What is the natural end of a therapy relationship?
November 3, 2017 4:27 PM   Subscribe

How can you tell when the natural end of a therapy relationship has been reached? How much ongoing maintenance is needed? What does that look like? Snowflake: young child.

My elementary-school-aged child has been seeing a therapist for about a year for some issues related to generalized anxiety. They have made huge strides in that time, and their current teacher has said that she has hardly seen any of the behaviors that were 4-6 time per day lesson-enders for much of last year. We still see those behaviors occasionally at home, but it's vastly improved. It's a slam dunk, really: they are now able to express worries and ask for help before imploding, they feel safe trying things that look difficult and so are catching up academically after nearly a year of plateauing, no one is walking on eggshells so they're making more friends at school. They're their same delightful self but better. They're definitely happier. The successes have built other successes. Great!

Child was seeing the therapist weekly until mid-summer, and every other week since then. I had a note from her this past week that mentioned that she checked in at school and that Child seems to be doing well, and that we should check in with her at the next appointment. I'm thinking that we're at a sort of natural reassessment point; we went to her with an issue that has largely resolved, and it might be time to move on.

But what does "moving on" look like in this case? The child themself LOVES the therapist and would happily continue to go weekly forever, and from observing friends and family members who struggle with anxiety, I certainly don't think that Child is forever cured. On the other hand, right now they seem to be doing very well, and I can't help but feel like we're taking a "slot" from some family that's really struggling (we had a difficult time finding a counselor that had openings, and as you can see she's done amazing things for us.) Is there some in-between? Quarterly mental health checkups? Keep the therapist's number on hand for occasional issues that pop up? What's typical, or expected? I haven't had any experience with therapy, and my co-parent has had only a negative "this isn't working" type of ending.

(other possibly-relevant info: Child is not taking any medication. Therapy style is play therapy and is very open-ended. The cost is not a concern, but more family time would be nice.)
posted by anonymous to Health & Fitness (6 answers total)
How was the transition to fortnightly appointments? Could you scale back to monthly, then quarterly?

This is a good question to ask your therapist. :)
posted by freethefeet at 4:43 PM on November 3, 2017 [3 favorites]

For the most part I ended therapy when I felt I had to the tools to manage the problem I'd identified with the therapist at the beginning of treatment. Perfect practice was not required so long as I understood the reasons for my failure to do whatever it is I was supposed to do when I failed to do it. Some therapists will allow you preference over completely new patients if you need to return for a tune-up, so you should ask your therapist about that.
posted by xyzzy at 4:56 PM on November 3, 2017

If this were me I would go with the monthly then quarterly thing and continue it indefinitely. It bothers me that mental health needs are so secondary to say, dental needs. Check ins are good! I wish it were the kind of thing that we all did and didn't warrant a second look. Maybe ultimately every six months would be great and I wish were just a normal thing, especially for those of us who are vulnerable to anxiety and/or depression. I can't think of any downside to doing this for my kid, especially considering kid seems to love it.
posted by A Terrible Llama at 5:28 PM on November 3, 2017 [5 favorites]

I mean I think the glib but also accurate answer is when you don't think child is seeing meaningful benefit, informed with input from child and therapist.
posted by PMdixon at 10:18 PM on November 3, 2017

If cost isn't an object, why disrupt an important relationship in your child's life as if it's meaningless? To you it looks like a doctor's visit but to the child it looks like closeness.
posted by Obscure Reference at 5:16 AM on November 4, 2017 [1 favorite]

As a therapist (though not one that works a ton with kids), my job is generally to help clients transition the relationship they're having with me into real-world, non-professional relationships with others and with themselves. Transitioning to less frequent meetings and then "Keep the therapist's number on hand for occasional issues that pop up" is generally what I encourage.

I also think that learning to deal with closure and endings is a very important skill to learn, especially for people dealing with anxiety -- there can be a worry of "I can never do this on my own! I will totally fall apart unless I have this exact line-up of objects/people so I must hold on to them with all my might and spend a lot of energy worrying about losing them!" It undermines resilience and flexibility, which are important for mental health. At the same time, of course, you don't want to just cut off a relationship with the therapist without there being a conscious transition. Which is why I tend to like the gradual tapering-off approach.

I wouldn't worry about whether a "more deserving" client needs the therapy slot -- that's not your job to manage -- but I do think there can be a concern about fostering dependence rather than independence if you drag the sessions out too much. It's actually bordering on malpractice for a therapist to continue seeing clients who aren't benefiting from the therapy but are just there to chat or play or whatever. The relationship with the therapist is important, but it's one that should be temporary and diminish in importance over time.
posted by lazuli at 9:28 AM on November 4, 2017 [1 favorite]

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