Help me understand termination of therapy.
November 24, 2017 7:57 PM   Subscribe

I was extremely successful in therapy for 13 months, and terminated about two weeks ago. I have very mixed feelings about it. Help!

Preface: My therapist and I worked extremely well together. When I first went in for therapy, I was asking for help being more organized so I could stop making my ex angry. A year later, I have left my physically abusive spouse, moved out, negotiated a divorce & custody agreement, been working full time after being a SAHP for 7 years, managed PTSD from rape, etc. I couldn't have done it without therapy. Having a space that was about listening to me, understanding my needs, and validating my perceptions --- this allowed me to start acting like I matter.

DEE DEE DEE DEE: An early inkling of the problem showed up in April - month #1 post-separation, month #1 of starting my job. My therapist had to skip a week. I was stunned to find how difficult it was for me to get through the extra week. We had skipped several weeks before without any problems. Therapist said, "It's natural, totally normal." He also said, "If it will help you feel less dependent, you can stop emailing me between sessions." (I only ever emailed at his request - homework or whatever - and never more than once between sessions, but I did always feel reassured and grateful of the contact.) I felt a bit pushed away when he said this, but it wasn't a huge deal.

Countdown:

Fifth-from-last session: September. My ex was threatening a custody battle, it was an insane time. I got the sense that my therapist was moving towards wrapping up therapy. Among other things, he would repeatedly say, "This process is about helping you regain your sense of independence." It kind of blew my mind, because I've never had trouble feeling independent. It made me feel like he was telling me to stop bringing him my issues. He said, "Oh no, that's not what I mean.." I asked him straight up if he thought we are done with therapy, and he said, "Termination is a conversation we will eventually have, but right now I see no reason to end this."

Fourth-from-last session: Late September. Therapist continued to say the same thing, in spite of our conversation the week before. After the session I cried and cried. I couldn't escape the sense that he was pushing me out the door in the middle of a crisis.

Third-from-last session: October. I forced myself to tell him that I still felt he was still trying to wrap up, and it was making me feel I have to be on guard. He said he definitely didn't intend to push me out, but at the same time, he doesn't want me to be afraid of termination. I told him I just need to know and be prepared if he does think we're done. He said, "I have overarching goals, of course, but no fixed plans. I'm not a mastermind. This is a shared process. You do have power here."

Second-to-last session: Late October. My legal crisis was over but I was somewhat depressed (crying, can't get out of bed). And I decided to take my therapist at his word: I stopped worrying about termination. It's not like it would be the end of the world. I've still made the progress I made even if he kicked me out next session. When I told him this, he said, "Hmm, it sounds like you're afraid I'm going to unilaterally bail on you."

Last session: November. I mentioned that I was emotionally exhausted from everything that's happened over this year, I wish I could take a break from the nonstop madness. And he says, "That's very interesting. That might actually be good for you. You've done a lot of work, you've been through a lot, you should pat yourself on the back. I think a break will do you a lot of good. Where do you think you are on that issue? How do you feel about taking a break from therapy?" I was stunned. I just couldn't bring myself to say anything except, "Sure, that's fine." And then we spent the rest of the session saying goodbye. Warmly. He said he admired how determined I am, and what a pleasure it was to work with me, and I said I was very grateful for how much he has helped me. The end.

What happened, you all? Was this normal? Is this how it's supposed to work? On one hand, I'm okay.... I just feel like I've moved to a new city or something, a bit dazed and sad about leaving a familiar comfort behind, but not in crisis. But also I do truly feel jerked around. I got very mixed messages. And that makes me angry. It was such an unsettling end to some very good work.

My therapist said I could return to his office anytime I want, but I just nodded and smiled. I would never go back to him. I would be much too worried that he will shove me out the door again, and what if he does it in the middle of a crisis next time? I just don't know how to advocate for myself when it comes to this issue. I am deathly afraid of imposing or coming across as needy.
posted by MiraK to Human Relations (17 answers total) 2 users marked this as a favorite
 
It sounds like a communication issue. You feel pushed out but he never said you had to quit. Get back into therapy ASAP and tell him you’re not ready for a break.
posted by Rock 'em Sock 'em at 8:26 PM on November 24, 2017 [8 favorites]


I'm sorry this happened to you. You should not feel pushed away or jerked around or railroaded into termination by your therapist. I've been in therapy for almost twenty years and I've never had an experience like this. I have always been the one who initiated the termination process.

