Reasons to Leave your Therapist, Part I: The Good Experience

Ok. So I lied: not ready to “go fishin'” yet. You see, it’s August, the traditional month most therapists take off (hit a beach on the Cape and you’re apt to see yours in a bathing suit). I, on the other hand, generally stay in the city and see patients. I figure just because most therapists take a break in August, psychological needs and interpersonal issues don’t necessarily.

So here I am, with a lighter load (many of my patients are off for part of August, too), thinking about the process of therapy. What helps, what makes it less effective, and, today especially, how to manage and understand the breaks: illness, vacation, I-think-I-need-to-try-this-alone-for-a-while. And ending therapy.

How in the world do you know when to end therapy? There are a number of scenarios, depending on you, your therapist, and your course of treatment. So let’s start with:

Part I: Leaving a good therapeutic experience. You’ve been in therapy what seems like forever. You look forward to your regular Monday afternoon sessions with Dr. Whoever. You save up stories during the week to share, you note things you need to discuss or get opinions on, you’re comfortable and always enjoy your sessions. You trust your therapist, even like your therapist (except, maybe, for that horrible taste in office furniture). So why in the world would you even think about ending therapy (we call it termination – but since neither of you are not terminating your life, just the therapy, it’s not a word I find myself using…).

If therapy’s gotten too comfortable, and you find yourself sharing views on the markets’ rise or fall, discussing the relative merits of one sort of restaurant (car, clothing line, gardening tip…you get the drift), or inviting your therapist to your son’s middle school graduation, it’s time to reassess. Maybe, hold on, even time to leave your therapist.

What! Leave, just when I’ve gotten comfortable, when I really trust this person?

Yes, leave. Graduate, perhaps. Or switch to another therapist with a fresh take, a different style, maybe even a different approach.

Therapy requires trust, a level of comfort, and communication to be effective. But really useful therapy, the kind that helps you learn about yourself and change, becoming more and more the you you want to be, that kind of therapy starts there, but moves on to so very much more. It’s not enough to get support, to feel understood and accepted. Crucial, but you can do better. And you should.

You should leave your sessions often feeling challenged to think in different ways, uncomfortable because you’ve felt emotions you haven’t in years, awkward because you are trying out new behaviors, angry because you’ve been pushed to confront something you’ve been avoiding, teary-eyed because your therapist ‘got it’. More than comfortable: growing, learning, taking therapy into real life, facing the hard stuff, sharing your fears and taking risks.

If that’s no longer happening in your treatment, bring the subject up in your next session. What have I learned and accomplished so far? What work remains to be done? What are my goals? What issues haven’t we tackled – and why? Do you think you can help me with the next phase, or have we done all we can together?

And then decide. Ending therapy. Ending therapy with this therapist and beginning anew. Getting a consultation. Or just taking a break and giving it some thought; maybe even with the help of the meditation you’ve been practicing.

Part II: The Not So Good Experience to come…stay tuned…

Copyright © 2009 Marlin S. Potash. All rights reserved.

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7 responses to “Reasons to Leave your Therapist, Part I: The Good Experience

  1. Hi! Your site is great, your blog extremely well-written. To the point of your most recent post: I’m in treatment (3Xwk) for “the worst case of complex ptsd” they’ve seen in my major US city. My therapist falls under your “really useful therapy” category, and I am eternally grateful to have found him and have no interest in leaving him. Just nice to see I’m supposed to be teary-eyed, etc.!

  2. Wow it feels like this post was directed to me. I hate the ‘August break’ because I feel like my therapist abandons me. Nonetheless this post served as an eyeopener because it has become too comfortable (2 years this winter).

    Do you have any suggestions on how I can bring this up with my therapist without it comming out sounding insulting or so?

