Quitting the Couch: Five Reasons People Leave Therapy Prematurely
July 17th, 2009 |
By Kate Griffith, MA
Click here to contact Kate and/or see her GoodTherapy.org Profile
After being in therapy for several years and in a particularly low place, a friend of mine asked her therapist if he thought she should look into anti-depressants. “I would recommend it if I thought you were in a crisis,” he said, as part of his response. This sentence jumped out and stung her. She felt completely invisible. Hadn’t he seen how much pain she was in? Did he think she was making a big deal out of nothing?
Upset, she confided in me that she was leaving therapy. She was mad at her therapist and felt like he clearly didn’t understand her. Besides, she said, she’d been going for a while now and her problems still weren’t solved! She was shelling out a lot of money, after all. So what was the point?
As I empathized, we started talking about the many steps she could take that would lead to a different conclusion. It’s an unexpected but solid rule of thumb that whenever the urge strikes to cancel and not go back, that’s the time you could use therapy the most. The best response to that urge is to talk about it in that same office that you are trying to exit.
Although people leave therapy prematurely for a wide variety of reasons, the most common can be addressed in the following ways:
1. “My therapist ticked me off.”
Therapists are not all-powerful; they’re human beings. And like all human beings, they make mistakes. In addition, sometimes they misunderstand you, miss something that’s important to you, or just see an issue from a different perspective. And they are doing all that while in a deeply personal relationship with you. So if you’re in therapy for any length of time, it’s almost a guarantee that you will be mad at your therapist at some point.
Despite how it feels, that moment is actually a rich opportunity. Most of us have some difficulties around confrontation in our lives. Maybe we get carried away and yell, or maybe we bottle it up and sulk. Whatever we do, it’s probably not what we would consider “ideal.” When you’re mad at your therapist, you can try out a different behavior while expressing your anger in the Petri dish of the therapy office. If the therapist is worth her salt, she will hear you and help you process what’s happening for you so that you can move through the anger. She will not try to talk you out of it, or burst into tears like perhaps your mom does, or get angrier back at you like your dad. It will be a different experience from the norm, and satisfying because of it. She will honor what you’re feeling and look at how it informs your work in therapy as a whole. She may even use it to understand you better. The result can bring the two of you closer, making your subsequent sessions more fruitful.
2. “I can’t afford it anymore.”
When our finances change for the worse, a first response is to scale back by eliminating “non-essentials” like gym memberships, eating out, and, unfortunately, therapy. However, if you’ve been downsized or your business is struggling, you may be experiencing increased levels of stress and anxiety, plummeting feelings of self-worth, shame, and even hopelessness. It is during bleak times like these that you can benefit most from the continued support of a caring therapist.
So what do you do if it’s just too pricey? Try explaining the situation to your therapist and find out if he or she will adjust the fee. Most therapists work on a sliding scale, meaning they move their fee up and down within a certain window based on what their clients can afford. The reasoning behind this practice is that the frequency and nature of therapeutic treatment should be based on what is in the best interest of the client, not what is in their wallet. Tell your therapist what you can afford, and the two of you will likely be able to negotiate a mutually agreeable fee.
3. “I don’t think it’s going anywhere.”
At social events over the years, I have overheard several variations on, “I don’t really know what I’m doing in therapy. I’m not sure it’s working.” If you haven’t yet made it clear, either to yourself or your therapist, what you want to get out of the work, your therapy may be stalled. Suggest formulating a treatment plan together that lists your goals in therapy as well as strategies toward achieving those goals. You may also want to establish a “check-in/check-out” procedure with your therapist. This would entail you stating in the first five minutes or so of the session what you would like to get out of the time that day. Then, in the last five minutes, you would review that intention and assess whether or not it was accomplished. If so, how? If not, why not?
