learning to do this well is one of the greatest outcomes of successful therapy. Right now, acting this way in relation to yourself may be challenging, but if so that just means you need to get on with exercising your abilities in this area. I note that you’re being given a chance to do that. Embrace it. It’s a good thing. I think it highly likely that you CAN deal with this productively. See that you do.
Tom, could you explain more about rejection being of “US” by “OURSELVES”. My take on that is that you’re saying the only real rejection is my thinking that I’m not good enough to be regarded as “therapy-worthy.”
Gail, excellent question. We’re in a bit of a thicket here, conceptually, so let me try again.
Certainly we can be rejected by others, including our therapist.
In the section of my reply to which you refer, I’m looking at the point in time after we’ve started feeling that we’ve been rejected. We often feel a bit down. I want to point out two things about that:
1. When we discover that someone else doesn’t value us as much as we’d hoped, we likely feel a loss – of the esteem we thought we had, and any of our sense of worth which DERIVED from that esteem. We then feel shame. The universal physical response to this, interestingly enough, is to lower the head – we look down. I’ve caught myself doing this – it’s a universal reaction.
2. In spite of this loss, for sake of our mental health some part of our view of ourselves MUST involve an essential self-esteem, NOT contingent upon the esteem of others. It is most particularly important to activate that part of our esteem when we feel that we’ve lost the esteem of others.
Why? Because we have to stay functional. Above all, we have to support ourselves, listen to ourselves, respect and respond to whatever our “inner voice” – our core desires – says to us.
Acting with respect in relation to our core desires – for safety, security, companionship, valuation – is necessary if we are to avoid depression, and in a worst case, death. It is the starting point of a good life.
A major reason we go into therapy often is that we are having trouble with this essential self-respect, and it’s hurting us. We want it fixed.
So, thinking for a moment about your being ejected from your therapy relationship, I’m also thinking that your desire for a certain kind of therapy relationship needs respecting – and most of all by YOU. Fail to to that and you will be rejecting yourself, and this would be a bad outcome. I remark about this specifically because I know that if we explicitly look for a problem we’re more likely to correct it. So…please look!
“Respect” here means “pay attention”, and “listen”. Then…take “appropriate action”. Maybe several actions. You may achieve nothing, but you’ll still be far better off simply because to went to work FOR yourself. You actively respected yourself. This is a very good thing. Always.
I want to point out that there is something about your experience which is universal – we all experience rejection, and shame, and the depression that follows. And…we all need to work to achieve a good recovery.
I think I want to write at greater length about this. It matters to me personally, and I know it’s very relevant to a great many other people.
Well, I hope I clarified things sufficiently. A great topic, really. And, I hope my thoughts are better expressed this time, and helpful to you!
Sorry, should have read your reply, I appreciate the explanation and your commitment to write about this more. I look forward to reading your thoughts.
An update. After 3 weeks of TORTURE (self-imposed) I suddenly came to a sense of peace about being in the group and leaving individual therapy for now. When talking to my therapist about the change I feel, we narrowed it down to a few things I did. The first thing was that my therapist kept stressing that I did not have to attend the group, that it was my choice. From that base, I decided to give group two more weeks, and end if necessary. I also had the AH-HAH moment that trying to substitute the group for individual therapy was making me more critical of the experience than I needed to be. It’s not a substitution, it’s a different way of getting help. The third thing that helped so much was prayer. For a while, I’ve been focusing on the concept of willingness. So I prayed to be willing to do whatever was helpful in the arena of therapy. I feel much more at peace, and not surprisingly, group went MUCH better this week, and I can see how it will really be helpful to me.
A fun thing to look forward to, I was asked by the clinic to be a volunteer consumer advocate to help evaluate ways that the clients can be better served. It’s a small commitment of time each month. I’m so honored, and really look forward to doing it.
Tom, your article and string of replies/responses was immensely helpful and informative. Thank you! I have been in therapy on a routine basis for over 2 years now, and was previously in therapy a few years ago for 6 months. I am at a very good place now and deeply believe in my ability to engage in life at all levels without therapy, despite whatever comes my way. That said, the issue of ending a very meaningful therapeutic relationship brings me sadness. I have struggled to make sense of this “duality” in me, and this site was just right on. I have jotted down some thoughts and notes on how I might discuss with my therapist my desire to end our work together. I see a lot more now than I did just by reading all of this! Thanks again.
