Breaking Up is Hard to Do - November 1, 2007

Dr. Rob,

You are clearly the greatest therapist in the world, so I can't ever imagine your clients would ever want to stop seeing you.* That being said, there comes a time in every therapy client's life that she wants to stop therapy. I'm pretty much sure I'm better, I have nothing to talk about anymore in therapy, and I know I don't want to go anymore. But after every session, my therapist says "See you next week," and I don't know what to say. How do I break up with my therapist?

Carrie

* Letter edited to inflate Dr. Rob's ego

Over the past few months, we've learned that you don't Drunk Dial your therapist, verbally abuse your therapist, bring your pet to therapy, and certainly do not threaten to shoot your therapist. However, the "Therapy Break-Up" is a common and completely healthy experience. Sometimes. Let's consider this from both the straightforward and Devil's Advocate positions.

In both my training and independent practice, I've had countless clients end therapy with me, for a variety of reasons. In the healthiest, most straightforward case, a client reports increased life satisfaction, applies the tools and skills that were learned in therapy, and simply feels better. This is generally a very exciting time for both the client and me, because the goals we set have been met (I also tend to interrupt clients when I'm excited for their success, which I am working on). Consider a client who formerly suffered from Social Phobia:

Client: I started to get anxious, then remembered that my anxiety might be misleading. I did a "mental check-in," and assessed my surroundings for real danger, not just the danger I created in my head. I...

Dr. Rob: Did you practice the breathing techniques?

Client: Yes, and I...

Dr. Rob: Was it helpful?

Client: Yes, it...

Dr. Rob: What about your Flight-Fight Response?

Client: Could you just shut the fuck up for a second?

Dr. Rob: Sorry.

Client: I noticed there wasn't any real danger, just people talking to me. I realized that they it was unlikely that they were judging me and, if they were, then to hell with them. I need to focus more on making myself happy than worrying about what some strangers think about my suit.

Dr. Rob: Good for you.

Client: Sorry about telling you to shut the fuck up.

Dr. Rob: You're only the fourth person today, so don't give it a second thought.

Client: You know I don't know if I need to keep coming here every week.

Dr. Rob: I think that makes two of us.

Save for my annoying quirk, that was likely painless for the client. In this scenario, I might recommend the client come in for periodic "booster" sessions, maybe once a month for three or four months, just to make sure he is staying sharp with the therapy tools. A good, albeit imperfect rule of thumb for considering ending sessions is when a client has worked very hard on a problem, has demonstrated progress, and is simply running out of things to say. If this is the case, just come out with the truth like the client above: you feel better and you don't need to be here anymore. Maybe that will change down the line and, if so, you may be back. But for now, you are done with therapy. While most therapists will be at least somewhat sad to see you go, especially if they enjoyed working with you, your improved mental health always overrides therapists' personal reactions to your therapy completion. If it doesn't, they need to be talking about abandonment and rejection issues in their own therapy sessions.

In a different scenario, some clients are not connecting with their therapist or are not making progress that is to their satisfaction. No therapist can work perfectly with every client , and good therapists understand this. Again, honesty is the best policy here, and simply telling your therapist that you would like to work with someone else is completely acceptable. However, some clients struggle with this, and will often leave me voicemails with specious reasons so as not to deal with perceived confrontation:

I'm cured
My insurance won't cover it (I often hear this as I hold an "Approved for Services" form from the insurance company)
It's too expensive (most recently, this came from a client with a seven figure salary)
Your office is too far away
It's too cold out
My husband won't let me see you anymore
I'm moving away (I often seem to see that person a month later in the grocery store)
You are too young
You are too old
You are incompetent (commonly relayed as "you suck," or "you're an arrogant ass")
I want to work with someone with blond hair
I need a Jewish therapist
Fuck off and die

While some of these reasons are probably valid, many clients knew that these obstacles existed before treatment began, so they become suspect. I don't push clients too much on this issue, because as consumers we have a right to choose not only what we spend our money on, but also with whom. The reality, however, is that your therapist will likely see through many of these excuses, so you're probably best off just being honest.

Now, consider the Devil's Advocate position. Is it possible that you want to terminate therapy not because you are better, but because your therapist has led you down a path that is uncomfortable? Did she touch a nerve by something she said? Are you starting to talk about something painful and, therefore, possibly very important? If the answer to any of these questions is yes, then you might want to consider not bailing out at all. Again, the advice here would be to simply tell your therapist that you feel skittish about continuing, that you are unsure how comfortable you feel about the direction therapy is taking, and let him or her respond to that. Very often clients are taken aback by the emotional force they feel from a particular issue or therapy session, and their immediate response is to retreat, psychologically and physically. Very often this is not the best long-term solution, so try to let your therapist know what your stance is. He or she can likely help you navigate through these difficult feelings and decide whether or not it is truly in your best interests to continue.

Again, please do not hesitate to share your "break-up" stories in the Comments, especially if you've used an excuse that hasn't been listed. And read this for a similar take from the New York Times.

Posted by Rob Dobrenski at 2:57 PM

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Comments

I didn't make this reason up for stopping therapy with this therapist, this was the actual reason, and I told him... I had to stop seeing him because he wore Birkenstock sandals with navy blue dress socks.

