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How To End Therapy With Your Clients

3 ways to signal the end of therapy

End Therapy
Nothing does, or should, last forever - including therapy

If you are in therapy yourself, and looking for help leaving your therapist, please read this article instead.

These days, knowing how to terminate therapy elegantly is a core therapeutic skill. Gone are the days when psychotherapy was supposed to continue maybe twice a week for decades.

In fact, the international guidelines for the treatment of depression suggest that if your depressed client doesn’t feel significantly better after five sessions you should refer them on to another professional (1).

It's not right to keep someone in therapy when they no longer need it. And remember - they're paying!

If someone sometimes wants to ‘catch up’ or ‘just talk’ once in a while, that’s fine, of course. But who was it who said: “A therapist should assist where they can but not leave footprints in their client’s life”? Therapists supply a service.

If you went to a lawyer for help but then continued to visit and pay them on a regular basis even after they’d completed the work, you’d kind of want them to draw your attention to that, would you not?

Terminating therapy as soon as possible isn’t about throwing clients out when they still need help. It’s about setting clear guidelines and helping them be emotionally ready for their therapy to end.

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3 ways to end therapy

1. Ensure basic emotional needs are met outside of the therapy room

Everyone has basic needs for attention and intimacy. If you don’t actively encourage and help your client to meet these needs outside of their therapy with you, then they’ll feel dependent on you. If you’re someone’s only real source of human contact and attention, then of course they’ll feel as if they can’t stop seeing you. But don’t confuse this with ‘successful therapy’.

Clean therapy happens when the therapist:

  • understands that the role of the therapist is to help the client with specific problems and not to meet their basic needs on an ongoing basis
  • helps the clients be clear about what these needs are and how to meet them effectively in their own life.

2. Draw their attention back to their original therapy goals

This is why it’s so important to be clear with someone from the beginning by establishing very clear and measurable goals. If nobody knows when therapy has been successful (because no clear goals were ever defined), then nobody knows when it’s supposed to finish. Imagine a builder doing this to you when working on your house.

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So from the beginning you need to build in the expectation that therapy will end and clarify the parameters that will govern it. You’ll be saying things like

So we’ll know you won’t need to see me anymore when:

  • you’re sleeping better
  • you feel more confident sexually
  • you have stopped smoking. 

The end should be there from the beginning.

When these goals have been achieved, you draw the client’s attention back to them:

You came to see me because you wanted to […] Now that we have achieved those goals to your satisfaction, was there anything else you wanted to work on before we wrap up therapy?

3. Make it clear from the beginning that therapy will be finite

Of course, you can’t always tell exactly how many sessions a person will need to get over a depression, or to successfully stop drinking, but you can give them an indication. So I might say:

Many people can be helped within a few sessions and often times feel better even after a single session. (Remember the power of the placebo effect!)

If they ask what happens if they don’t feel better, I might suggest that if after four or five sessions they feel they haven’t benefitted (above and beyond enjoying the companionship of therapy), then I will refer them onto someone else.

If someone wants to pay me to be a professional ear every couple of months, that’s fine – as long as neither of us think that anything else is happening and I’m clear with the client that this is what we are doing. You don’t need to throw someone out in the cold, but what you do need to do is ensure the outside is ‘warm enough’ for them.

Nothing does, or should, last forever – including therapy.

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About Mark Tyrrell

Psychology is my passion. I've been a psychotherapist trainer since 1998, specializing in brief, solution focused approaches. I now teach practitioners all over the world via our online courses.

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Notes:

  1. Diagnosis, Vol. 2 Treatment Aspect. United States Public Health Service Agency.
  • Caroline Marike

    Hi Mark,
    Thanks so much for this clearly written article on how and when to end therapy. It not only clearifies the ending, but the way to go to. The metaphore of builders building your house without clear goals to begin (and end) with, speaks to me very strongly: we are not there to redecorate whole lifes; our influence should only be in that part that was asked for. There can be another part decorated after goals were met, but only when that’s a new question by the client because the first one is welladressed.
    It must be a new contract to.

    Thanks for pointing out to me the value of basic emotional needs being met outside the therapy room. I often hear the phrase: ‘When I’m in here, I’m quite allright… but out there… it’s still hard’. I tend to deliver a lot, during therapy … and sometimes forget that it should be there for them, out there. And it is my task to teach and motivate them to get it.
    tnx!