I went into therapy in June 2007 as I had gone through a period of feeling really low and think I was depressed. My therapist told me she could see me for one year but then she was retiring. I started off seeing her once a week – then about three months in she suggested I go twice a week which I did. I became very attached to her and couldn’t bear the thought of the ending – I told her I wasn’t coping and tried to finish earlier (at Easter) she said I should keep going. I did. Once again I tried to finish a month before the end but she persuaded me to keep going. In the end I phoned her to say I couldn’t go to the last two sessions – I couldn’t bear it. She gave me the name of another therapist and as I was so distraught I went to see her and have been for the last eight months. The problem is I can’t get the first therapist out of my system – I’m so hurt. Hurt that she never said It would be ok to phone her if I was distressed after the ending and as a result on the occasions when I have I feel like a terrible nuisance. In the meantime my relationship with my partner has broken up too. I can’t seem to move on. I’ve gone through hell, spent a lot of money, lost a relationship and feel like a completely different person. I just wish I could rub out the last two years of my life.
Hello!
Very Interesting post! Thank you for such interesting resource!
PS: Sorry for my bad english, I’v just started to learn this language 😉
See you!
Your, Raiul Baztepo
Hi ! ^_^
I am Piter Kokoniz. Only want to say that your posts are really interesting
And want to ask you: will you continue to post in this blog in future?
Sorry for my bad english:)
Thank you!
Piter Kokoniz, from Latvia
Sam,
Sorry to be late in discovering and responding to your comment. The period of midwinter through late spring is a very busy time for many therapists, including me. It’s our busiest time of year, in many cases. So, I’ve been absent for a few months, of necessity.
This actually relates to your comment. You see, one of the problems we therapists have is that there isn’t enough of us to spread around as much as we might like. Being conservative in the use of one’s time with clients is a necessary self-preservation measure, I’m afraid.
Much of what you say in your comment suggests to me that you may have issues with abandonment. This can be very painful. I urge you to take this up with your present therapist. It’s important to work on this so that it doesn’t affect you so much in the future. This work, done right, can be rather successful. I wish you the best of luck, if you decide to go in this direction. Have courage, and keep on going!
Hello
I’ve just come to the end of my therapy( not my choice as my therapist is moving away). At the last session I was feeling quite emotional but struggled to verbalise how i was feeling. He told me that he too felt sad about the ending. That was exactly what i feeling, but is this disclosure appropriate from a therapist?
Louise, I presume you’re asking for my opinion, and I say that because there no “right” answer to your question, I think. If we assume he was speaking truthfully, he was engaging in a conversation with you as what he was, a human being who also is a therapist. Is that acceptable to you? I hope so. It is to me.
Some people have trouble relating to their therapist as just another human being, albeit one who has unusual training, education (not the same thing), skills, and experience, and who. as a result of this, is offering a professional service.
Some clients seem to want their therapists to be demi-gods, or Experts, or avatars of some sort. We’re not. We’re just people. We have feelings. We make mistakes. And…we can be really, really useful to our clients. I think it fair to say that overwhelmingly we wish to be, and try hard to be.
So, is it more useful to mislead you about our nature, or to reveal it? I think that in revealing his feelings, he was likely trying to do two things: a) validate and “normalize” your own distress, and b) let you know that you were valued by him, in that your termination was distressful to him as well.
I would ask you to dwell a bit on the latter information: his involvement with you, focused appropriately ON you, was at the same time of value to him. THAT’s about YOU. Were I in your place, I’d appreciate knowing that.
I know that I value highly all my clients (with the exception a very very small number who simply make trouble in all directions), because they, as human beings, have inherent value, in my eyes. Having contact with that enriches me. I have a very distinct sense of this, and I do share it at times with my clients – when I am moved to do so and it seems appropriate to the context of our work together.
I think it would be quite unusual for someone not to value BEING valued, and I suspect that in sharing his feelings, your therapist wanted you to know something important about YOU.
I hope you can see his remarks in that light. I do think it is appropriate for therapists to see value in their clients, and express that sense of their value at times. Most of our clients have not had enough of this in their lives, and ALL of us need this appreciation from others from time to time.
