What Is Your Therapy Termination Style?

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When I terminated therapy with my former psychiatrist, Dr. Lev, I gave myself a year. At that point, at the end of 2015, we’d been working together for 10 years, with two sessions a week. I believe when I told her I wanted to spend 2016 terminating, we reduced our sessions to once a week, so I could gradually become less dependent on her. Our last session, right before Christmas Day, went too fast. Any gifts I could buy her seemed an inadequate way to thank her, but I tried with some books I thought she might like, since we both enjoyed reading. And, since I was a writer, I wrote her an eight-page letter. When the time came, we shed a few tears, hugged, and I walked out the door. After the fuss of the holidays passed, it seemed very strange not to have therapy to attend every week as that’s precisely what I had been doing for over 30 years, but in a way, it felt absolutely empowering. I got used to this new sense of freedom quickly and I reveled in it.

In some of my recent posts, I have written about how my depression has returned. I’m facing some overwhelming medical issues and they seem to be dragging on. When I saw Dr. Lev, she generously adjusted her fee so we could work together but if I saw her now for therapy, I’d have to pay her regular rate, which I cannot afford.

I sought out Cathy, a provider who was covered by insurance, and saw her for about two months. The therapy was not helpful. I think it was a combination of several things: I did not know what I wanted beyond support around my medical issues and depression, Cathy kept telling me I was resilient and had overcome so much in life, which I didn’t find helpful, and also — and I didn’t think about this until I was already into therapy with her — for me, no one could measure up to Dr. Lev.

One in five clients will drop out of psychotherapy before completing treatment, according to a 2012 meta-analysis of 669 studies on dropout by Joshua Swift and Roger Greenberg which was published in the Journal of Consulting and Clinical Psychology.

According to the American Psychological Association, reasons people drop out of therapy before treatment is completed include “unrealistic assumptions about therapy, the degree of commitment that is required, their feelings of how quickly benefits should appear, external difficulties such as obtaining childcare, as well as anxiety about revealing their feelings and experiences that may have been traumatic.”

Although my termination with Dr. Lev was planned and productive, I have to admit that my termination with Cathy was not. I came to several sessions planning to break it off, but not having the nerve to tell her. Finally, I just said I wanted to take a “break.” I didn’t tell her that the therapy was not working for me or give us another couple of sessions to work it out.

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According to Psychology Today, “Some clients simply stop showing up to appointments or returning phone calls. But “cut and run” is never the best termination strategy; it both denies the client the opportunity to process any feelings associated with ending the relationship and may leave the therapist unsure why a client left and whether they plan to return.”

“Every competent therapist will thank a patient for their courage and candor,” John Norcross, a professor of psychology at the University of Scranton, told the New York Times.

I don’t know if I will try someone else. I need to, but I’m wary. I intend to take a break, but for how long, I don’t know. As I’ve always maintained, I need to be proactive about my mental health due to its severity and its propensity to spiral so quickly.

Thanks for reading.