What is therapy? Part 9
When is it time to end therapy?
There are three points at which it is worth considering stopping your therapy:
You have met your goals
The cost outweighs the benefit
Something is going wrong.
The first of these is easy enough but requires that either your therapist or you had the foresight to establish clear and measurable goals at the start. Maybe you wanted to date more, perhaps you had a fear of flying, or it could be that you wanted therapy to help you to get through the first anniversary of a loved one's death. These are all definable and measurable goals, and it's easy to tell if they have been met. If they have, you can either bring therapy to an end or set new goals and continue.
Many people, however, enter psychotherapy with less measurable goals. They might sense that they are easily offended, intolerant of intimacy, or want to understand why they experience life differently to others, sabotage their success, or choose unavailable people. There are countless examples of situations like these, and while some do offer clear endpoints, many have the potential to lead to long-term therapies that end when the therapist or patient or both decide that it's time to call it a day. The decision to end often comes down to an assessment of whether the benefit continues to outweigh the costs, i.e. are you still making good progress or finding help? Assuming the therapy is affordable and providing value, there is no inherent reason you should end it. Emotional growth and development unfold over time, and some have found integrating psychotherapy over the course of their lives enormously enriching. Of course, you may not want to do this, and there is nothing wrong with that either. But there is no need to end therapy out of fear you might become dependent, or fear that being in therapy proves you are weak. Well-trained therapists know how to establish a long-term therapeutic relationship that breeds independence and strength rather than dependence and weakness. This is one reason they don't tell you what to do and encourage you to find your own solutions. Unfortunately, therapy doesn't always end because things have gone well and your goals have been reached. Sometimes it must stop because things have gone or are going wrong. It might be that the therapy frame has become eroded. The frame includes all the things that distinguish being in psychotherapy from having a friend who is also a psychotherapist. This includes the rules that structure the engagement, e.g. who's there to get help, the length and frequency of sessions, who speaks first, whether meetings can be rescheduled, whether contact is avoided outside of sessions, etc. An eroded frame will render the therapy ineffective. It is always the therapist who works to maintain the frame, but it is sometimes the patient who must call it a day if the therapy relationship has turned into something else. Signs that your therapy has an eroded frame include: your therapist telling you their difficulties; holding long, unscheduled telephone conversations; meeting casually outside the therapy room; spending therapy time catching up on each other's lives; and flirting (or worse) with each other. Ending a therapy that has reached this point can be especially painful since you may have developed a strong bond with your therapist by then. Try not to let this prevent you from moving on to the real help you need. It is unethical for a therapist to allow the frame to erode; consider reporting them to their respective licensing authority. Here are a few other signs that indicate things are not going well in your therapy: a clear sense that the therapist is uncomfortable about discussing what troubles you (e.g. sex); having the therapist dismiss each of your concerns or worries; finding that your therapist needs constant reassurance or admiration; being subject to your therapist's agenda (e.g. applying pressure to attend their expensive workshops); and finding that the therapist pushes their moral view, tells you how to live your life or speaks more than they listen. The ending of a therapy can be a surprisingly emotional time. It is not unusual for symptoms to return around the time, and many people find that they doubt whether they are ready. This is quite reasonable, and things do usually settle down again. For many, this will have been the most open and supportive relationship they have ever had. It is not uncommon to have told your therapist more intimate things than any other person before. There is a good chance that you formed an important and powerful bond with your therapist and this can make saying goodbye quite challenging, since it involves facing genuine loss. When you do decide that it is time to end, it is wise to set a future date for the last session and then to use the run-up time to properly say goodbye, and process the feelings that saying goodbye can evoke. This is particularly useful if you tend to dismiss goodbyes or minimize loss, because it can help you to hold onto the good of the experience you have had by allowing you to face the end in an authentic way. The length of this ending period should be proportional to the duration of the overall therapy; a week or two for short-term work and possibly many months for therapies that have lasted years.