I have not looked at your blog in a long while, was pleased to see it’s still going. It seems so odd to me that while I was struggling with a feeling of being moved on or rejected by my therapist, that when I finally let go and felt the sadness below my anger, it got better.
My mom died in the spring, and since then I’ve actually been seeing my therapist more often. I’ve grown to trust that when I face something really difficult, she’ll be there for me to work it through. Just knowing that has allowed me to be more balanced in my view of therapy, to trust that I’ve learned a lot in therapy about my ability to go through hard times and survive.
Right now, I’m having a resurgance of grief, a feeling of loss. I would like to meet it well, but feel like I’m still running. I want to lean on my therapist, but am a little afraid of it being viewed as regression. Probably what it really is. I wish one of the things I’d done better was to be able to have a good friend to talk to. Still not doing well on that front, and I feel somewhat desperate to find comfort with my therapist. What to do?
In re-reading my posting, realized it sounded like I think my mom is always there, when I was actually referring to the experience of knowing my therapist will see me again when I’m in need.
Gail,
First of all, I’m sorry to hear of the death of your mother. We only get one, and for better or worse it’s a life changing experience. Everything I know about mothers and children tell me that the mother-daughter relationship is often especially charged with feelings of various sorts. But then, both people are women, and women have about twice the feelings men do (little known true fact).
So, all that’s to say that I would expect that this would be a Big Deal for you, as indeed you report that it is. It’s another Leaving, akin in some ways, to leaving a therapist. Such things tend to trigger in us very basic questions. How else can it be?
It’s an obvious thing to say, but worth saying anyway: the goal of psychotherapy is to change our inner world, not our outer world. Of course, there IS a relationship, yes? Fundamentally, the primary issue is emotional stability, I think – being able to stay on our feet, or get back up, when life throws us a curve ball. True emotional stability is often a life-long project. Our goal should be simply to keep working on it.
So, with something like the loss of your mother – I think you need to talk with someone who can simply listen. Your therapist has another job, although listening is part of it. Have you thought of seeking out some woman you know who is approximately your peer, and asking them about the loss of their own mother? If it hasn’t happened yet to them, surely they are thinking about it. The point is to find a social context in which you can safely and simply talk about what you’re experiencing. We MUST do this, because we are social beings.
Don’t worry about being dependent. You don’t really want that, I’m sure, and it’s probably not really a risk. You DO, however, have some real needs. I need to eat. Does that mean I’m dependent upon food? Well, of course, but that’s not really an appropriate use of the word. Neither is its use in relation to your need to share with another human being the experience you’re having.
Feeling loss, and expressing it, is part of being human. You get to do it. You get to expect that you can find someone who will be interesting in taking the time to talk with you about this. It’s fully legitimate.
A technical tip: make your “talking” reciprocal. Such experiences work best when you and the other person are exchanging meaning. Pay for what you get by giving back. THAT will work just fine.
You’ll have a need to talk about this a number of times, if you experience is like that of other women I’ve known. So, learning how to do it well is important. I hope you’ll give it appropriate attention.
Thanks for the insight on loss. Grief is really a hard one for me, maybe all. I tend to avoid. I’m working to reach out, I like your description of the give & take. Thanks
I have been in therapy for about 2 and a half years and have definitely grown in that time and my therapist has helped me so much. I have always looked forward to going to see her each week, and, more recently, every two weeks, as she makes me feel stronger and reassured and basically okay and safe in her presence.
I am moving back to my home town which is an hour’s flight away from where my therapist is based. I think we both feel that my therapy is drawing to a close but at the same time I am desperate to keep the relationship going, I can’t bear the thought of it ending, it makes me feel so sad. We’ve discussed this together and she says we can work out an arrangement to keep seeing each other -I can fly back every month, or phone her, etc. but I have this dreadful feeling of loss and ending.
I have come to think of her as one of the most important people in my life alongside my boyfriend and my mum. I always envisioned still going to see her when I am in my 30s and 40s and all through my life really. You mentioned in your post the idea of maybe sending a postcard and the therapist maybe thinking about the client from time to time… that isn’t enough for me! I don’t want to be a memory! I know I have issues with loss and have been working on that in my therapy. I know I don’t need her like I did when I began therapy but now I WANT to see her. I don’t want the relationship to change, every time I think about it I just start crying!
