Any resources/tips about ending long term therapy?

[Abstract]

Hi Barefoot,

Sorry it's been frustrating and not going on the direction you wanted it to go.

It sounds as if stopping is challenging and you wanted her help wrapping things up. Instead she has picked up on your sadness about ending and is pushing you in the opposite direction than the one you want to go.

Could you ask her to help you wrap things up? That it is going to be very hard for you but that you need her help doing so.

If you still aren't able to get words out during sessions could you email it to her ahead og time?

You could of course use the situation to do work on your response to crying and partings. But it sounds as if you have tried doing that with her in the past and it wasn't helpful. Even though she has been a good therapist it's normal for someone to always be able to give us what we need.

I still quite figured out my crying stuff. I'm behind you as I do dissociate in T if I cry. Extremely annoying! I think I feel trapped and powerless. Or at risk in some way. I hate feeling trapped. And in general, I do very much miss dissociation too. And in other ways not of course. It's crazy how I feel a totally different person as a result of dealing with it.

Could part of your annoyance be you trying to help yourself disconnect?

Oh! And thank you so much. :) I crashed and left then stabilised then have been lurking more rcently after a family trauma. Great to see you have made such progress. Good luck with your next step and this.

 

[RainbowSearchParty]

What worked for me in terms of winding down with my old therapist was to just pick a date in the future that was the end date, and then the structure seemed to build around that. And for me, I started to put a lot of focus on my own coping skills and trying to build skills like healthy eating and sleep habits, and even though we didn’t talk about that at all in session, the extra focus on self care and regulation was stunningly helpful when the end did come.

 

[barefoot]

It sounds as if stopping is challenging and you wanted her help wrapping things up. Instead she has picked up on your sadness about ending and is pushing you in the opposite direction than the one you want to go.

Yes, very challenging. To be fair on her, I was very focused on telling her about how I felt about losing our relationship/saying goodbye to her. And then I was crying about it. So, it's not really surprising that we got a bit stuck there. I think I was telling her about that and how hard it was because I was hoping she could somehow help with that? But, I suppose that was unrealistic. I don't think she can do/say anything to make that feel less difficult/painful. So, I probably had unrealistic expectation/hope and was then frustrated when we just got stuck in me spilling my guts about how upsetting it was and her just nodding and smiling and validating that!

Could you ask her to help you wrap things up? That it is going to be very hard for you but that you need her help doing so.

I tried to do that again today. But she just suggests I reflect on it and then let her know what I want to do because we can do it however I want, whenever I want... It just feels too wide open and too many options for me to get my head around!

I crashed and left then stabilised then have been lurking more rcently after a family trauma. Great to see you have made such progress. Good luck with your next step and this.

I'm sorry that you have experienced a recent family trauma - though I have been pleased to see you here again (but not pleased that you've needed to come back, if you know what I mean!)

What worked for me in terms of winding down with my old therapist was to just pick a date in the future that was the end date, and then the structure seemed to build around that.

Thanks @RainbowSearchParty - I think this is probably what I'll have two do. If you don't mind sharing: how did you come up with the end date? Did you somehow work out how much time you needed? Or were you just quite random about it? (Not totally random-random, stick a pin in a calendar the thing, I don't mean. But I'm wondering if I'm over-thinking this timeframe decision)

 

[RainbowSearchParty]

We chose a date that was about four months in the future, which was during a slow time at work for me, so that I could use the final month to focus on wrapping up and not just needing symptom management.

 

[barefoot]

Had therapy today. I'm feeling stuck - confused and frustrated.

I had hoped/expected that my T would help me get clarity about how to move forward. But that's not happening. I don't feel we're getting anywhere.
Perhaps I have been unrealistic hoping/expecting her to help with this, because I don't really know what her helping with this would look like. Maybe she can't?