    • http://www.uncommonhelp.me/ Mark Tyrrell

      I’m glad you found it useful Caroline : )

  • artandnature

    Thanks for this Mark. i have been seeing a therapist for seven years, first for weekly sessions, then when i moved, for weekly phone calls. At times i wanted to end but she often said things like ‘ oh clients go on for years and years’ ‘why end , this can be for life’. at times she called me ‘family’. she also wants a friendship after therapy. i realise i got too dependant, but now she has announced she wants to stop being a therapist and stop supporting me. its destroying me as i never saw it coming and she never gave me any impression of this. i am in such a lot of pain about it, any advice would be welcome, thanks for your article, i think i can see how it ‘should ‘ be done!

    • http://www.uncommonhelp.me/ Mark Tyrrell

      Hi, I’m so sorry to hear this. The old idea that ‘therapy should be for life’ or not have any proper goals is terrifyingly outmoded. But on top of that this person has manipulated you and blurred the boundaries whether she intended to or not. Therapists should make you more independent not dependent. I suggest you find other (or perhaps I should say ‘real’) sources of support that don’t cost money. If you feel you have specific emotional issue and this therapist hasn’t helped with that then find a therapist who is solution focussed, strategic and time limited in the way they work. I wish you all the best for the future and remember breaking away from this person may be exactly what you need.

      • artandnature

        Thanks very much Mark, that’s most helpful x

      • artandnature

        I feel a bit of a fool cos I kind of ignored the alarm bells, but moving on will be good.

  • Luc Anderson

    I’ve been a client football before, it’s not fun. Being passed around for therapist to therapist b/c I’m not feeling better actually makes me feel worse and increased my abandonment issues. But you don’t care, you’re a therapist who goes by guidelines and follows “ethics.”

    Therapy doesn’t always work, but your analogies show that you believe your profession is cut & dried, when it actually is much more complicated than that. I feel sorry for your clients, you seem like a jerk.

  • Linda Farrugia

    Hi Mark,
    I find offering to e-mail or ask the client to e-mail me after a suitable time has passed, so we can check on progress usually does the trick.
    This in itself can give almost a placebo effect with that knowledge there is support available. The client will then be reassured and feel confident by any advice given if an e-mail is necessitated.

  • William Otto

    She is dissappointing.

  • Milleniumistic

    I saw the same therapist for many years. Then I started becoming late for sessions or cancelling them, so my therapist and I decided it would be best to cease therapy until I could meet my responsibility to show up on time. I never really told him why this was happening. I was becoming fearful of the journey to the therapists office. I felt bad, but I completely agreed and understood that it wasn’t doing anyone any good, and that the time I wasted would be best served if someone else could use it. Recently I’ve been in crisis and called my therapist. He said he was no longer seeing new patients or even former patients, but would agree to see me.

    I showed up early, making sure I would not be late, waited outside until it was time, and went on in. I was determined to not to repeat past mistakes no matter how fearful the journey across town was becoming. After we talked a few minutes I had a horrible sinking feeling. It turns out I was mistaken in believing that the therapy would go on I was not going to enter back into therapy, this was pretty much a temporary thing, only to last a very short time. He was not seeing therapy patients or was ending that part of his practice. But I could be seen once or twice, maybe a few times, when there was an opening.

    I decided not to go that route, as I felt short time was not doable. I’d not be able to stop thinking about the final ending, and that would cloud the sessions too much. I decided that if the end must happen, this would be it. Any crisis I had would have to be dealt with by me alone. I was polite, and wished him well and left, for the final time. I forced myself to not cry even though there is an overwhelming sense of loss. It feels like a sudden death in the family or a sudden breakup. It’s hurtful. However, it is what it is.

    I guess my point is, that going into therapy, it’s wise for all concerned to know, that there will be a goodbye. Never take anything for granted. Appreciate it, learn all you can while you are in that setting, and hold onto the lessons. Plan a goodbye scenario if possible, and know, that it’s not an abandonment, it’s a natural part of the process. It can be painful, very painful. I don’t think there is a way around that part of the process. It’s like all aspects of life though, there is a beginning and a middle and an end, and that’s how it’s supposed to work.