I feel so upset and that I don’t want to leave her and live my life without her (I don’t mean that in a melodramatic sense, just that I want to enjoy my life knowing I will be seeing her regularly like I am at the moment.) I just don’t want to move on from her. Any thoughts you have or advise you can give I would be grateful for.
Katie,
Sorry to hear of your distress. Endings aren’t always well-timed, much less desired. To my way of thinking, the real issue here is your self-sufficiency. People need people, but not all such needs are healthy or developmentally appropriate. And it very rarely is true that our needs can be met by only one person.
You well may be still working out unmet needs left over from childhood – this is common in therapy, and getting it done is truly good work. I would hope you can continue this work.
Assuming the move WILL happen, what can you do? You don’t seem to see a way to maintain the relationship as it is presently. Once a month may be better than nothing, but it won’t be the same, will it?
I think I’d like to see you recognize your needs, relative to this therapist (and I assume she can help you do this). Then…honor those needs. In general, our needs are for relationship more than for a particular relationship. That said, all good relationships have an aspect of uniqueness about them which makes them irreplaceable. There’s no avoiding that. Relative to that you simply will suffer a loss, but not one you can’t work through.
It seems reasonable to me that you spend time clarifying WHAT your loss is in leaving, then seek another therapy relationship in your new locale. Do not for a moment believe that there is only one therapist for you in this world. That’s like believing there’s only one good brownie (!), or one great piece of music, or one true love. Utter nonsense, say I.
You almost certainly CAN find another therapist who will work well for you. Beyond that, you are likely to discover that a different therapist has different lessons for you to learn, ones that are also valuable. You are fearful about this change, but consider that it is also an opportunity. It’s a big world out there. You really don’t need to keep yourself parked in one small corner, in one person’s office.
Celebrate what you have gained with this therapist. You should, together! Then, continue to look after yourself, in your new home. Keep working on your mental health, by finding a new and competent therapist. You CAN do this. It’s definitely a good idea to head in this direction. And, you can send your present therapist a note in the future, about your progress – an opportunity to express gratitude again for what you achieved with her.
I hope for an excellent outcome for you in this life change. Have courage, and move forward to your future with all the optimism you can muster – it justified, I firmly believe.
Hi Tom.
This thread is very interesting for me. I have been seeing a psychotherapist weekly for about the last 9 years, apart from a 2-year break which was necessitated from financial constraints.
About a year ago I was going through a very rough time, and my therapist recommended moving into a twice-weekly pattern. This proved very beneficial for me, and we really made significant progress. The flip-side, however, was that the consultation fees were absorbing more than half of my disposable income, and creating very real out-of-therapy stresses. Recently I have been feeling that the benefits of the second session are outweighed by the anxiety generated by my financial distress.
When I raised this with my therapist, he seemed uninterested in the realities of my predicament, and disrespectful of my decision, and spent the entire session pursuing what felt to me like a bunch of strategies designed to make me change my mind. I was genuinely shocked and infuriated by this. I communicated to him as honestly as I could, at the time, that I felt that he was attempting to manipulate and browbeat me into perpetuating the twice-weekly sessions, and that he was disregarding my motives for scaling back the therapy. I left the session feeling very frustrated and angry at him.
Today my therapist attempted to unpack every one of his last session’s manipulative guilt-trips, insults, threats and belittlings as confused perceptions on my part, and asserted that the resultant hostility I feel towards him is just an expression of childhood repressed anger I feel towards my parents.
Whilst I currently lack insight to assess whether or not my therapist may be correct in these assertions, I do know that my trust in his capacity as a listening and caring professional was profoundly diminished by his attitude towards my needs, and the way that he appeared to use his intimate knowledge of me as a means of persuading me to act against my best interests.
Accordingly, I told my therapist all of the above, and that as a result of losing trust in the therapeutic value of his methods and our relationship, I had to finish working with him, there and then. I was clear with him that further discussion about terminating would only serve to amplify my perceptions of being manipulated and abused. As I left the room, he was speculating aloud about “what is it that you might be allowing yourself to do” in making my disappointment and disillusionment apparent.
I recognize that this blow-up may be symptomatic of an embedded resistance to therapy on my part. Possibly it’s an expression of repressed hatred of authority and self-hatred, an attempt to harm myself and any prospects for making further progress. I recognize that today I had an authentic desire to hurt my therapist, in revenge for the way he ignored and hurt me, and that I set out to achieve this by terminating, and by demonstrating contempt for his perspective.
