Guest blogger Amie Frischer Asks, "How Does Therapy End?"

Hi folks:

Some of you may remember Amie from a column she wrote at the beginning of the year on New Year's resolutions. I've asked her back to write about another topic and she graciously agreed to conclude my series on searching for a therapist with how to finish therapy:

There are many jokes about client and therapist growing old together across from each other in the therapy office making permanent dents in their respective chair and couch, but contrary to this image, a good therapist generally hopes that eventually he or she will be rendered expendable and that the client will graduate with the tools necessary to live life without therapy.

How long does therapy last?

This question has to do with the scope of the therapy or the goals you set out to address.  Sometimes therapy is brief and targeted to address certain symptoms, cognitions, or behaviors.  Brief, cognitive behavioral therapy programs generally specify a circumscribed goal at the outset of treatment and target an end date often in the range of 12-20 sessions.   Other times therapy can more broadly and deeply encompass the exploration of one's internal experience.  This type of therapy can provide an opportunity to reappraise one’s history and how one has been shaped by the past and how one chooses to live in the present.  In this case the therapy can continue for a longer time, sometimes for many years.  The duration of therapy may also be dictated by one’s need for support or help through a transition when supports are not readily available otherwise.   Within the first few sessions, a conversation with your therapist about your shared sense of the scope and goals of the therapy will generally help set your expectations for how long the therapy will last.

Who decides when you’re done?

If you’re thinking of leaving therapy, it helps to find some clarity about why that is.  Are you not getting much out of it?  Have you accomplished what you set out to do?  Do you feel that your world will be manageable on your own?  Your therapist may also be contemplating whether the therapeutic goals have been met, whether this therapy is really helping you, or whether dependence on the therapy relationship may no longer be in your best interest.  There are a variety of reasons to begin the conversation about ending treatment, and ideally, whomever initiates the discussion, the decision to end therapy is made collaboratively between you and your therapist. 

What is a good ending?

Even if you’re leaving therapy because it isn’t the right match or is not helpful, there is much to gain from a direct and honest goodbye met with acceptance and kindness.

If therapy has been a good experience, leaving your therapist is bound stir up a mixture of emotions.  Ending therapy heralds a success and the feeing of capacity to move on and engage in the world in a healthy way, but it also means losing a relationship that may mean a lot to you.  Anxiety, anger, sadness, and a myriad of positive emotions can all be a normal part of a good ending.  

Why say goodbye?

The scope and goal of any particular therapy can vary enormously, but psychotherapy outcome research tells us that successful therapies all share a strong and positive relationship with one’s therapist.  In a good therapeutic relationship, whether brief or long term, trust develops through the sharing of intimate information and the relationship can take on a variety of functions: sounding board, parental stand in, confidante, and sometimes a skilled partner in navigating interpersonal conflict, but at the end of the day, when the therapy closes, there comes a time for goodbye.

Goodbyes can be emotionally difficult, but avoiding this often challenging part of the therapy with an abrupt leave-taking can shortchange you of a valuable experience with many useful applications in your life.  Sometimes the richest gains in the whole therapy happen around how to end, and having an opportunity for a direct conversation about the end of the relationship with your therapist can be enormously fruitful in modeling how to allow for change, separation, individuation, and how to emotionally manage a meaningful goodbye.

The last session:

Usually, a date for the last session is mutually decided upon in advance.  For a short term treatment the end date can be scheduled one or two weeks in advance.  For a longer therapy, there can be a tapering period of decreasing frequency toward the end date several months out.  During this period, the focus shifts from exploring new issues toward consolidating the gains already made, processing feelings about the end of the relationship, and reviewing the struggles overcome and successes earned in the therapy.

Ending therapy doesn’t necessarily have to be a big, dramatic deal and will vary quite a bit with each individual therapy and relationship.  Often there is a brief, professional goodbye, perhaps with a handshake.  In other situations, the therapy may end with tears, and possibly a hug if it is comfortable and agreed upon.

Life after therapy:

If you’ve had a good experience in therapy, you know that help and support exist, and that you can take all that you have gained with you back into your life.  You also know firsthand, that should you ever need to return to therapy in the future, a good therapist will be waiting for you.

Next week:  Josh starts an extended series on the intersection between psychology and spirituality and religion.

Amie Frischer, Ph.D., is a collaborative, solution-focused psychologist in private practice, with offices in Oakland and Pleasant Hill. She can be reached at (925) 685-9463 X11. For more information about her work please visit:  www.amadorfamilycenter.com.

Do you have a question about struggles with your partner or within yourself? Is there a particular topic on relationships or individual psychological issues you would like addressed in this blog? Ask Josh in the comments below or email him at josh@joshgressel.com.

Josh Gressel, Ph.D., is a couples and individual therapist based in Pleasant Hill, CA. Visit his website at joshgressel.com. He is accepting new referrals.