Importantly, you are in no way imposing on your therapist by telling that person about your feelings, especially your feelings about whether you wish to continue therapy! Remember that although this is a special kind of product you are buying, you ARE the buyer. Your therapist isn't doing you a favor by providing you with therapy.

Find a new therapist. Tell your new therapist about what happened here and how it made you feel. Best wishes - I hope your next therapeutic experience is a more positive one.
posted by sevensnowflakes at 8:26 PM on November 24, 2017 [9 favorites]


My therapist is taking some time off during the holidays, so we’ve been having a lot more explicit conversations about our relationship. I find myself doubling down on all my defense mechanisms almost instinctively because of course I can only rely on myself..

He also says that it sounds like I’m worried I will be unilaterally abandoned, and that time apart can also uncover trauma we might not otherwise talk about. I’m often suffering cognitive dissonance by always feeling independent, but also uncomfortably vulnerable in relying so heavily on my space in therapy.

I’m a bit frustrated that this is a pattern. I did this last time he scheduled some vacation. But a lot of therapy is repeating patterns and becoming more aware and less beholden to them over time.

Our conversations haven’t led to a miscommunication like yours. But I could see it happening. Therapy can bring a lot to the surface so it’s a balance of safe space and hard work. It’s really unfortunate you didn’t feel safe to correct him that taking a break didn’t include a break from him.

I would encourage you to go back at least once more. One of my biggest breakthroughs was getting back on track in therapy and having my therapist apologize for not quite hearing me. Maybe it won’t be enough to repair the relationship in your case. But I think it could be incredibly healing to understand why this is so intense for you.
posted by politikitty at 12:21 AM on November 25, 2017 [2 favorites]


Thanks everyone. I am curling up into the world's most intense cringe at the thought of returning, even once more, to my therapist and being honest with him about this. I tried, you know? Every bit of what I wrote here, I TOLD him... except for the last part. Either he just couldn't hear me when I talked about this, or he just isn't the kind of therapist who deals with these issues. (He's a trauma-focused CBT guy and I think this is all psychodynamic work?)

But I now think I will find a different therapist. I've been wondering whether this is a standard way to terminate and if so I'd rather about therapy altogether. But it seems like it's not necessarily so?
posted by MiraK at 5:40 AM on November 25, 2017 [3 favorites]


I'm not sure what to make of this. One the one hand, he asked how you felt about quitting and you said you were fine with quitting. On the other hand, he knew you were anxious about being pushed out of therapy and then kind of pushed you out. I can read this as him thinking you wanted to quit and I can read it as you correctly picking up on signals that he wanted to terminate and him denying them for whatever reason.

You can make a one-time appointment with another therapist to talk this out and get some perspective. I've done this in the past and it's been helpful.

I've been in therapy a few times and so far every termination is different. In one we agreed to terminate a few weeks prior to the termination date and had a final debriefing session. With another I went from once a week to once every two weeks to making an appointment when I felt like it - once every few months or so. With my first "real" therapist I couldn't figure out how to quit so I kept showing up week after week even though I didn't feel I was making progress at all - and I suspect he didn't terminate because he wanted the $$. If you decide to see another therapist - a good idea - it would probably be good to ask them how they typically terminate therapy at the first session.
posted by bunderful at 6:15 AM on November 25, 2017 [2 favorites]


I switched therapists this year: the first one was CBT-based and my current one has a focus on EMDR. The first was ready to continue our therapist-client relationship for months, if not years, but I felt I wasn't continuing to grow in a way I would like. She was supportive but I didn't feel she was the best match for processing trauma, which I was ready for; this is fine because different things work for different people but trust needs to be there. Both are good in their own ways, although the second is a much better fit. However, the first certainly got me to a point where I could be open to the more direct, deeper (for me) work with the second. I'm so sorry that your therapist left you feeling high and dry: breaks are normal in therapy but usually the decision feels more mutual. Your frustration is valid so, like others have said, I'd start looking for a new match.