But I recognize also that today I stood up for myself, and insisted upon my my needs taking precedence, and upon my right and capacity to prioritize my own needs.
Naturally, as a result, I am feeling conflicted and confused, elated and yet betrayed, sad and yet emboldened. It has been a long road that we have traveled together, and I had not anticipated its ending would be abrupt and acrimonious.
Have I done the right thing? Is there anything to be gained by attempting to repair the therapeutic relationship? Have I unloaded both barrels at a soft target who was only trying to help? Exactly what has suddenly made me feel so deeply suspicious of and threatened by someone I had previously valued and trusted? Did I somehow manufacture the circumstances to enable me to terminate?
Along with the dawning sense of loss I feel, there’s also an emergent guilt at having having “killed” my therapist. Yes, I know he has other clients, and he can work through his problems with his own therapist. But it’s going to take me a while to try to sort through the very mixed feelings generated by these recent events.
I welcome any perspective you may be able to bring to bear.
Cheers – Mike
Mike,
I seem to have overlooked your comment. Sorry for that – l do get a bit over-scheduled at times. People in my office tend to get more attention than others in my life, and I can only hope that I have my priorities straight in choosing to respond this way. Also, the past six months of my life have been very very busy ones.
About your post:
So, I suspect you’ll continue to think about what happened, and that this will be productive for you. One way or another, you’ll likely learn some valuable lessons. Can we ask more than this of our experiences? I think not. I say that you have done well, and will likely continue to do so. I urge you to continue to work at supporting yourself, and at seeking the company of those who can also support you, constructively. I wish you the best of luck.
In all therapist resistance to a declaration of intent to terminate, also be aware of “unconscious fiscal convenience” on the part of your therapist, especially if you are in a fee-for-service as opposed to a salaried-therapist relationship.
This can be the most powerful countertransference out there. It’s also one your therapist will just about never tell you about. Tom Cloyd, have you seen this in your clients? I sure have!
I think you’re being a bit cynical. Some therapists can be overly concerned about their income, to be sure, but most I know are far more concerned about their effectiveness and their ability to diminish their clients’ suffering – that’s why they got into the profession in the first place.
So…how does one tell the small number of money-grubbers from the large majority who are not? I suggest you consider how compassionately you feel dealt with. I don’t think I have a better suggestion than that. The obviously compassionate are likely putting people before any other concerns.
Consider, too, that we therapists do have to run a business, to be able to do what we do (in private practice). For some, surely, this presents problems. As for me, I give away significant amounts of my time, and accept being poor, financially. My real rewards are not found in my bank account, and I like that.
@Katie —
Why not at least try to work with her by Skype videoconference? It’s free, you have a relationship already, and the technology works very, very well. I personally know several clients who have continued relationships with their therapists following a move this way. Telephone is a possibility too, but I think Skype is way more effective because of the visual. Then, maybe you can fly back to see him or her every few months, as need be or when it’s convenient for you.
There has been a ton written about Skype therapy in the last year. Mostly positive. I would urge you to give it a try.
Mike, I’m not a psychologist, but I experienced a situation that parallels what you describe. My therapist was useless from the beginning, sorry, a mismatch.
But when I tried to leave, he unloaded every accusation he could reach for, told me I couldn’t perceive reality, that I didn’t have any friends and would flounder if I left. Like your situation, he deflected all my attempts to discuss events with “interpretations.” He used his training as an arsenal.
My episode happened some years ago. Now I see the guy was trying to preserve his ego…and his fees.
So in my amateur assessment, you impress me as smart and perceptive much more than your therapist, and able to sort things at and take care of yourself. (In my case the guy hooked me into staying a while.)
I was quite shaken when my therapist freaked on me, and over the years still sort this out. Peers “got it;” therapists were scared of the subject. If you feel like sharing notes, there’s an organization called TELL–Therapy Exploration Link, which helps connect those with unfortunately therapy experiences to share their stories.
In any event, hope you’re doing well.
I had a horrendously bad experience in terminating therapy that never was insightful to begin with. The therapist became furious and denigrating, predicting a poor future if I left his care. He also deflected all my attempts at a direct discussion by “interpreting” everything I tried to tell him.