And I think what makes it most difficult is that I'm not actually sure what to do. I can't decide whether:

1) I definitely want to stop now - in which case, do as as @RainbowSearchParty mentions and choose a date to have our last session and then have a few sessions leading up to that to wrap things up and focus on achievements/progress, and then stop.

Or 2) whether I just want to continue with reduced sessions (once a month, say) in an open-ended way. And that could either give me clarity that it's useful for me to have that regular monthly space to just use as a check-in. Or, it may clarify that I don't have enough content/purpose to sustain on-going monthly sessions, so that realisation would then lead me to decide to end therapy.

I can see the benefits of both options:

1) is a clear, structured, purposeful, conscious ending, which feels contained, offers some closure and doesn't keep things dragging on with uncertain direction. Plus, on a practical note, I'll save a lot of money if I end therapy!

But a big concern I have is that, most weeks, I only speak to my partner and my T. I don't really have anyone else that I really speak to. So, I'm worried that, if I stop therapy completely, I'll either drain the life out of my partner by having to direct everything to her! Or that I will just end up not talking, not expressing myself, stuffing things down etc. So, I'm worried about lack of connection. And not having someone to talk to. Which option 2) helps with.

I need to make a decision. Don't really see the point in having a session with T again until I have decided and can then tell her what I want to do.
Just don't know how to decide! Ugh!

 

[Movingforward10]

you could try option 2 for 3 months or so and then make another decision about if you’re ready for option 1 or want to continue with option 2 for a bit?

I’m sorry T isn’t helping with this. That must be really difficult.

 

[barefoot]

Yeah, that's a tempting plan.
The lack of other people to talk too and concern about lack of connection/loneliness feels significant (it's not like I want to go and try to make new friends so I have new people to talk to!)

But then I worry if I am just avoiding ending/saying goodbye?
But maybe that is unhelpful overthinking?!

Danger is also that, every time I bring up ending, our sessions are unsatisfying and I end up feeling frustrated and deflated...and that makes me feel like I should just finish now because what's the point in keep turning up and paying out for more stuck sessions. But I realise that's an emotional decision because I'm frustrated (with her for 'not helping me' and with myself for not knowing what to do) I want to make sure that, whatever I decide, it's been a sound decision.

Maybe I need to sit with the plan you've suggested for a bit. And think about how I would use those monthly sessions. My current thinking has been to use them as light check-ins to chat about whatever's going on that I want to chat about. But I wonder if that might end up feeling too flabby and lacking in purpose/direction? I don't know...

 

[Teasel]

Given everything you've said going to once a month or similar for a while seems a better idea that stopping altogether. I can understand your frustration in her not helping you get clarity with how to move forward, I think I might feel similarly frustrated.

 

[Friday]

So, it's not really surprising that we got a bit stuck there. I think I was telling her about that and how hard it was because I was hoping she could somehow help with that? But, I suppose that was unrealistic. I don't think she can do/say anything to make that feel less difficult/painful. So, I probably had unrealistic expectation/hope and was then frustrated when we just got stuck in me spilling my guts about how upsetting it was and her just nodding and smiling and validating that!

But what if she HAD been able to help???

Just because it’s not something she could do, at least not at that time, doesn’t mean that it was unrealistic. Someone else being incapable of ABC, or unwilling to XYZ, doesn’t mean you are wrong to ask. Nor that you should have somehow known the answer to your question before asking. Nor that it’s unreasonable or unrealistic that a professional might be better versed than their client in creating a successful exit strategy. To my mind it was an entirely reasonable & realistic ask.

Not sure if you’ve gotten any of these links earlier in thread (my reading skills right now are lamentable)… but some have worksheets attached, others just good ideas.

Successful Therapy Termination | Article | Therapist Aid

When successful, termination is an opportunity for closure. Together, the client and therapist can take a step back and look at the growth that has unfolded during treatment, and make a plan for handling future problems.

www.therapistaid.com

Termination in Therapy: The Art of Gently Letting Clients Go

This article examines how to plan for termination in therapy.

positivepsychology.com

Counseling termination and new beginnings

The end of the counseling relationship can be emotional for clients and counselors alike, but when done well, the process can serve as a tool to empower clients and prepare them for continued personal growth.

www.counseling.org

 

[barefoot]

Thanks for the articles @Friday
And for this:

To my mind it was an entirely reasonable & realistic ask.

