Ending therapy

Some insightful blogger recently said

“Still questioning the therapy - wondering how I will recognise when I am done.”(end quote)

It is a good question that sometimes does not have a clear answer. I always suggest to clients that they often ask self the question - “Am I getting what I want from therapy”. This needs to be answered from the Adult ego state as much as from the Free Child. Those two parts of the personality will know. It’s just a matter of the client listening to them and of course the therapist must not be interfering as well.

For personal reasons (counter transference) the therapist may complicate the client getting their answer and may suggest the client ends therapy before the right time. For personal reasons or financial reasons the therapist could suggest the client remain in therapy longer than necessary.

How long to hang on?

This is particularly so in the longer term treatments where the therapist has the time to develop an attachment to the client. If the therapy ends with some kind of angst, argument or acrimony between client and therapist then the time to end was not right. Either the therapist has hung onto the client too long as they find it hard to end their own attachments or for some personal reason they push the client away too soon. If the longer term therapy ends without any enmity then that is a good sign that the time was probably right.

Also therapy is very much related to the stage of development that the client is at. In initial interviews I always ask the client if they have been in therapy before and if so what happened. Not uncommonly it is reported that as a teenager they ended up in counselling for some reason. One then sometimes hears comments like, “But it just was not the right time and I was not receptive to it”.

My point being that ending therapy is relevant to the client’s current stage of development. As they move further through the life cycle they may be again ready for some kind of therapy.

Ending therapy is also dependent on what the problem is. For instance grief work and trauma debriefing are finite things. Right from the beginning it is necessary for the therapist to have the attitude that trauma debriefing and goodbye work are finite. That the person will ‘get over it’. It does not go on for ever and this is automatically assumed by the therapist.

Indeed it is a good idea to get the client to identify the time when it is over. That may not be during the counselling but some time after. However, have it placed in the client’s mind to make such an identification and that such a point will be reached. I sometimes ask clients to make a contract to send me a letter when they have ‘moved on’ and over the years a few have indeed done that. This leaves the client with this notion in the back of their mind that there is an end.

Some object to this idea and will say things like, “I can’t gain closure until the trial is over or until they have found him or until she apologises”. All these are not true, as one can gain psychological closure (ie Get over it) without any of them happening. These are what is known in Transactional Analysis as waiting for santa claus. The client is conning self and finding a reason to halt their progress.

Waiting

In the literature one sees lists like:

“Instead of moving on in my life I am waiting for...”

Santa claus (Magic)

Others to change

Understanding

A push or a kick

Certainty

Consensus

My turn

Fairness

Justice

Revenge

Hitting rock bottom

More time

The right feelings

The right reasons

The right words

Someone else to be here

A certain age

These are particularly the case with things like trauma debriefing and grief work. Of course people enter therapy for many other reasons such as depression which is different from things like grief work. However it is still important for the client to have a sense of finiteness about the therapy.

The best scenario is when the client responds well to treatment and the depression decreases. Sometimes that does not happen and then I suggest the client accept that this is as good as it gets, at least at this time, and live with the disability of depression just like an amputee has to learn to live with one leg.

The goal is for the client to have a sense that therapy is finite and this will end one way or another. If there is no significant reduction in the depression then the therapy goals change to learning to live with the disability and how long will the client keep banging their head against the brick wall called therapy for very little therapeutic outcome.

Graffiti