I lost my failure-to-refer grievance. The doctor insisted his behavior was “for my own good” on the one hand and the incident was my “distortion” on the other. Apparently the simple concept–I want to leave–made me a difficult case.
In healing, I’ve searched through much literature, both professional and consumer. I’ve found little on harmful therapy and nothing about countertransference in termination, though I understand mine is hardly a unique situation.
Can you tell me why the profession doesn’t explore the issue for harmful termination. Can you recommend reading I might have missed?
Sue,
It certainly sounds like something went very wrong in your experience with your therapist. I strongly believe that therapy clients need to do their own thinking. I’d hope that your therapist could assist you in doing this, but if not, leave, period.
As I’ve said before, clients DO leave therapy inappropriately, sometimes, but that has to be acceptable. Making mistakes is a part of learning, and we all do it. As to whether or not a therapy-leaving is a mistake – that is yours to determine. That’s obvious, I think. Do your own thinking. What other option do you have, in truth?
At the same time, do not expect always to be supported in your views. That just won’t happen. So therapists ARE too focused on their performance rather than on their client’s experience, just as some are too concerned about their financial well-being. I am confident that these individuals are the exception, by a considerable margin – truly.
Counter-transference is not a minor subject in psychotherapy literature, but it is also not universally considered. Many other things have a higher priority, and I’m not sure there any problem with that. I think that sufficiently client-focused therapist is not too likely to get caught up in such issues. We get a lot of supervision in our training, and those who have such problems are not likely to escape notice.
As for literature on harmful termination – I suspect there isn’t a lot because it doesn’t happen very often. It shouldn’t happen at all, of course, but in the real world it does. Of all the unsolved problems in the profession, this one likely doesn’t rank in the top 20 or so. It’s understandably a big deal to those to whom it happens, but I don’t think it happens much. I do know that I’ve never seen a formal study of the subject, although one might exist somewhere.
A far bigger concern is overuse of medication, or inadequate diagnosis of people with multiple problems, or unavailability of treatment due to financial constraints or unwillingness of service delivery systems to respond to the real need of populations supposedly served.
We cannot take up all problems, and some very large ones have historically been seriously neglected or ignored, such as the real sources of drug addiction (it isn’t the drugs), or the nature of the majority of those who are afflicted with PTSD (posttraumatic stress disorder) – they aren’t male, and they aren’t soldiers. Millions of people are affected by these systemic failures, and we haven’t begun to address these problems. I have to confess that it is these concerns which keep me awake at night, sometimes.
Harmful termination requires a client’s antipodal paradigm shift from promised relationship to a new reality, be good intentions, run-away narcissism or…money. Cynicism could be a healthy coping tool here.
Understanding a harmful termination can be multi-layered. First, it didn’t happen in a vacuum. It could be a visible artifact of a shaky foundation.
It can parallel leaving a cult. The client might have been lulled into suspending judgment. The client’s human deficiencies could have been magnified and pathologized. If the therapist stoked an over-idealization, the client now has his therapist’s dysfunction added to the original conflicts. The client must reject his perceived source of nurture and salvation and accept he bought a bogus promise from a false guru.
I wonder if it might slather more dismission by to caution against–over-thinking. There’s an entire construct to dismantle in some cases.
Sue,
I understand “cynicism” to be essentially overly-negative expectations, NOT just negative expectations. The problem is that it is not an accurate representation of reality. For example, while I have a very negative view of the likelihood of my successfully flying unaided from the top of a tall building, it could never be said that I have a “cynical” view of the same matter. My view is well grounded in reality, and therefore NOT cynical.
So, I must differ with you as to the adaptive nature of cynicism. A given cynical view might be MORE accurate than a given overly-optimistic view, to be sure, but it’s still problematic due to its inaccurate representation of reality.
I simply urge that we do best to strive to an accurate view of things. In the case of therapists, I assert that the overwhelming majority act in good faith, with good intentions, and with values oriented primarily to goals other than money. If this be true, it is still possible for a disturbing minority to be possess different values. But, in truth, I know of no formal study of the matter, and in the absence of such we are merely speculating.
I want you to know that I agree with much of what you say, and I rather like how you express yourself. You’ve clearly thought carefully about this matter, and I respect that.