It's just really baffling to me that, when there seems to be so much info/advice for counsellors and therapists out there about good practise stuff re ending with clients, my T just doesn't seem to have any thoughts, ideas or suggestions to offer me.

Well, the only thing she did say was that she'd spoken to her supervisor about it as, me bringing it up with her, she thought it was interesting for her to think about endings...and her supervisor apparently said the rule of thumb is generally that you do a month of ending sessions per year of the work. So, I've been seeing her for 10 years, so that would mean we would have 10 months of therapy to end therapy. And, when she said this, my T was pulling a face and said that, to her, that didn't sound like ending therapy but it sounded like just a continuation of the work. And I said that I wouldn't want to do a long, drawn out wrapping up of therapy. So, we are on the same page about that, at least!

 

[Movingforward10]

It's good that she's asked her supervisor. But it makes me think - what endings has she done?

Also, is that a general rule? My T initially say 1 session per year rather than 1 month. So maybe different types of therapy have different rules?

 

[barefoot]

It's good that she's asked her supervisor. But it makes me think - what endings has she done?

Also, is that a general rule? My T initially say 1 session per year rather than 1 month. So maybe different types of therapy have different rules?

Well, she's been a T for almost 20 years so she must have had plenty of clients finish therapy. But I don't know whether she just waits for people to say they are ending therapy and then they just do? Or whether she waits for clients to say how they want to end and when, and then she does that? I don't know...she just doesn't seem to have any suggestions. But also isn't asking me many questions to help me get clear about what I'd like it to look like/what timeframe would work for me. It feels like she's not really leaning in to the conversation.

To be fair on her, she did ask me some questions for me to go away and think about at the end of the last session. But I found it a bit irritating because I'd already thought about them (and given her the answers to them really, when I brought up the subject of reducing sessions/wrapping up a few weeks ago)

She suggested I reflected on:

- do I actually want to end now? If so, why?
- if I want to wrap up, is there any 'unfinished business' ie things we still need to work on/go back to to tie anything up. Or anything I still want to say. In other words, what do I want to use the wrap up sessions to work on/how do I want to use them.
- if I choose to reduce sessions and continue in an open ended way - what do I want to do in those sessions.

They're not bad questions. It just annoyed me that she asked why I was thinking of ending....when I'd already been clear about that a few weeks ago (I don't think we are going to get any further on any deep stuff - we've worked on things for 10 years and, if I haven't got there with those things by now, I don't think we will now. I didn't phrase it quite this bluntly though, I don't think!) It felt like she thinks I'm just bring up reducing/ending without reflecting on it, which got on my nerves!

I've also clearly told her the answer to the third question. About using them as check-ins on everyday life stuff because I like having that time and space carved out to talk, otherwise I will only really have my wife to regularly talk to and that doesn't feel ideal.

It also looked like she was reading some of those questions out, so I suspect they might have been questions her supervisor said she could ask.

I don't know...maybe she would say those three questions are examples of her asking me questions to help me get clarity....I just think it's bizarre that she doesn't think I've already reflected on those things before I've brought the subject up with her (especially as I've already said about those things)

I'm just frustrated with it and haven't booked another session yet as don't want another session where we talk about it but not in a very meaningful, clarifying way....so feels like no point in another session until I've firmly decided what to do.

It feels like other times where we've agreed to work on something difficult, then we spend a few sessions talking about working on it....then it just sort of fizzles out and neither of us then ends up bringing it up any more... and so we then never get to actually work on it. It's a frustrating pattern we seem to fall into and this whole conversation about ending/reducing feels similar...like we're just spinning our wheels about it...