How to as gracefully as possible switch therapists

September 9, 2016 11:57 AM

My shrink, for reasons below the fold, is not working out. Given that I'm being treated for anxiety, it may come as no surprise that this makes me EXTREMELY ANXIOUS. Looking for mental handholds to get through as well as maybe a graceful way to phrase the need to exit.

I have a long-term relationship with my shrink, who has been excellent in many respects. However, I've been ignoring signs for a while that he may not be the best choice (namely, falling asleep a lot). Today he showed further signs of maybe not the best choice (namely, getting pretty perturbed with me when, as far as I can examine, I didn't act outside the bounds of propriety).

I'm speculating that physical issues on his part relate to the above. I know that sounds ableist AF, and some readers may remember I'm disabled myself. I'm therefore inclined to overlook the dozing off, when I shouldn't, but when he got frustrated with me today, well, it really stressed me out and was sort of the tipping point.

First off, the prospect of finding a new person fills me with dread. So my question here for you all is this: were you, like me, in a situation where you grew to depend on regular therapy and you found your therapy disrupted? What did you tell yourself to help you calm down? How did logistically you find a new therapist?

Second off: Is there a graceful way to end this therapist relationship? I really don't know what the diplomatic version of "You're falling asleep and biting my head off. I can't even anymore" is. I totally grok that I need to prioritize my mental health over nuances of courtesy, but having some sort of exit plan that doesn't involve insulting a man I've grown to really respect will help address my overall stress about the situation.

The situation is exacerbated by my at the moment crazy work schedule, which makes putting significant time into a new therapist search difficult until December.

THANK YOU

posted by angrycat to Health & Fitness (15 answers total)

I can relate to this, and I've had to do it a number of times.

Be utterly no-nonsense and businesslike about this. Look, the therapist works for you. Whatever your history together, this is actually NOT a person you need to please, and you won't die without their approval. If you had a contractor whose job was to fix your roof, and they were falling asleep on the job, what would you do? I'll bet you'd be kind but firm and let them know the relationship wasn't working out for you, you no longer needed their services, or any other way you could think of to put it.

If it's important to you to be diplomatic with this person, then do that. If I had a therapist who did to me what yours is doing, I wouldn't even pay for another session. This is egregious malpractice. In a nutshell, I would:

1) sever the relationship by phone or email, no need to come in and chat or explain anything, and
2) report them to the state board of behavioral health in your location.

You started therapy because you needed help. You're ending it now because you're not getting the service you've been paying for. Screw this therapist. Start taking care of yourself. And the best of luck to you!
posted by cartoonella at 12:10 PM on September 9, 2016 [1 favorite]

Can you do this via email? Maybe that is passive-aggressive of me but that is how I handled the anxiety of ending things with my therapists. My basic template for the email was:

Hi [therapist!]
Thank you for helping me for the past [x] years in working on my [condition]. You have really helped me identify my needs around [blah blah blah] and how to handle [blah] more effectively. I have decided to move on from our therapy sessions and pursue other modes of treatment. If I find myself in a situation where I need more assistance with [condition] you will be the first one I reach out to. I understand that you may not have availability at that time, but will stay in touch just in case.

Regards,
[me]

I suppose if you wanted to provide specific feedback about falling asleep and biting your head off during sessions, you could add that, but I choose to just keep my farewell emails neutral unless pushed for more info.
posted by joan_holloway at 12:12 PM on September 9, 2016 [1 favorite]

Oh yeah, if you have his email, use that. I've done that.
posted by radioamy at 12:20 PM on September 9, 2016 [3 favorites]

Yeah, you don't need to pay him hundreds of dollars to tell him that you don't want to go there anymore. If he doesn't have email, leave a voicemail.
posted by grouse at 12:28 PM on September 9, 2016 [4 favorites]

The situation is exacerbated by my at the moment crazy work schedule, which makes putting significant time into a new therapist search difficult until December.

"Dear Therapist,

My god, my schedule is insane and I do not have time for therapy right now. I am going on therapy hiatus for the foreseeable future.

Best Regards
Cowards Way Out To The Max, fuck dealing with anxiety."


If/when you decide to resume therapy, get another therapist at that time.

When my therapist moved, I declined a referral because the idea of starting over and retelling my epic tale of drama just made me feel exhausted. I continued to journal, but I stopped doing therapy and it was nice to stop wallowing in my self image of broken loser and victim. I began getting my head out of the past and more into the present and future and it was a good thing.

Best.
posted by Michele in California at 12:49 PM on September 9, 2016 [5 favorites]

Dude, you probably wouldn't hire a blind person to counsel you on color choices. I mean, you might try it for a while, since there's some science behind color combinations, and people make creative adaptations, so it might be actually awesome, but if it's not working for you, please feel no guilt.
posted by amtho at 12:53 PM on September 9, 2016

My best friend is a therapist and people ghost all the time. You can do that.

If you want to be nice, send a note by snail mail, "I just wanted to let you know I won't be coming back."

With snail mail you don't have to stress about getting a response.

You can also continue to see them while looking for someone else if it would help. And you can do that without telling them.
posted by orsonet at 12:56 PM on September 9, 2016 [3 favorites]

Falling asleep? Just no. Frankly, I wouldn't waste time giving him reasons since you are not negotiating.