Tom, you and I would be a truly iatrogenic practioner-client pairing, because I’d find you, in subtext, conveying an authoritarian construct.
I don’t know how anyone could know the “reality” of what happens in the majority of consulting rooms. I’ve talked to a number of consumers abused by therapists. Based on those viewpoints, I’d advise other consumers to hold on to their own judgment, or skepticism or cynicism if needed, as they negotiate the process of therapy.
I feel you avoided from my previous point to split hairs about the semantics of “cynicism.” My purpose was an obviously unsuccessful attempt to share the conflicts of healing from harmful therapy.
This is why I can’t work with therapists. They have to go into “expert” mode, instead of listening and understanding. The subtext is that you know something that I never will.
Sue, I’ve spent decades learning my trade. Is it not possible that I now have some knowledge not possessed by most other people who have not made a similar effort? What I know that I am most confident about has been validated in my clinical work. I think you do me injustice in mistaking confidence for an authoritarian stance. I am not authoritarian, but rather am open to new knowledge and points of view. I learn every day. I am not, however, open to accepting nonsense.
Subjective reality – say, of an abusive experience with a therapist, is not to be confused with the sorts of verbal reports which may be assessed quite well by survey research. If research subjects give good faith responses, I believe we may tabulate them, and report our findings, as generalizations with a certain demonstrable degree of validity. In the absence of research that does just this, I think we really do not know the percent of former therapy clients who would say that they left therapy because they found it abusive.
Beyond that, if a client found a relationship abusive, was it? Subjective experience does not always equal objective reality. I have had clients leave therapy simply because I disagreed with them about an appropriate course of treatment.. I suspect some of them felt unvalidated, and may even have thought me “unprofessional” for not “supporting” them.. But…was I unprofessional? We need careful definitions, and careful examination of reports before we arrive at such conclusions.
The people you and I have had contact with cannot be an unbiased sample of the larger universe of people about whom we might wish to generalize. Without such a sample, we cannot make valid statements about this population. We can only conjecture. This is basic inductive logic.
When you write “I’d advise other consumers to hold on to their own judgment, or skepticism or cynicism if needed, as they negotiate the process of therapy…” I have no issue with you. I advise the same thing, explicitly, and often, with my clients. Hiring a therapist does not get a client out of the dilemma of how to make sense of their situation and take action to improve it. They have decisions to make, and it is the therapists job to try to assist them.
I do not think I split hairs about “cynicism”. Rather, I offer a correct definition of the concept, as I understand it. I invite you to examine the definitions given here. My point is finely drawn because the discussion demands this. We’re not talking about baseball here, and words cannot be made to mean whatever we want.
A cynical point of view, developed from a small sample of experience, has, at best, questionable validity, and this can be a large problem in the real world. You are the authority on your own experience, as I am on mine, but neither of us are in a position to go much beyond that. We just don’t have the data. I cannot retreat from this position because to do so is to embrace nonsense, in my view. I have spent my life trying to make sense, not nonsense. I do not know how to do better than this.
Hi there,
I wrote a comment to you Tom on 22/01/2010 about being very upset at leaving my psychotherapist when I returned home to England after several years living abroad and seeing her.
I never said at the time when you responded but thank you, it is really nice to know I can write what’s on my mind and send it out into cyberspace and someone will consider my situation and offer suggestions on moving forward. (TPG, another person who reads this thread also responded to me reccommending skype -thank you for your suggestion too).
I’ve been getting lots of emails lately on this thread as you and therapyisacon thrash it out. I thought this would be a good opportunity to give you an update. I am still in regular contact with my therapist: when I arrived home from living abroad I was greeted my a few massive family bombshells so her support was needed far more than I anticipated.
Things seem to have calmed down a bit, and certainly I am finding I need her less than I used to. We speak every two weeks for half an hour or so -sometimes I have lots of worries and anxieties and news and sometimes I struggle to find anything to say, which I suppose is a good sign!
In fact, I am finding myself wanting to speak to her far less than I used to and a lot more self-sufficient. there are still very hard times though -I just broke up with my boyfriend of 6 years (seems I can’t get enough of these long term relationships!!) and have been very grateful to still have my therapist as somebody to talk to.
