When is the right time to end therapy?

The question of when is the right time to end therapy remains debatable. In some cases, the decision is easy to make, while in others, it's unclear both to you as a client and, in some cases, even to your therapist whether the time has come.

The premature abruption of therapy has several undesirable effects. Swift et al. (2) point out that clients who prematurely terminate exhibit poorer treatment outcomes compared to those who stay in therapy longer or complete it. Sherman & Anderson (4) note that the decision to terminate early often leads the client to decide that therapy is not for them, thus depriving themselves of a broad and diverse range of approaches and specialists generalized under the umbrella of "therapy".

So, let's take on the subject of the opportune time for ending therapy.

1. The easiest decision is when the client comes with a concrete problem, e.g., "Help me get through a divorce", "I need help with changing the job, but something within stops me", "I want to earn more, but feel that I sabotage myself", and so on. In such cases, recovering from the problems and reaching a concrete and measurable result - i.e., finding a new job, getting a divorce, earning more, and/or improving functional abilities, becomes the point where therapy can be completed.

2. Another straightforward decision to end therapy can be made when addressing issues like specific phobias, panic attacks, or anxiety related to a concrete current or future event (such as an exam or relocation to a different country), or sometimes even when processing grief. In such cases, unless these issues are found to be part of a broader problem like PTSD, progress can be measured objectively through standardized tests or subjectively through the client's reported satisfaction with their newfound state of calm.

However, most of the time, identifying the appropriate time to end therapy is not that easy and straightforward. For instance:

1. The client comes with emotional symptoms (anger, guilt, shame, sadness) which have roots in childhood traumas.

    a) A high-achieving attorney deals with too much stress and has no idea what he genuinely enjoys. All his hobbies are about self-optimization and earning more. His family complains that he spends too much time at work, and he angrily retorts that he does it for them. A profound grief emerges, a sudden welling of tears when he realizes that his father died in unknown circumstances. Working has become a coping mechanism to gain control to avoid painful losses. Therapy, which had been about stress, changes direction and becomes about grief and control.

    b) A successful executive feels a constant, hollow emptiness, numbed by alcohol and a series of draining relationships. She proudly describes her achievements as "finally making her mother proud," yet she feels no pride herself. Therapy, which began to address her dependencies, shifts irrevocably when she recounts her mother's venomous confessions: "I didn't want to have children" and "Your father left because of you." The work is no longer about quitting bad habits, but about excavating and reliving a childhood buried under a mountain of guilt and learning that she deserves a life of her own, not one lived as an apology.

    c) An individual who has always been the "scapegoat" for the family's problems develops a strong, positive alliance in therapy, then suddenly quits without any explanation. However, they soon return to continue and explain the decision: "I felt safe that you will not punish me, no matter what I do." The new feeling of safety was so antithetical to their identity within the family that it created a crisis that they could only resolve by terminating immediately and unexpectedly, reenacting their core trauma of abandonment. In this case, terminating therapy is a part of therapy to exercise a free choice, not its end.

2. Oftentimes, when the client starts to feel better, the progress is accompanied by a fear that the symptom will return. Here we are dealing with a basic mistrust in oneself and the world - a fear that the world will not let you keep what "it hath given". This fear becomes the new target in therapy. Even though the client might decide to graduate from therapy, it is highly advisable to continue in this case and to work with these newly found fears and what they connect to in one's life.

3. Discovering the depth of the problem might scare a client and cause a desire to terminate. Talking about a problem helps uncover its depth, and sometimes it is deeper than we thought. This discovery is not unusual in therapy. Sometimes the client's first temptation is to stop here and end it. "Wow, so I'm that depressed? Better not look into that. I'll just take medications without therapy." However, discovering the depth of the problem means that you're moving in the right direction in therapy, because you have finally reached a real understanding of the problem. (Read my article about 6 common fears about starting therapy
https://www.psychologytoday.com/us/blog/the-psychology-of-relationships-and-emotional-intelligence/202406/6-common-fears-about)

4. Silence. You, as a client, no longer know what to talk about in sessions (but still feel you need help). For psychodynamic therapists, especially psychoanalytic ones, this is less of a problem than it may seem. Sigmund Freud said already at the beginning of the 20th century that analysis (the only available form of therapy back then) is hard and resistance accompanies it. Silence is one form of such resistance, so we address what hides behind it: are you really out of subjects and we can start bringing our process to an end, or perhaps you feel like talking about something but found an issue that you don't know how to approach, you're dealing with something psychologically very early and preverbal, therefore words fail you, and so on.