Dr. Sleepy,

Upon reflection, I have realized that our sessions are not productive for me. I'm pursuing alternative options, and xx/xx/xxxx was our final session. Please cancel and future appointments you may have scheduled.

Best regards,

You can write that note now and save it while you find a new therapist.
posted by 26.2 at 1:25 PM on September 9, 2016

This has nothing to do with being ablist: One of the few undebatable, across-all-modalities things that your therapist owes you is their attention.

IF his physical issues are causing such sleepiness that he falls asleep in sessions, it's on him to address that, by acknowledging the issue to the patient, apologizing, and either fixing whatever the root issue is, or deciding to take a hiatus from having people's emotional lives in his hands until he can remain focused on each client throughout the session.

This is the type of thing that should be reported to his governing body, after you've resigned as his patient.

I agree with folks that there is no need for a confrontation with him. A generic email is sufficient. You could also start vetting new therapists online as well, so it will be easier to ask the tough questions that will help you determine compatibility. There are tons of online search engines for mental health care, that allow you to search by location, modality, gender, experience, and on and on.
posted by mysterious_stranger at 3:17 PM on September 9, 2016 [1 favorite]

I think someone falling asleep in session is really a massive red flag and that you should feel free to move on.

However, depending on how invested you are or how you think the therapist would respond, you could call him on it.

I posted a question here a while ago. A lot of people told me to leave my counsellor. I seriously considered it. I left my counsellor a message. Counsellor was good about it and offered up extra support and to even help support me through choosing another counsellor. But I decided to try something else (also recommended by some Mefites) and to see what would happen if I called her on her crap. In the end, she ended up seeking advice from other counsellors and doing a ton of personal professional work to look at how she'd handled things. She recognized and validated how it had affected me and she apologized. And still offered to help me figure out whether I wanted to stay or go. More surprisingly, she realized she had never considered my argument in full and that she had been caught up in the modality she was using, with it never occurring to her that, in my view, she did not have informed consent and was acting unethically. She ended up completely changing how she was approaching therapy with me and I have gone on to make a lot of therapy gains. It also helped me to see that some things -- even very painful things -- can be worked through. But I also know that, if I went there tomorrow and said I wanted to leave, she would support and validate that and offer to connect me with other therapists and would also not push a client retention agenda on me.

But she does not fall asleep in sessions. She actually has attention so focused that she stuns me by remembering the name of some fleeting person in my story.

I had another therapist who I went to on again, off again. I ghosted her, basically.

Another therapist, I emailed and said I thought I needed to take a break. She just wrote back that it was no problem, feel free to come back anytime.
posted by Chaussette and the Pussy Cats at 4:38 PM on September 9, 2016

Dear Dr Freudenap,
I've benefited from our sessions immensely and thank you for your insights and patience. I realised it was time for me to explore other therapeutic options when I started to worry for your welfare when you fell asleep and were sometimes irritable in our sessions. In no way has it undermined the usefulness of our past therapy, but it is time for me to move on.
I am very grateful for all your expertise and support over this time. Please take care of yourself.

Sincerely,
Angrycat
Via email.
posted by taff at 5:06 PM on September 9, 2016 [3 favorites]

Speaking as a therapist, they fall asleep on you?? Ack. No.

People ghost, yes. You wonder why, you hope they're OK, you live.

Ideally, someone says "this isn't for me right now. I've gone as far as I can for now." You have a conversation as to why. You both learn something. Maybe about saying the unsayable you wouldn't say to civilians in real life. You both grow, you live. No hard feelings.

Really, it's ok. If it's not working it's not working, and ending a not-working relationship in an open and upfront way is a success all by itself. The therapist will not be hurt (and if they are they can take it to supervision). You are your priority. It's ok. Good luck.
posted by billiebee at 6:51 PM on September 9, 2016 [4 favorites]

A therapist falling asleep during the session, let alone multiple sessions, is not being a competent therapist. If it were me, I'd send an email, or if phone was the only option, call during a time he'd be unlikely to answer, and say that I need to cancel my next session and thanks for the help, but I"m going to take a break from therapy for a while.
posted by lazuli at 8:06 PM on September 9, 2016 [1 favorite]

Therapist here. I've had many clients over the years decide that I wasn't a good fit, and very, very rarely did I ever take it personally (unless it was kinda personal, like one time, specifically because of my appearance.) I very often tell my clients, "Just like you aren't going to fit with every person you meet, you won't fit with every therapist, because we're just humans, too. Even if it's been a long time, relationships can change and it's ok to move on or try someone else if our therapy isn't helping." And I can assure you, I really do mean every word.

It's always okay to be done with therapy. It's your life and your choice, and, PS, falling asleep in session is one of the most unprofessional things I think a therapist can do, as our presence and ability to attune to the moment is where all good therapy is born.
posted by fairlynearlyready at 11:35 PM on September 9, 2016 [4 favorites]

Also as a therapist. Billiebee and fairlynearlyready are spot on. You've good reason to move on and you don't need to feel any guilt (or need to explain).
posted by HuronBob at 10:49 AM on September 10, 2016 [2 favorites]