This break up has actually made me realise my worst fear -i.e. the loss of a hugely important relationship. This is a loss that I feared for a good portion of the relationship with him, and I spent a lot of time wondering if my feelings were actually those of somebody in love, or perhaps I was terrified of the prospect of loss. I feel a lot freer now that “the worst” has happened. I really hope we get back together because I love him very much but I feel now that (hopefully) this would be a choice, something I actively want to do, rather than fear of not being able to cope without him.
In the same way, I realise there are other therapists out there, and I don’t necessarily need her in the same way I did, it is more that I want to continue a relationship I’ve come to enjoy very much. However, I realised recently that if it meant things would work out ok with my (ex)boyfriend then I would give up my therapist forever. Sounds a little strange but I suppose it was the first time I thought I might want to continue my life anew without her.
Anyway, wanted to let you know where I’m at, as it must be very strange to have people tell you personal stories and give your thoughts never to hear from them again. I appreictae knowing you read and thought about my situation.
As for therapy being a con, I am very interested in the workings of psychotherapy, and as you can probably tell, a huge supporter of it, but I am not widely read and do not really want to enter into a giant debate (maybe because I am afraid of being proved wrong!)
I can only speak from my own experience, which is that it has helped me tremendously. I don’t know if it “works”, and I certainly know that it does very little for some people -a few of my friends have been to see therapists and have hated the entire thing- but it has, and continues to help me, even if it just because there is someone there to listen. I realise that for various reasons people can have bad experiences, and am really sorry this happens. I am still confident that the benefits outweigh the potential risks and am glad to have a had such a good experience.
Different things work for sifferent people. I am very grateful to have benefitted from psychotherapy, and my only regret is that I waited until I ws at crisis point (being physically ill) to finally give it a go. I won’t say it is always easy, it is sometimes very difficult, and embarrassing to open up to somebody else. The fact that this person is paid actually helps me though, because I think however boring or pathetic or weird they think I am, “they are being paid to be hear so have to listen, ha!”
There may well be con artists but I think, given the amount of study and training you have to go through, most therapists are in the job because they love it rather than for the money.
Best Wishes,
Katie
Katie,
Thanks for checking in. It’s always good to receive a follow-up.
It is noteworthy that you talk of having endured your worst fear, and then discovering that you could get through it intact. This sort of experience is at the heart of the trauma-psychotherapy I do, and it is most definitely liberating. And yes, it would be far far better to be pulled into a relationship by desire for life-enrichment than pushed by fear of being alone, or whatever.
Often I find that what we need isn’t so much to leave a relationship as to realize that we could leave, and then decide we don’t want to or have to. In chosing to stay, the relationship is revitalized.
One of the most important ideas in psychotherapy is that a key goal is for the client to do for themselves a major part (if not all) of what initially the therapist does for them. It’s about achieving a kind of emotional and intellectual maturity and self-sufficiency. So, I might ask, as a result of your therapy, do you now listen to yourself better than you used to? I hope so.
Therapy, like all human activities, has its share of incompetent, dishonest, and dangerous people. Why would anyone expect otherwise? However, the process we go through is rather arduous, and we get looked at long and hard before we are released to go work with our clients our in the real world. Overwhelming, therapists are NOT con-men/women, but rather sincere, well-intentioned individuals who really want to be helpful. How to be helpful is our single most-talked about topic. It’s sad to me that a few people who had bad experiences in therapy think that bashing the profession is the appropriate response. This makes no sense to me.
I once had a significantly bad experience in therapy, at a critical time in my life. I was angry about it. I then went out and got another therapist, and did some of the best therapy of my life. This happened because I viewed my experience as my responsibility, AND because I refused to adopt a cynical view of a profession which I knew was full of very earnest, hardworking people. Therapy changed my life profoundly, as a result. I wish that that could be everyone’s experience.
I am decidedly in this profession out of love for the process. I have little concern for money, often give away my time (to people who otherwise would have no one to work with them), and find every day of my life interesting and educational. I’m grateful to be doing what I’m doing.
Thanks again for writing, and I’m happy to hear of your progress. Keep it comin’!
Tom
Really comprehensive post on a an important issue for many including myself. Very helpful indeed. You inspired me to write a post on my blog about leaving therapy, which you can see here http://bit.ly/piF45i I have also quoted you leaving a link to your site. Please let me know if this is not suitable and I will remove this.