Posted by: Anonymous at November 1, 2007 06:05 PM

Dr. Rob, I broke up with a therapist of mine because she led me down a *VERY* uncomfortable path that I wasn't ready to deal with. I think I may have called her "a fucking quack" and told her that I was going to write the licensing board. Hey...I was a 17 year old. I should probably apologize to her. But you're right. She was the first therapist (out of 3) who saw through my bullshit and hit the nail right on the head ("I think you're angry at your mother and won't admit it") and it pissed me off/scared the hell out of me.

Oh my gosh! Did that mean I had to deal with the issue at hand? Nope. Just continue wasting mom's money on therapy until I was old enough to mask my problem with illicit drugs and loose women. I love adolescence.

Posted by: Eric Ogunbase at November 2, 2007 02:50 AM

Mine broke up with me. I was seeing him for two months, then I called to a cancel an appointment due to another dr's appointment. He then sent me bills, instead of my insurance company, claiming they didn't pay him. This is after I spoke with my insurance and they told me he was paid. This was the last contact I had with my therapist. Ahhh new jersey, we grow them well here.

Posted by: Jessica at November 2, 2007 07:22 AM

Dear Rob,

I know this is not an advice column per se, but perhaps if you run out of content for the site or if you are feeling adventurous, you might want to provide some assistance. I think I know the answer to this question, but I love your style and wanted to know your thoughts.

My wife of nine years and I, have a seven-year-old girl who is the apple of my eye. Recently, however, my wife has had the tick tock of her maternal clock blasting in her ears that is now causing me to have a flaccid cock. For the past seven years I have been a fan of the "Don't Blow Your Load Inside" birth control method which has kept us from having another rug rat, but now that I have been bowing down to my wife's idea of having another kid I have noticed that shooting with the gun loaded has affected my libido in a very negative way. Shit, for years I have dropped my loads anywhere but inside of her.

I've told her my concerns about another child running around and the fact that since we work opposite shifts that it puts a tremendous straining on me and my other fatherly responsibilities but she doesn't want to hear anything of it and will cry and threaten reassessing our relationship. Should I be a deceitful prick and fake my orgasms to eliminate said chance for kid or just bite the bullet and shoot? Well I won't bite my own bullets, but you know what I mean.

Thanks - No More Diapers McGee

Posted by: Nore More Diapers McGee at November 2, 2007 11:55 AM

I had to stop seeing my old therapist because I was rehospitalized and when I got out, my old therapist wouldn't work with my new psychiatrist. Although the 'rehospitalized' part is probably an indication that it was time to change anyway...

Posted by: Eris at November 2, 2007 04:05 PM

I didn't even "Break up" with my shrink. I just neglected to schedule the next appointment. Of course, I legitimately didn't really *need* a shrink. "No Ma'am, I'm just stressed out because I have a lot of shit cut out to do, what with the IB Programme, and not much time to do it in--let alone to spare fun in. I'm not depressed (she thought this). I don't suffer from anxiety (she thought this); anyone would be stressed like this--especially my classmate that's going gray from it. If I am ADD like you suppose (and I don't believe that it exists to begin with; she thought this), I wouldn't take the meds anyway. I have a friend who was put on the meds, and sure, he focuses now, and he's still my friend, but he isn't the *same* friend."

That is essentially how I began an ended every session. In the middle of them, she'd spend her trying to convince me that I suffered from these orders, putting words in my mouth ("You said your parents don't support you...does this hurt you"
"When did I say that?"
"Well, I think you did"
"You *THINK* I did?") and telling me both how I feel about everything and about my "Shell," which she was apparently "determined to get through," because doing so would help me. It's not a shell, hon'. The only person I don't put up with shit from is *you*, and that's because you're getting paid by the hour to help me.

...She was (and probably still is) a terrible shrink.

Oh, and why was I going to the shrink in the first place if I was fine? She got the idea that I suffered from anxiety and depression from my mom. In the first session, she said that it was my mom that was anxious and that I was doing fine, and that was why my mom was worried about me; however, by the next three she'd forgotten this and was convincing herself and me that I was messed up.

Did I mention that she was the exact kind of person I don't like to begin with anyway? Look, if you're a shrink and you're bent on being the smiley kind, try not to make it plastic. Seriously, a plastic smile makes me want to test your limits and see how much fucking around I can do with you before it slips. It's like a challenge.

Posted by: Anonymous at November 4, 2007 02:29 PM

Thanks, Dr. Rob. My wife and I are actually talking about 'breaking up' with our therapist. He's quite good, but we've been with him for over a year and a half, and have made significant progress. Many of our sessions are simply digests of our week, and discussing anything that may have come up. He's also QUITE expensive - his discounted rate is $125 a session. We're down to every other week due to financial strain (we just bought a house over the summer), and he was very hesitant to do that. He expects us to go back to our weekly sessions very soon. We thought a marriage counselor with many years of experience would recognize that financial issues can be stressful on a marriage and be proud of us for taking the time to solve them. Hmmm...

Posted by: Anonymous at November 6, 2007 03:51 PM