Locating a therapist can pose challenges, particularly with high demand and limited availability. According to a survey by the American Psychological Association, over half of practitioners (56%) lack openings for new clients, despite widespread acknowledgment of a mental health crisis. Once you've secured a specialist, deciding to terminate the relationship can be even more daunting.
You've mustered the courage to schedule that initial appointment and engaged in a few preliminary sessions, divulging your deepest vulnerabilities and truths—a process inherently uncomfortable.
"The inaugural therapy session is one of life's most peculiar hours," notes Dr. John Duffy, a psychologist and author. "You're offering an unusual level of vulnerability to a complete stranger, merely to gauge compatibility in terms of personality and approach."
But what if the discomfort extends beyond the expected? How can you discern if this therapist isn't the right fit? CNN consulted multiple experts to determine when to end therapy and, if necessary, how to navigate the process.
Is the problem you or your therapist?
Prior to discontinuing therapy with your current provider, experts advise assessing whether it genuinely isn't effective or if discomfort is the issue.
"You could be delving into challenging topics that you've avoided for some time, eliciting feelings of sadness, fear, or anger," noted Dr. Andrea Bonior, a psychologist and psychology professor at Georgetown University. "However, consider: Are we making progress?"
Bonior emphasized the significance of honesty regarding your needs and your willingness to be candid.
"Frequently, we conceal our true habits, like alcohol consumption or parenting frustrations, out of fear of judgment. Perhaps shame weighs heavily on us. When we're truly honest, we're not divulging the entire truth to our therapist."
She recommended expressing discomfort to your therapist directly or preparing a written note beforehand. While therapy may not consistently feel pleasant, its purpose should be beneficial.
Know what you want from therapy
Be explicit about your therapy objectives, even if they evolve. Are you seeking a platform to discuss your experiences with minimal intervention, a more interactive dynamic, assignments to complete between sessions, or another approach?
"Some individuals prefer a therapist who assigns substantial homework, actively engages, and challenges them," Bonior explained. "Conversely, others seek a quieter, more nurturing presence, fostering an environment conducive to open dialogue."
Shop around for a therapist
If you perceive little benefit from your sessions or sense a mismatch with your therapist, it might be prudent to explore other options. Even if you conducted thorough research before selecting your initial therapist, your understanding of your needs may deepen after a few sessions.
Your primary care physicians could provide valuable referrals. Additionally, friends and family who have undergone therapy may offer recommendations. Various online directories, including those hosted by the APA and PsychologyToday, frequently feature therapists' profiles detailing their backgrounds and areas of expertise, such as anxiety, grief, family conflict, and couples counseling.
Many therapists offer complimentary initial consultations. Dr. Sheehan D. Fisher, a psychologist and assistant professor at Northwestern University, suggested approaching these discussions armed with a list of questions to help ascertain which therapist you feel most compatible with.
Sample inquiries encompass whether concrete and specific objectives will guide your collaboration, the therapeutic approach they adhere to—such as mindfulness or cognitive behavioral therapy—and whether their religious beliefs, or lack thereof, create discomfort for you. Additional queries revolve around the flexibility of session scheduling and their acceptance of insurance.
However, efficacy isn't the sole determinant of a fruitful patient-therapist dynamic.
"Chemistry is also crucial," Fisher remarked, along with alignment regarding the objectives you aim to achieve, a sense of safety, and a genuine connection.
If these elements are lacking, or if progress toward your goals feels stagnant, it might be prudent to pivot and terminate the arrangement.
Endings can be opportunities
Concluding any relationship can evoke emotions like sadness, self-doubt, or a sense of failure. However, it's crucial to recognize that therapy is intended to serve as a tool for your benefit. If it's not fulfilling that purpose, it's acceptable to disengage.
Don't prolong the arrangement out of fear of disappointing your therapist. "Many individuals remain in therapy to spare the therapist's ego," Duffy observed. "But that's not a valid reason to stay."
Duffy recommended viewing the termination as an opportunity for personal growth and advocating for your needs. "Approach the conversation with honesty," he advised. "Express your discomfort, anxiety, and uncertainty, but acknowledge the necessity of discussing the possibility of transitioning to a different therapist."
This applies equally to long-term therapeutic relationships. While your therapist may have been instrumental in your initial progress, you may now find that your personal growth has stagnated or your needs have evolved, yet you remain loyal to them.
The most constructive approach is honesty, emphasized Bonior.
"If you're apprehensive about potential awkwardness or hurting your therapist's feelings, bear in mind that addressing uncomfortable and challenging topics is integral to their professional role. It's literally part of their job."
Don’t ghost your therapist
Under any circumstance, abruptly discontinuing therapy without explanation is highly discouraged.
"The irony lies in the fact that those most inclined to 'ghost' are often individuals prone to avoidance and social anxiety, struggling to assert their own needs," remarked Bonior. "By doing so in therapy, you miss an opportunity to break that cycle."
Fisher added, "Ghosting also puts you at a disadvantage," as it deprives you of the therapist's expertise in navigating your needs. While you may no longer wish to continue with your current therapist, it's within their purview to assist you in finding a more suitable match, if given the chance.
"As therapists, we hold responsibility and accountability for our clients," he emphasized. "We need assurance of their safety and well-being."
An exception arises if the therapist's conduct makes you feel unsafe or if they engage in unethical behavior. In such cases, immediate termination of the therapeutic relationship is warranted, with potential consideration given to reporting them to the appropriate governing body.
The good kind of break-up
The most favorable scenario is when you reach a point where you feel you've progressed sufficiently and no longer require therapy, akin to ceasing medication when it's no longer necessary.
"It's akin to discontinuing medication when it's no longer warranted," Fisher noted.
Yet, this transition isn't always seamless.
"Many individuals linger in therapy indefinitely because it offers a familiar, comfortable haven, even when stagnation prevails," Duffy remarked.
Rather than passively continuing, he advocates for regularly assessing progress and taking ownership of the therapeutic journey. After all, the primary goal is your well-being.
Ending therapy doesn't have to be abrupt. It can be a gradual, phased-out process, keeping the option for future sessions open as needed.
Similar to tending to your physical health by visiting the gym, therapy serves as a tool for mental well-being, whether requiring intensive intervention or occasional maintenance.
"I've had clients return years later, recognizing a resurgence of old patterns and seeking a brief series of sessions to regain equilibrium," Bonior shared.