  3. Hi,

    I’ve been with my therapist for almost 15 years. I have come very far working with her, started a new career, got married, had a kid, bought a home, kept the job for 10 years plus. My husband sees her also and we have seen her as a couple. There is however one area of my life she has not been able to help me with and that is my weight problem. I have gained almost 100 pounds since the start of our sessions. She has expressed her upsetment over this fact. I have discussed my weight issues with her then I have banned the topic because I get pissed off at the way she handles the topic. She has used humilation, compliments on how beautiful I was when she first met me and how I could be that way again, scare tatics about my health on and on. Just when I feel like I’m getting a handle on my problem, I start working out and following a low carb diet she brings up my weight in tonight’s session and I tell her that I’ve started to get my act together again. She didn’t really say anything insulting, it’s just that the topic is so sensitive for me…and I end up feeling angry….she did make a comment about me maybe losing my job next year, I’m a teacher, budget cuts, maybe that’s what got me annoyed, not very positvie comment. I ended up over eating tonight once I got home and picked up carbs. There is something wrong here…but I am a bit afraid to leave her. Help

    Jane

  4. Jane – Clearly I know neither you nor your therapist. And it seems you have learned quite a lot from your therapy experience. But you raise some interesting points that come up during a long-term psychotherapy experience that are really useful for everyone in this situation to consider: both patient and therapist . So I will speak to some general issues about long-term psychotherapy; maybe it will spark some thought and discussion with your therapist.

    Long-term therapy can be remarkably productive. I certainly find it very much so. But it’s really important to check in periodically to see how it’s going. How are you doing on the goals that brought you in to therapy in the first place? What have you learned? What problems have you solved? What remains to be done? What works best in your therapy? What’s not going so well, and why, and what do you do about it? What are you afraid to bring up (and why)? Anything you’ve been sitting on for a long time? Something that bugged you, or that you were embarrassed about? Even if you don’t feel comfortable bringing up the particulars, it’s still really important to address the question of why you’re not comfortable to do so.
    I think this kind of checking in and checking it out should happen periodically. Regularly. Not just when there are “problems” but also when things are going really well. Because sometimes it’s time to move on, because you’ve gotten all you can get from that therapeutic relationship. And because sometimes it’s time to move to a deeper level of inquiry into your issues with your current therapist. Time to risk facing yourself… with your therapist.

  5. Thank you for your response, I will consider your suggestions.

  6. I’d love to see Jane’s therapist’s written treatment plan for a fifteen year therapy, where the patient had to place a major topic off-limits because of how the therapist approaches it. Oy. Dr. Potash, do you do written treatment plans? So many of my teachers and mentors say that they are crucial.

  7. In training, it’s commonplace for a therapist to write: intake questionnaires, family-of-origin diagrams, detailed history, diagnosis and prognosis, treatment plan, periodic assessment of progress, summaries, and notes to herself.

    Oy, indeed.

    It’s important to write – treatment plans, and all the rest: it helps focus, ensures quality control (of sorts), gives a common language and reference frame to discuss the therapist’s work with a particular patient/client, serve as a reminder of what you thought, said, tried at a former period of time. And it is really crucial in focusing on a plan of attack: what’s the problem; what are you going to try, how, and why; how will you and the patient/client assess success; what are reasonable expectations of success and timeframe.

    But, alas, real life intervenes. Focusing the first sessions on taking a history, asking questions, diagnosing is useful – and critical. It’s just insufficient. Patients in private practice enter treatment – often after a long period of deliberation – with expectations: a professional who will listen, ‘gets it’, and can help. For me, that means eye contact. For the entire session. No note taking, no routinized questionnaires – at least not so that they break the flow.

    Over time, experience and education become a sort of professional intuition informing the attentive therapist. I know I remember all sorts of things patients are amazed I know; I also tend to forget most dates, names, numbers. I remember what I pay attention to, and I prefer to attend to the person sitting in front of me. Not just what she says, but when, how, with words, with body language, with silences. The real deal is often between the words, not in them.

    Having said that, the point of therapy is to improve the understanding and quality of the patient/client’s life. It’s important periodically to ask questions about the treatment: “What is the work we need to do? How are we doing? What’s no longer problematic – and why? What issues remain, and which have emerged? What are our priorities going forward?”

    And one of the tougher questions: “Is this process helpful (enough) to you, or can we do better?” Even: “Is it a good time for a consultation to assess how your treatment’s progressing?” “Are we stalled? Is it time to switch therapists for another approach?”

    Copyright © 2010 Marlin S. Potash. All rights reserved.

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