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

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.

How 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.

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.

Note:

  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.