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Julie Cohen is a licensed Marriage and Family Therapist MFT and a Child Mental Health Specialist with a private practice in Los Angeles Her areas of focus include depression anxiety panic post-traumatic stress bipolar…
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I was seeing a client today who I have worked with for quite a long time. Not that therapy has to be "goal" oriented but he really has done what he set out to do in therapy. Although he has met his goals his desire and dependence for therapy remains high. We have started discussing if it's time to end treatment.
All therapists have their own unique style and guidelines regarding the "how to's" of therapy and ending therapy is no different. Some believe that especially after long term treatment you should allow for up to four months or longer to say goodbye. Others believe that a shorter time frame such as a few weeks to a month is appropriate. Regardless ending treatment is just as important as the beginning and middle and should be allowed a process.
My goal is to help clients plan their own termination. I always tell clients at the onset of treatment that this is THEIR journey and they will know when it's time to end. The only exception to this is if a client's judgement is impaired. For instance, I would strongly encourage a client to stay in treatment if they want to stop while in crisis.
Most therapists are dedicated to helping clients. When their clients meet their goals and end treatment ethical therapists rejoice. Rarely is this a one sided relationship where the client is then dismissed and not thought of again. The therapist-client relationship is just that a relationship. When treatment ends even for good reasons most therapists also experience a sense of loss.
Those feelings of loss are appropriate and a sign that a healthy client-therapist bond was established. However, there are occasions when a therapist may act inappropriately towards termination. For instance, if a therapist refuses to let you end treatment or dismisses your request to talk about termination. Therapists are taught in graduate school the importance of embracing a client's voice. It's a problem if a client brings up an issue such as ending treatment and the therapist evades the topic.
If you are in therapy and considering termination bring it up with your therapist. A good therapist will not be offended and should welcome the discussion regardless if you decide to end treatment or continue. Ending therapy is a normal part of treatment and should be part of a dialogue between you and your therapist regardless if you are in the beginning, middle or late stage of treatment.
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I was fortunate to receive free counseling through a domestic violence agency. The first time I ended therapy because I was not in a good place and felt like a failure to have had some of the insights she shared with me come to light, as in the relationship was much worse than I could admit to, and I did not want to deal with it.
Later I was in another abusive relationship and was ready to deal with it after it ended and during time of back and forth and getting into different situations and attempting sobriety for the first time in my life. Her help was invaluable and I imagine it must be quite gratifying to watch someone in counseling improve.
She handled terminating counseling extremely well, giving me plenty of notice and time and tapering off and ensuring I would be taking steps to build a social network who could support me. Of course I cried at the mention of it, but it was ok. I went through the termination process with her twice as I found my next relationship a couple years later to also be abusive, and again, I am grateful that the goal of therapy was for me to use the tools and insight I gained there, not become dependent upon her.
Earlier in life, a counseling intern worked with me longterm (over a year) and I was not sober and not progressing, in fact probably backsliding, and she determined she was going to take a break and decide if this was the career she really wanted. I always felt a little "responsible" as I was a poor candidate without addressing my addiction/alcoholism issues, and I think her inexperience or whatever maybe did not address that I had this issue, either.
I think it is important to find someone who can deal with the issues in particular one is dealing with, as they are revealed.
Mary Rettig
New life story coach
Mary@transitionaldreams.com
The last time it came up we talked about it for four weeks and then I walked out the door. I was in tears, not only because I knew I would miss him, but because I knew I had a safe place I could return to if I needed to.
About a year later, I was diagnosed with Atypical Glossopharyengeal Neuralgia. The ATN caused an incredible amount of pain, screwed up my sleep cycle, and most importantly messed up the balance I had worked so hard to achieve with the Bipolar Disorder. I couldn’t find anyone who seemed to know what to do to help me, and finally, in a desperate moment, I called my former therapist. Even though he didn’t understand the mechanics of the pain and the medications, he was willing to do some research on it. I feel at times that I have been walking a tightrope, and he has been willing to help me develop a safety net that will catch me if things ever get too far out of hand. I bring up the idea of ending every few months (I only see him twice a month), and we discuss whether I am ready or not.
This idea of being “done” with therapy is something I really wrestle with. As a religious leader, I believe that each person is created with a potential to impact others around them. If we are “done” with therapy, then do we stop assessing who we are and how well we are functioning? Stop thinking about how we relate to other people? I think having an ending process is important; the critical point needs to be that we can go back when we need to.
My point is, a good therapist, one you could actually have a good "connection" with is hard to find. It takes time. If you ever feel betlitted, worthless, or even hopeless after sessions, it's a good time to search for another therapist. No client should ever feel obligated to stay with a therapist who isn't able to help heal the deep rooted issues in a person.
One therapist died and no one bothered to tell me. I learned when I called the hospital and they told me she was no longer there. There was supposed to be someone else to call/see. She called me once and there was never any follow-up as promised.
Second one knew I was in financial straights. I kept bringing up ending but he kept convincing me, though I was not in crisis, rather playing on my inability to take control and say "No." Only when I was really at the last dollar did we "end" There was never termination begun or ended.
Third, a woman I had seen for years. I stopped because the first person, above, specialized in chronic pain patients.
There was no enmity however, a few years later I was doing my medical malpractice case,(against Dr. Peter Jannetta for doing the Jannetta procedure, for paralyzing my face, and for egregious malpractice, as proved by records, I had to go Pro Se (self representing), for a period of time; long story) I asked her to write a letter and told her what I needed it to say. She agreed she could write such a letter, but then wrote something else that gave a completely different tone than what I needed.
She agreed to meet with me at her home office.
She was late and I asked if I coud walk around the property. No, I could not do that while I waited.
Once we were seated she asked nothing about me, even the basic courtesy questions -, How are you? much less anything else.
After years of being her client, 2 times a week for probably 8 -10 years, she had no interest whatsoever. (even in my chronic pain situation despite spending the majority of that time dealing with the pain, having surgery, or dealing with terrible side-effects.)
It would have been nice, although Mary, the first had no say in hers, to have at least one end, 'terminate', with a level of caring or scintilla of loss.
I was helped, a lot of it from my being completely alone and having someone to talk to about the horrors of my life with disabling overwhelming facial pain (trigeminal neuralgia)
The second one helped me uncover memories about sexual abuse, later circumstantially corroborated, but no help as to how to change my thought patterns and behaviors that kept me from having had or having a relationship .
The complete lack of caring evidenced at my leaving or any interest in me, just from a courtesy point of view, was very hurtful.
I am a hypnotherapist. One of the reasons I chose this was because it is not a potentially openended relationship, years long. The client can't be hurt because we spent hours upon hours together and then I cut them loose or their money runs out.
Thank you.
Leej
(author A PAINED LIFE, a chronic pain journey.)
I truly am "high functioning" because I have been aware of my needs and had the opportunity to work through things with a good therapist that knows me. My current therapist, that I have had for over 10 years knows this and she works with me when necessary and always has an open door policy for me to return when necessary.