Based on your final session with the old therapist, it sounds like you two have already tied up any loose ends. You could go back and ask for a final session but you don't have to either. I had a final session with mine where we checked in; the session before I had expressed my gratitude and explained my plan to try a different approach, which my therapist supported. Like you, it had been in the works for awhile. I got recommendations from friends, and then tried an out-of-pocket session first. It's totally normal to interview a number of therapists before settling, and anyone worth their salt with be understanding and supportive. You would want to briefly explain your therapy history like you did here as well as your goals. You certainly don't want to trash the old guy but you can summarize it in fewer words: for example, "I am very happy with the work we did together on XYZ; he has recommended a break. However, while I have accomplished those goals, I wish to work deeper in other areas and am looking for someone who would be a good fit for this next step." That may be too vague for you -- there's no need to sugar coat things but being completely negative can be a red flag to therapists. Frankly, you could just print out this post and share it with prospective matches after asking your initial questions if you're feeling a good vibe. I wish you luck, and I hope you can feel more support from other sources while you look.
posted by smorgasbord at 6:52 AM on November 25, 2017 [1 favorite]


The level of intensity you’re feeling about this indicates that it’s a real issue you need to work on in therapy. You are feeling cringey but I think that this therapist is not intending to humiliate you. Rather, it sounds like he thinks you’re taking a break (not terminating) which you’ve been okay with before. You’re feeling rejected and having a really hard time with it and that’s understandable. But it sounds worth working through this with someone who has been trustworthy and caring.
posted by Rock 'em Sock 'em at 7:13 AM on November 25, 2017 [3 favorites]


That sounds odd on the therapist's part, and if I were the client, I would read it as him trying to end things for his own reasons (Trying to pare down his practice? Trying to open up a slot for someone else? Planning on going on a long break and feeling guilty about leaving clients alone? Starting to feel in over his head with you? I don't know) rather than yours.

A year later, I have left my physically abusive spouse, moved out, negotiated a divorce & custody agreement, been working full time after being a SAHP for 7 years, managed PTSD from rape, etc.

Good lord, you've been through a lot! These are not small issues, they do not have small repercussions, and I cannot imagine a year is enough to process all that. Given how much you've accomplished behaviorally (for lack of a better word) in therapy, I wonder a bit if this therapist is great with the big behavioral changes but maybe less so with the emotional processing aftermath (especially since the issue you came in with was more of the "getting organized" variety). If it were me, I'd be looking to start up with a trauma-focused therapist with experience and training in working with survivors of intimate partner violence and sexual assault. (A lot of therapists say they do that work, but I'd want one with actual training and experience doing that work.) You deserve support right now, and I'm sorry this therapist left you feeling unsupported. That's on him, not you.
posted by lazuli at 7:50 AM on November 25, 2017 [7 favorites]


I've been wondering whether this is a standard way to terminate and if so I'd rather about therapy altogether. But it seems like it's not necessarily so?

And no, this is not a standard way to terminate therapy, because it doesn't sound like he was at all attuned to your needs. It would have been standard if you had been at the stage he was projecting on you -- independent, doing things on your own, not needing him anymore -- but you weren't there, you told him you weren't there, and he didn't hear that for whatever reason, which like I said, is more about him than you.

Therapists cannot help people with emotions or traumas the therapist hasn't dealt with themselves -- not in the sense of "You must have been raped to help clients deal with rape" but in the sense that a therapist who hasn't dealt with their own fears or issues of dependency will get triggered by clients who are dependent, a therapist who hasn't dealt with their own fears or issues of vulnerability won't be able to let clients be entirely vulnerable, a therapist who is scared of their own anger will push clients away from their own justified anger, etc. This therapist may just not yet have done the work he needs to do to better support clients going through what you're going through. Which would not mean that you're too much; it would mean that he's not enough. As smorgasbord said, I've also found that in such situations, finding another therapist who could go much deeper with me has resulted in some amazing healing.
posted by lazuli at 8:00 AM on November 25, 2017 [15 favorites]


It almost seems like he had a pre-conceived plan for when therapy "should" end and didn't really open the conversation with you in a meaningful way to gauge whether he was right. He just started pushing you towards the door and then took the first opportunity to make the final push when you were talking generally about needing a break from the nonstop madness and stress of the year. I mean, what?! It's like a cowardly break up.