  • Love of truth

    I’ve seen my therapist for a little over two years. Previously, I worked with one for 9 years, resulting in significant change, but likely what appeared minimal to others because (1) I have severe problems with emotion regulation and tendency to isolate; and (2) I was on and off abusing the prescription Meds he gave me (I would overuse and then go without over and over, so shifting between mild withdrawal and active impact of the Meds-stimulants. We dealt with that in the final year, I began recovery, and from there out our work was very goal and task oriented, me finally drawing support from people other than him. While I was using, I thought I was working, but I spent a great deal of time in agonizing pain over need for him/more help and feeling passively suicidal. He didn’t know I was using and became more and more frustrated with me, advising he that I was stuck and making many shifts to try to get things on track. This made me very insecure about whether he would stick around and my life was completely about this horrible set of issues I had with a therapist I loved and could not leave. The first 5 years were very different, and I didn’t understand why he suddenly seemed so unhappy with me. I assume it was a growing sense that something was off with me in addition to my neediness (stemming from fear of his changing approach and what I saw as the beginning of abandonment. I can’t sort out what, if anything, was a true issue in the relationship vs something caused by the effect of my abuse of Meds. I just know that I still fear repeating that experience, even clean.

    I quit with him when I moved out of state. I was off Meds so was not abusing them, and I worked wonderfully with an analyst in traditional psychoanalysis for 8 years until my life went into crisis and I needed a more active therapy with engaged therapist. It took 2 years to find my current therapist, who felt like a Godsend when I found him. He presented many new approaches and ways of thinking to me, and it was very happy working with him twice a week. I later joined a group that he runs. I consider him to be an excellent, professional, and very committed therapist, having particular strength running groups. At one point, we lost one member with whom I had been close and took in some new ones-also kind. My tgerapist was under physical strain at that time, which lasted a few months. He worked through it and never once complained. However, he started getting very frustrated with me. I accepted it for a couple of weeks in a row, but then it continued on a regular basis, and sometimes the way he responded it me in group felt so hurtful and humiliating I was becoming concerned. If he wasn’t voicing frustration with me, his eyes were closing-felt like he wanted to leave, frankly. I started to watch how he was with others, and he continued to be encouraging. I asked him several times privately about it and he denied that anything was different. I started leaving therapy feeling much worse than when I arrived. I came close to quitting, but I didn’t think I would find a replacement and I still felt attached.

    Them for a couple weeks in a row I was directly confronted by group members for behavioral problems I was not seeing in myself. By this time I felt suicidal, but I stated with it and did my best to take in the feedback and grow. It was good feedback-just delivered very angrily in a setting already feeling unsafe to me. I’m actively working on this and have received very positive feedback about progress. During this time, my t

  • kittykitty

    Hi, Mark. Great blog! I have a question hopefully you can tell me your opinion. I ‘m an Asian lady in mid 20s living in Singapore. I have been seeing a SG registered Psychodynamic therapist for 12 times in the past few month. Now with my past trauma no longer affecting me, depression lifted, anxiety lessened and some new understanding about my maladaptive way of relating and more assertiveness , I feel pretty much okay. What really need work is my self -confidence and to find out what I am truly passionate about doing and capable of doing well. What happened now is that my therapist and I had ran out of past things to discuss. I have been telling him about my desire to write more or look for a role involves writing like becoming a journalist or editor. He has been encouraging me to write a blog and bringing my writing to show him. He has also encouraged me to depend on him more ( Let man includes him to care for me -his original words) as I am the type of girl who prefer to rely on herself and have some trust issues with men in a intimate relationship. Since I have been taking a long break from work and paying my therapy entirely my myself, my finances has been tight.I have just enough for living and nothing left for saving and other purpose. I am not sure It is necessary to see him at the frequency of 3-4 times a month . I even feel I can take a break from therapy now. And come back once I start working full time again soon if I feel like to. I am also a bit worried that my therapy session feels more like a coaching session now .My therapist is also a trainer ,lecturer to MNCs and in public and education sector. Should I lessen the frequency of my therapy now or take a break ? I am weighting the long term benefit and value and the necessity of the therapy of my current situation.

    Despite having confessed into him some of my deepest secrets, it scares me to depend on a “paid ” expert as a crutch to my difficult emotion and decision making. As a previous people pleaser who has been taken advantage by other people and a child who grew up with smothering and controlling parents up until the age of 15 to be dropped to live independently in a new country and immigrated on her own, I tend to subconciously associate care with control. My therapist is younger but close to my parents’ age.There was always an irrational fear at the back of my head that my therapist just want to keep me in therapy as he long as he deems fit. He sounded like he is always open to see me back if I fall into pieces again in future. Though I have been sharing with him some of my worries whether his care is genuine or just him wearing therapist hat, I have not shared all. If I would like to consider seeing my therapist less often or even taking a break from him, what would be the most important things for me to consider in making my own decision? And what are things I must discuss with him to make sure we end on a good note. Thank you for reading .