Sometimes, though, a different situation arises. The urge to leave may strike precisely because you ARE about to get some serious work done. Denial is in some senses a healthy coping mechanism to protect you from issues that are too painful to look at if you’re not ready. Could it be that a painful realization is lurking around the corner? If you talk about the possibilities behind this uneasy desire to leave, your therapist could help you establish comfortable boundaries and pace the work into smaller steps so that you can feel safe again. That way, you can stay long enough to deal with that important, if frightening, issue you’ve been avoiding.
4. “Maybe I’m just not cut out for therapy.”
At the very beginning of therapy, people often encounter the case of it just not being a good “fit.” A mismatch happens as often in therapy as it does in dating, and it relates mostly to the intangible – the vibe between the two of you. It’s also possible that, on occasion, you have landed in the office of someone who simply is not a very good therapist.
The key at this point is not to give up therapy, but to do some comparison shopping. Try to get some personal referrals, or read as much as you can about each therapist. Many therapists offer free initial consultations, either on the phone or in person. Commit to trying out no less than three and then picking your favorite. Remember, you are the customer in this business relationship. You are picking the person with whom you are going to share the most intimate details about yourself, so it’s important that you feel comfortable with them. It’s OK to be choosy.
5. “I’m just going to call and cancel.”
There are many times when it is appropriate to leave therapy. Maybe the reason you came to therapy, like a phobia or a life adjustment, has been addressed and resolved. Or maybe the insight and awareness you have gained has empowered you to grapple with the struggles of life on your own. If you are leaving for reasons like these, your therapist will be an active and proud participant in your “graduation.”
A good practice is to honor this change with at least one termination session. It might be tempting to leave a voicemail or send an email letting your therapist know that you won’t be coming in any more. That way, you don’t have to face what you imagine will be an uncomfortable goodbye. But once again, if it’s hard to do, that’s a good sign as to where your growing edge is.
Many of us have difficulty with endings, particularly in relationships. Therapeutic termination is a perfect practice ground for fully experiencing a good-bye. The closure makes the experience as a whole richer and complete. During a termination session, therapists will often review with you what you felt you got out of therapy, how you have felt yourself grow, what if anything you are still working on for yourself, and what the two of you appreciated about each other. Even though your relationship with your therapist is a professional business arrangement, it is also be a deep personal connection where private and intimate moments have been shared. Termination highlights that connection and allows each of you space to reflect on all the therapy has meant.
My friend confronted her therapist with her feelings, and felt gratified not only by his genuine apology, but also by how seriously her took her experience and the earnestness with which he wanted to understand her better. She also left feeling empowered and proud of speaking up for herself. Perhaps most importantly, she realized that her confident demeanor often led her to feel distanced from others who didn’t understand her vulnerable side. She has since started practicing showing that vulnerability to loved ones, thereby building a stronger support system. And the therapy is now anything but stalled.
©Copyright 2009 by Kate Griffith, MA. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Kate and/or see her GoodTherapy.org Profile
15 comments so far
Thank you Kate.. about every couple months I feel like quitting therapy and this list was very helpful for me. But, I’m still mad at my therapist for being so dang nice all the time! :)
I am feeling some of these very things right now and have been debating about whether or not I should continue to go to my sessions. Sometimes they are great but then there are other times that it completely feels like a waste of time, like she does not even hear or understand what I am saying. And then there is always the money issue. It gets expensive going for an hour every few weeks, especially since I have no health insurance. There is a part of me that insists that this has to remain a priority for me, but there is another side that just encourages me to call and cancel my next appojtment to see if I can just get through everything on my own. There have become more times than not where this does not seem to be an expense that I can justify anymore.
Quitting therapy won’t solve anything. You can walk out of a dozen therapist’s offices. You can’t hide from yourself.
I liked how you explained that, Kate. Thank you and well done to your friend.
When you go to a new therapist, does the new therapist have any contact with the old one?
I want to know what happens to the case notes. Can you request them or a copy of them from the therapist when you terminate your contract?
I’m so glad to see that readers found this article helpful, and also that it raised some important questions and concerns! These issues are exactly the type of material that can be brought into session and discussed directly with your therapist. Hopefully, your therapist can not only address the concern, but can explore with you what led up to these questions, what your hopes and fears are around talking about it with your therapist, and how this discussion may impact your therapeutic relationship and future growth.