Long term therapy would be great for you as a support and to process everything that's happened. You have a history of severe trauma and that doesn't get resolved in a year or two. Find a new therapist and do that work with them. Tell your new therapist about this termination and how it went down. What your last therapist did sounds really off and you shouldn't feel like it was because you're not a clear communicator or you misunderstood cues.
posted by quince at 10:01 AM on November 25, 2017 [8 favorites]


Yup, go find another therapist. Sounds like this one was really good for you until he wasn't. And that sucks but there are good therapists out there and you have done amazing, incredibly hard work and improved your life immensely but you still need that support. So go get it. Please don't be discouraged if it takes a few tries to find a good fit. I hope you are proud of yourself for all the hard work you've done. That stuff is exhausting. Good luck!
posted by Bella Donna at 12:34 PM on November 25, 2017 [2 favorites]


To my mind this guy manipulated you from the start. Your instinct not to return to him is right on.

I had a therapist who in answer to my question about how it would eventually end, said that our parting ways would be mutually agreed, and it would be positive for both of us. Fast forward a few years...The guy tells me he’s come to the end of his ability to help me. I was in the middle of one of the most chaotic and complex and miserable periods of my life. My mother was dead, my father was dying, I couldn’t find a job, my relationships were a joke, I’d dropped out of college, and I couldn’t find a reason to keep going. And he knew all this! I could not believe what he was saying to me!

I dug in my heels and said I wasn’t leaving. He was surprised, but let me keep coming to our sessions. We limped along for another year, but he had checked out mentally. A waste of time and money. If I could go back in time, I should have left as soon as he said what he said.

Therapists aren’t deities. Don’t fear the judgement of any therapist. They’re often in over their heads and can be wrong about all kinds of things. They’re just working folk, and some of them are better than others at what they do. Some therapists are jerks! If they suck, or treat you in any way that doesn’t feel right, bring it up in the session. If they can’t deal with you, if they insult you, if they blame you or dismiss your concerns, if they fail to hear you—Kick them to the curb! But don’t become bitter, just keep looking.

Audition a number of helpers. It can take a few tries. I’m pulling for you in your search :-) Oh, and congratulations on your progress so far!
posted by cartoonella at 4:26 PM on November 25, 2017 [2 favorites]


I found therapy to be deeply rewarding, and the thought of permanent termination was a concern.

I dealt with it by working through scenarios with my therapist:
1. She is still there, my needs are related to my previous needs and her skill set
2. She is still there, but my needs have changed, and her skill set is not well matched to them
3. She has moved on to another employer/situation

That was about 20% through my total number of sessions to date, on her initiative. At this point, it seems to encompass most of the likely crossroads.
posted by Caxton1476 at 5:32 PM on November 25, 2017 [1 favorite]


I don’t think you failed in any way here. I think that his behavior triggered a really deep issue that you have with feeling rejected. That is very normal, and it happens in settings where you trust the other person. It’s normal for therapists to sometimes make mistakes, or otherwise communicate things that they do not intend to communicate. Figuring out how to repair those missteps, and how to handle this kind of conflict, is one of the most useful things that you can do in a therapeutic relationship.

If you search for the phrase “therapeutic breech” or “rupture-repair” you will see that your strong response, and this issue of conflict between you two, is a very normal occurrence as part of therapy that is working very well. Given all of the positive things that you have to say about this therapist, I think that you have an excellent opportunity to use this disjunction between the two of you to continue to heal and grow.

Obviously, communicating your feelings about rejection and about feeling pushed out is something that is extremely difficult for you, and involves a lot of shame, embarrassment, feelings of being abandoned, and similar. That is completely understandable! You value this person highly, and you were very vulnerable to him. That makes dealing with perceived rejection very hard. This is a legitimate and hurtful emotional crisis. Your feelings are very real and they are important.

