Dear John,

I want to break up with my therapist. She is amazing and has really changed my life for the better, but I think the treatment has run its course. I’m not interested in sitting on the couch for years and years. How I do it: Ween myself off or rip off the bandaid?

Leigh

Dear Leigh,

Thank you for writing in. Your question is full of possibilities for exploration. Here, I offer you a few points to consider as you and your therapist work on determining the best course of action. I encourage you to act in collaboration with your therapist, remembering that, ultimately, you have the right to decide when to end the therapy.

Therapy is a relationship. Having a discussion with your therapist about your feelings concerning the treatment, your progress, and what you believe is best for you would be the ideal first step. Your therapist may have insights into the therapy process and your progress that you have not considered.

Termination, which is what therapists call the end of treatment, is also a point in the relationship where you can take a step back and reflect on how you generally end things. To an extent, the therapeutic relationship mirrors other relationships and, therefore, the desire to end treatment can allow you to peer into these other areas of your life.

A few questions to ask yourself before you move forward: Does this desire to stop therapy come up when other endings or changes are happening in my life? Am I able to navigate changes with more subtlety, or allow my decision concerning my therapist to simmer for a while?

Hit pause for a moment and scan your life to reflect on other relationships with friends, family, teachers, current and former lovers, etc. These are all relationships where this dynamic may surface. Perhaps tearing the bandage off is how you drive yourself to change. Ask yourself how gentle, slow, and deliberate you are when you feel stuck or when something is nagging you about yourself. Once you complete this reflection, jot down your insights in your journal so you can share them in therapy.

Next, take whatever ideas you have garnered from this reflective process and apply them to the treatment relationship. Where in the relationship are there areas in which more growth and potential are possible? Are those areas in which you think your therapist can further guide you?

Often, therapy is done outside of the immediacy of the present-moment relationship. I invite you to try to shift that dynamic by being direct and unafraid to be honest with your therapist about your feelings. A well-trained and practiced therapist can hold this kind of contemplative space to be with the challenges of “stuckness” without slipping into defensiveness. Notice if your therapist can provide you with this sort of “holding.”

You mentioned that you feel that you have achieved important life changes in this work, so this could be a time to explore exactly what those changes have been. The termination of therapy can be a time of celebration. It is a time where you and your therapist can honor the work you have completed. It can be a time of recognition of the incredible journey that you have undertaken.


Related: How to Know When You Need to End a Friendship


If the therapy has, indeed, plateaued, this is something that can be acknowledged and workshopped as well. It is wise to recognize and explore it. Some diagnostics may be to consider, such as how you are preparing for the sessions. Sometimes there is a kind of “autopilot” that catches us all. In the context of the therapy, it could manifest as a complacency about the areas of discussion, the range of emotions expressed, or a “collusion” between therapist and client on avoiding the scary, deeper, and not-so-easy- to-work-on material.

This avoidance can sometimes show up in trauma therapy or work with deeper feelings of abandonment, isolation, fear, meaninglessness and angst, or the other side of these, such as freedom, happiness, self-actualization and self-transcendence. Therapy does not necessarily have to stop at symptom reduction; its goal can be performance maximization. Therapy can move humans toward their full potential. There are many ways in which we may sell ourselves short by not thoroughly mining the depths of treatment. You can touch into the depths of your psyche through this relationship. Interestingly, the existential and transcendent realm can be one that doesn’t fully come to the surface until we confront an ending.

I recognize that the above may sound dramatic, but it is something worth shining a light on in therapy. Ideally, the urgency of the existential givens come into awareness early in treatment, but they often live in the shadow. In my view, the most significant truth of human existence that treatment termination symbolizes is that of death. Notice if you are already cringing about that! The reality of mortality is a profound source of anxiety, and death, as such, is widely avoided by clients and therapists alike. Therefore, I invite you to think about how the ending of therapy, even if you decide it is the most appropriate action for you, may be a symbolic representation of death. If you feel that your therapist can hold this type of metaphor, it may be more grist for the mill and can move you through a therapeutic impasse.

Ultimately, it may be that you decide to end your therapy and that is your choice and a path forward. It can be beneficial to take a break for some period and keep the door open to return to therapy to see if things feel different. If we hold psychotherapy in a psycho-spiritual context, typically, there is more work to do.

Another path forward may be to end with your current therapist and visit with a different practitioner. They may have other insights that could spark further growth.

I agree with your sentiment about not wanting to stay on the couch for years and years. Therefore, an approach of doing a certain amount of growth work, pausing therapy for a time to reflect, may be of utility. In any case, it is critical to work with your therapist to monitor your progress. Early in therapy, determine what clear and concrete benchmarks of achievement are and keep a steady eye on them with your therapist. When you have met your goals, perhaps it is time for the therapy to terminate.

The termination process can then serve to summarize the treatment and review what skills you learned and how to carry those forward. You can always keep the door open to return for “booster sessions” if needed.

I recommend having a few conclusion sessions to process the end of therapy. An intentional termination process will help you integrate the learning and growth. Therapists may structure this process differently based upon their own treatment strategy. Ultimately, it is a meaningful opportunity to experience how a healthy relationship can come to a close.

Thank you again for writing me. I wish you the best on moving forward with your decision!

Many blessings,
John

 

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