Thanks so much for your feedback, and good wishes for your upcoming sessions!
Why oh why do we do these things to ourselves? Therapy is a process, not just a quick fix for our issues!
Deciding when to leave therapy is a difficult process – for both the client and the helper. This is a great conversation!
I am so glad to have read this. I was going through a very low phase with therapy. I have decided to rethink my decision of quitting therapy after reading this.
You know, therapy for me is like a car and house payment- just seems like this is something that is going to be in my life forever
I love this post. So clear and well-written. Of course there are many times when it makes sense to end therapy, but I do think it’s great to offer clients information on when they may get more out of it and when it may be premature. Of course, hopefully, if clients do end prematurely, they will feel that it is okay to return and address some of these issues.
@Craig asked whether new therapists have contact with the old ones. Usually, if I see a new patient who has recently worked extensively with another therapist, I will ask the client if they are willing to sign a release of information to have me speak to the previous therapist, if they think it will be useful. We cannot speak to the other therapist without the written release of information.
Also, clients can always request their notes. Depending upon the laws of the state, therapists have a certain time period in which they must respond to this (written) request. Most therapists will prefer to release a summary of the records rather than a photocopy of the entire chart. Patients can be expected to have to pay any clerical fees for copying. (In CA, we have 10 days to provide a summary and 15 days to comply with request for the full record.)
California psychologists must maintain the chart for a minimum of 7 years following the termination of therapy.
Hope that’s helpful.
Keely, thanks for the answer! I wondered if permission was needed. I’d not worry about going to a new therapist and them having my notes. I think it would be good to help them hit the ground running. However say the original therapist disliked me and that influenced their notes. Wouldn’t the new therapist form a preconception of what I’m like from their notes? I hope I’m making sense.
Craig, I think I understand what you’re asking. It’s certainly possible that a therapist’s subjective experience with you could influence their diagnosis and assessment, although I’d sincerely hope that this was not conveyed in the chart.
I don’t generally ask prior therapists to forward the entire chart. Part of that is that I like to learn about my client from my client rather than through someone else’s impressions. But there are circumstances in which it makes sense to speak to the former therapist. If I get a release of information, I’m generally having a 5-10 minute phone conversation with the other therapist in which I’m asking pointed questions about length of treatment, diagnostic impressions, and potential risk issues (suicide risk, etc.). I *always* discuss with the client the types of questions I’d like to ask, and I’d hope the client would let me know if s/he worried that a poor connection with the therapist might influence the information I’d receive.
When I’m in the position of being asked to give the same, I may mention it if I had a difficult time connecting with the client or if we had ongoing conflicts because this *may* be useful information diagnostically (about the client). But then, it could always simply just be about me or our personality match (or mismatch). What I’m trying to say is that I’d hope that any negative responses could be contained and directly communicated in this manner so as not to seep into diagnosis/interpretations that would be passed along more indirectly. I would also hope for the same from clinicians making referrals to me.
While it’s definitely possible to inherit someone else’s negative feelings about a client, I’ve had enough experiences getting a referral of a “difficult client,” who I found delightful, and referring my own “difficult” cases to others who were able to make a great connection. So I’d hope we would all feel free to allow that sometimes it’s just poor chemistry and not necessarily about the client and hopefully clinicians aren’t using the chart to act out in reaction to their clients! But I won’t deny that it’s possible for that to happen.
I hope that makes sense.
These are some pretty good reasons and although I’m not in therapy or ever been, I can see where the money and not getting the help can be understandable.
Thank you again Keely! That was kind of you to go into all that. :) You set my mind at rest.
Thank you Kate too. I had rushed in with questions and no thank you for a very good article. Sorry! Better late than never.
I just decided yesterday to leave therapy because it was just too much. After working together more than one year, I felt that we were making progress. However, it was far too overwhelming. I left a message on her voicemail to let her know if & when I felt ready to continue.