Here’s what the relationship between a therapist and a patient should be: compassionate. Accepting. Challenging — to the point of painful, sometimes. It should be a space where you can air your flaws, where you feel free to talk about yourself practically nonstop without worrying about the person on the other end of the conversation.
Here’s what it shouldn’t be: infinite. As I’ve reminded patients, my job isn’t to make them dependent on me. It’s to help them reach a place where they don’t need me anymore.
But quitting your therapist isn’t as easy as quitting, say, your accountant or dentist — cutting ties with someone who’s repeatedly listened to you spill your guts can be an uncomfortable prospect, or even a frightening one. And many people seek out therapy in the first place to deal with issues related to attachment and loss, which can make it that much harder to excise someone from your life. Still, like therapy itself, ending things can be a huge opportunity for healing and growth. The trick is to know when to do it, whether it’s because things aren’t working out or because it’s just time to move on.
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Sometimes, the signs are obvious, like when your therapist clearly isn’t the right fit for you. Research has shown that a positive “therapeutic alliance” is crucial for treatment success. This doesn’t mean that you need to have a ton in common with your therapist — you don’t necessarily have to laugh at the same jokes or understand the same cultural references — but it does mean that they need to understand you and your thought processes. After the first couple of sessions, you shouldn’t have to keep laboriously explaining yourself or rehashing the same details. When it’s a good match, your therapist remembers things that are important, and never insists you do something that doesn’t fit your values.
That was the red flag for one of my patients, who explained at our first session that she’d left her previous therapist after they kept insisting that she go on a diet. She was comfortable with her size, but the therapist seemed convinced that she wouldn’t be happy unless she lost weight. “When I found myself editing some of my stories because they involved eating meals I knew she wouldn’t approve of,” she recalled to me, “I knew I had to leave.”
There’s also such a thing as meshing too well, and it can be equally problematic. No matter how well you feel like your therapist gets you, you shouldn’t leave an appointment feeling like you’ve had a great time venting about your co-worker’s latest misstep, or like the biggest takeaway was that you learned about a great new Peruvian restaurant. Being comfortable with your therapist is great, but it should always be a different kind of comfort than what you feel with a friend. If you are my patient, I will not be your Facebook friend, take a phone call during a session, or share personal details unless it’s something that can help you cope with a trauma (i.e., yes, I know what it’s like to have a parent with Alzheimer’s).
It’s no big deal if sessions occasionally veer off into unproductive chattiness. But if you’re no longer being challenged to delve deeper into the issues that brought you to therapy in the first place, it’s time to assess why: Are the two of you treading water because you need more time to build enough trust in your therapist to drop to a new level of sharing? Or have you already milked this relationship for everything it can offer you? There’s no shame in realizing that perhaps you need someone with a different perspective, or that you might benefit from switching to a new therapeutic orientation (like going from psychoanalysis to cognitive behavioral therapy, a short-term treatment that teaches skills to deal with a mood or anxiety disorder).
But even the therapist-client relationships with no red flags — even the healthiest, most productive ones — likely should eventually come to an end. In the first session or two, you and your therapist hopefully discussed treatment goals. Perhaps you sought help to become more assertive, or finally understand why you keep getting into disastrous love affairs, or to grieve the loss of a loved one. These treatment goals are just that: goals to be achieved.
Some people benefit from open-ended, long-term therapy — especially people battling chronic issues like depression or grappling with early abuse or trauma — but for the most part, there will be an end point defined by the progress you’ve made. Maybe you’ve reached it when you notice a decrease in symptoms, or when you find yourself able to use new coping skills in triggering situations (both of which, research has shown, are commonly cited reasons for ending treatment).
That’s not to say that an ending has to be forever. Sometimes, patients of mine who have met their initial goals stay in or return to treatment to work on new ones. And graduates know that my door is always open for check-ins. But being able to openly discuss why you want to leave is a mark of progress in itself — it’s a transition to a healthier way of communicating that you can carry over into your real life.
At a closure session, my patients and I will discuss what was learned in our months or years together, and how to make sure that the patient has the tools and confidence to keep their progress going on their own. Sometimes, I’ll try to suss out if the reason they want to end treatment is an unwillingness to discuss certain topics; if that’s the case, I might recommend continuing, rather than quitting as a way to avoid addressing something painful.
For the most part, though, I just feel a sense of bittersweet pride: It’s always sad to lose someone I have come to know and care for, but I’m also deeply touched to have had a positive impact on someone’s life. The best piece of advice I have to ease your mind: If we’ve done our jobs right, we want to see you go.
Sherry Amatenstein, LCSW, is a New York–based therapist and editor of the anthology How Does That Make You Feel? True Confessions From Both Sides of the Therapy Couch.