I am not at all saying that dealing with this should be an easy process. Rather, I am saying that these are issues that are likely to continue to come up in your life, and that addressing them in this situation, with someone you trust and who, despite this current conflict, has your best interest and safety in mind, is something that could be very positive for you in the long run.
posted by Rock 'em Sock 'em at 12:44 PM on November 26, 2017 [2 favorites]


Rock 'em, thank you for your responses on this thread. I feel unable to return to my therapist, however, because I communicated my feelings about termination to him repeatedly and explicitly - that I'd like to know in advance in order to prepare, that I have never felt capable of asking for more when someone is hinting that I should not need them - but he did not hear me. He didn't seem comfortable with talking about this, to be honest. He would only repeat that "he didn't mean it that way" or "this is a different kind of relationship," and a couple of times he even changed the subject like, "Well, let's try this. What do you want your next year to look like?"

Early on in therapy, when I had struggled with whether or not to leave my marriage, and started feeling like he was getting impatient with my inability to decide, he'd very deliberately made room for my process by saying some pretty empowering things. "Let's leave what *I* think about your marriage outside this room," and "This is YOUR narrative and YOUR decision." He had probed, asked questions, helped me process the contradictory feelings, etc. But in this case it was like he shut me down at every turn. I took risks repeatedly in spite of the signals I was getting but every time I tried to talk about my weird feelings about termination, he repeated the same two things and expected me to figure it out? Or something?

Anyway. Long answer. I think I just got into an area he did not know how to handle. It doesn't discount the work we did but I don't see why I should subject myself to the same sense of feeling shut down again which I fully expect.
posted by MiraK at 3:10 PM on November 26, 2017 [2 favorites]


Right. I don’t want to discount your feelings here. You feel let down and disappointed. You feel that he failed you at a time when you needed him desperately. And, because he has been skilled and successful in the past, you feel like his failure is not an accident, but instead, reflects a lack of will on his part; a lack of effort to fulfill an implicit promise he made to be there for you and do a good job as your therapist.

I think it’s great that you are taking steps to protect yourself against someone who seems to be behaving in a way that is careless with your vulnerability and trust.

My suggestion is not intended to discount your desire to protect yourself. Rather, I think that you asked third parties about this because you (wisely) feel that there is some ambiguity here. In reading the post, from what you are telling me about his warmth, positivity, and the things he’s helped you with in the past, and from what you report him saying, I think that it’s still okay to trust him. Nothing here reads to me like he is being manipulative or predatory or purposely trying to harm you. That doesn’t mean that he’s perfect! But what I see is that you are really hurting and from what I read here, you could really benefit from his reassurance, ongoing support, and—importantly— an acknowledgment of & correction of his mistakes.

And, in the long-term, since every intimate relationship suffers from disconnects and disappointments, this could be a useful way for you to experience healing and repair (or, at the very least, an acknowledgment of the disconnect that feels mutually respectful and emotionally tolerable).

Ultimately, I think you are a strong and self-aware person and I respect the level of thought and sensitivity that you are bringing to this. I hope that whatever you decide to do works out well for you!
posted by Rock 'em Sock 'em at 3:51 PM on November 26, 2017 [1 favorite]


I "ditto" almost everything that's been posted above, and just want to briefly add a couple of additional comments.

I don't see this as you being needy so much as need-ful. It sounds like your therapist acted ethically, *and* also like he's perhaps a bit less attuned/intuitive/empathetic than you would like.

To be fair, and I'm going to be blunt here, in your description you also gave mixed messages, which even therapists can fail to pick up on and address.

You say you felt shut down and that it's difficult for you to advocate for yourself. An excellent place to practice and hone those skills is in the therapy room with a trusted therapist you have done good work with. If the 13 months were very successful, it could offer both of you some really valuable growth and development to address this together.

Finding a new therapist is an equally valid choice.
posted by dancing leaves at 8:49 AM on November 29, 2017 [1 favorite]


« Older Is this half a turkey done for?   |   How can I subscribe to this Google calendar from... Newer »
This thread is closed to new comments.