5. Haste. Another resistance is rushing things. Just as clients want to get rid of the symptoms or reasons that have brought them to therapy, naturally many of them think that rushing the process will make it faster. And rushing to end therapy is a part of it. Sometimes we, as clients, might feel like children in the backseat: "Are we there yet? What about now?" Therapy is work, sometimes hard work. You can't take it in stride. So, if you are prepared for it and have some imagination of what you want from it, it reduces the chances of unilateral untimely abruption of therapy. Sherman & Anderson show in their research (4) that being able to explain why you need therapy and imagine your goals reduces preliminary dropout by half.

6. Needing ongoing support. Many people are shamed for needing therapy as support. As support does not bring much in terms of measurable results, it has a negative stigma among some therapists and insurance companies, and especially in the client's family and social circles. It's not uncommon to hear: "My friend has gone to therapy for 7 years and I see no change." Or: "You spend our family budget on private therapy, it clearly doesn't help you. We could use this money somewhere else". For some people, therapy is the only place of safety where they can be themselves and talk about whatever, and they value it more than substantial changes.

Moreover, some of these clients can be depressed in a non-obvious way, so they don't have the energy for a change. As they gain more confidence, the subject of depression would emerge along with the answers on how to address it, so that energy appears. The negative stigma of long-term support therapy and its value as a safe relationship with the therapist which reflects the developing safe relationship with themselves, to trust themselves more and accept themselves for who they are might bring a unilateral - unfortunate - abruption of such therapy.

7. Hunsley et al. (2) interviewed almost 100 clients and their therapists after therapy termination. They found a mismatch between the client's satisfaction with reaching their goals in therapy and therapists' awareness of such success. This means that therapists need to bring up the subject of satisfaction and success in therapy more. Another mismatch was found between the client's unvoiced dissatisfaction with therapy and the therapist's awareness of such dissatisfaction, which also means that therapists need to bring up the subject of dissatisfaction and disappointment in therapy more.

Conclusion:

Råbu et al. (5) found that the most successful endings in therapy surprisingly come not from attaining presented goals, but from a shared feeling of readiness to complete therapy. Sticking to the Winnicottian principle of "good enough" as opposed to a perfect outcome and discussing the decision to end therapy with your therapist builds confidence for life after therapy ends and makes it a resourceful and positive process. Therapy is a multi-layered process. To prevent premature abruption, discuss your decision to end with your therapist. Talk about your successes as well as your disappointments. Have therapeutic goals in your mind and discuss them too. And allow yourself to have the right therapy and therapist for you. Then its ending will also be right.

Bibliography:

1. Freud, S. (1937) Analysis Terminable and Interminable. International Journal of Psychoanalysis 18:373-405
2. Swift, J. K., & Greenberg, R. P. (2012). Premature discontinuation in adult psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology, 80(4), 547–559.
3. Hunsley, J., Aubry, T. D., Verstervelt, C. M., & Vito, D. (1999). Comparing therapist and client perspectives on reasons for psychotherapy termination. Psychotherapy: Theory, Research, Practice, Training, 36(4), 380–388.
4. Sherman, R. T., & Anderson, C. A. (1987). Decreasing premature termination from psychotherapy. Journal of Social and Clinical Psychology, 5(3), 298–312.
5. Råbu, M., Binder, P. E., & Haavind, H. (2013). Negotiating ending: A qualitative study of the process of ending psychotherapy. European Journal of Psychotherapy & Counselling, 15(3), 274–295.