Maybe you don't like your therapist. Maybe you do, but you've resolved the issues that drove you to seek counseling in the first place. Or maybe those issues remain unresolved, with few signs of progress. Maybe your sessions feel as if they've morphed into very expensive chats with a friend.
For myriad reasons, people come to a point when they wonder if they should break up with their therapist. And "break up" is the right term for it, because quitting therapy can spur emotions as painful and complicated as ending a romantic relationship.
First, any therapy that is abusive or destructive should be stopped immediately, said Dr. Kenneth Settel, clinical instructor in psychiatry at Harvard Medical School. Examples of abusive therapists are those who are disrespectful or insensitive to certain issues; those who violate boundaries; those who reveal too much about their own problems; and those who insist on focusing on areas the patient didn't come in for.
But assuming you're not dealing with that, patients should approach ending therapy as a chance to grow, Settel said. Rather than cut and run or avoid the topic altogether — tempting routes for the confrontation-avoidant — it's important that patients, well, talk to their therapist about it.
In therapy, the relationship between the patient and the therapist is a vehicle for understanding the patient's issues, Settel said. So the way you end therapy can be a way of examining how you say goodbye to people, and the feelings involved in leaving and loss.
Ask yourself why you want to move on. When did you start feeling that the therapy was no longer helpful or productive? What happened that made it different? Was there a change in you, in the topics being discussed, in the therapist? Confronting that tension can be a turning point because it forces you to work through obstacles, Settel said.
"Ending therapy can be very therapeutic," Settel said.
Though the patient-therapist relationship can have a weird power dynamic — you're paying, but the therapist is the expert and knows your every demon — patients should feel they have control of the process, said Lynn Bufka, a psychologist and head of the department of practice, research and policy at the American Psychological Association. Patients should feel empowered to ask questions, steer the sessions to focus on particular issues and let the therapist know it's not working, if that's how they feel.
The tricky part is making sure you're not leaving therapy just because it's unpleasant or difficult, which oftentimes it has to be, Bufka said. More than make you feel better, therapy is supposed to help you understand yourself better.
On the flip-side, therapy shouldn't be some indefinite appointment you keep as part of your routine. There should be regular discussions about what you're trying to accomplish and whether you're approaching those goals.
"I hope that I'm going to work myself out of a job," Bufka said.
There is such a thing as staying in therapy for too long. One warning sign is if a patient has to run all decisions by his or her therapist, which can signal dependency, Bufka said. Another concern is if the therapist relationship is taking the place of building other relationships.
Another downside of staying in therapy for too long is that you don't have the opportunity to practice the skills you're developing independently, Settel said. If the therapy was aiming to help you build internal skills of self-observation, stopping therapy can encourage growth because it forces you to internalize the process.
Sometimes the therapist will break up with the patient.
"Sometimes people seem to be rehashing the same thing over and over again and don't seem to be making any progress with me," Settel said. "They get stuck in a rut, and you can't get them out of the rut, then sometimes it's not useful to continue."
Many patients who have made progress in therapy get scared at the prospect of cutting the cord, Bufka said. To help determine if you're ready, answer a few questions:
•Am I functioning at a reasonable level of my capabilities?
•Do I have satisfying interpersonal relationships?