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 taking 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 my friend. She felt completely invisible. Hadn’t her therapist 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 therapy 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 his or her salt, he or she will hear you and help you process what’s happening for you so that you can move through the anger. He or 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. He or she will honor what you’re feeling and look at how it informs your work in therapy as a whole. He or she may even use it to understand you better. The result can bring the two of you closer, making your subsequent therapy 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, increased feelings of 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 okay 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 goodbye. 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 he 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 Korsh, LMFT. All Rights Reserved. Permission to publish granted to GoodTherapy.org.
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