Tuesday, August 16, 2011

Ask the Doc: How do I fire my therapist?

I've been with my therapist for several months now, and it doesn't feel like it's going anywhere. How do I know when it's time to move on? And, how do I do it? Also, I can't help but wonder if I just want out of therapy because my sessions have been really tough lately.

Some relationships are easier to quit than others. And for many people, the therapy relationship is one of the hardest to leave for a number of reasons. Feelings of guilt and responsibility get in the way. You're reluctant to start over again and tell your difficult and personal story to someone else. Or you're just not sure if it's time to go. Could it be, you ask yourself, that you just want out because therapy is hard work?

Several months is definitely enough time for you to get a feel for your therapy, and a good idea of how things are working with your therapist. No matter what kind of treatment you're receiving, no matter what your therapist's theoretical stance, it is well-established that the therapeutic relationship is key to your success. Often, when we feel like "firing" our therapist, it's because that relationship just doesn't feel right. This knowledge can be helpful when you're wondering if you're just getting out because the going is tough. Put aside your recent, difficult sessions and ask yourself about your relationship with your therapist. Do you trust them? Are you holding back more than you feel you should? (note: just about everybody holds back in therapy as a way to keep themselves feeling safe. But, are you holding back even more, because you just don't feel comfortable?)

If you establish that your relationship with your therapist isn't what you need, or what you've hoped for, it's time for the next step. Interestingly, one indicator of a good therapeutic relationship is the feeling that you can talk about things when the relationship feels less than ideal. If you can trust your therapist with that conversation, and feel heard and responded to, you may be in the right place after all. But, if you can't open up like that, it's an indicator that there are probably other things you won't want to share either. It's time to let your therapist know that things aren't working as you'd hoped.

A lot of clients simply vote with their feet - a couple of missed appointments, a follow-up phone call, and that's that. I'd encourage you, though, to schedule at least one final session. If you've had a long relationship with your therapist, you may want more than one to feel like the termination is complete.

Yes, that's what we call it. "Termination." An unfortunate term, at best. I tell my clients that we can call it a "goodbye session," or whatever else they like. Termination sounds a little too much like there's a hitman involved for my comfort. Regardless of the name, though, that last session holds a lot of potential. Rarely in life do we get an opportunity for a mindful, face-to-face goodbye. In the world of therapy, that goodbye is a real one. You're moving on, and in all likelihood you won't see your therapist again. Unlike leaving a job, or moving out of town, there are no promises to keep in touch. No Facebook friend-adds. No "I'll drop in once in a while to see the old place." When was the last time you had a chance to truly say goodbye? Take the opportunity if you can. You'll probably learn a lot.

As for guilt - don't worry about hurting our feelings. One of the difficult parts of the job is that we've learned to say goodbye, over and over. All therapy comes to an end, even the good stuff. Through our training, we move around, we terminate with dozens of people, we learn not to take it personally. A good therapist won't make you feel guilty, or beg you to stay, or figure out a way to stay in touch with you. Part of your therapy work unfolds right there in the last session.

The bottom line is that, unlike many other situations, the goodbye can be the most helpful part of the whole process. Don't deprive yourself of that opportunity. And, when it's time to hire another therapist, ask about the goodbyes up front. Set a timeline to check in on the relationship, and on your progress. And, like all things learned in therapy, use your new knowledge to make progress in your next relationship.

Note: "Ask the Doc" is a regular feature here at DocBlog. If you've got a question for me, drop me an email at drjeff@gmail.com.


  1. For a while, I was being seen at a clinic where I was seeing student interns (due to financial issues). It was very interesting - of the 3 interns I saw, I was actually glad to see one go, I did not feel that I had a good relationship with her. Another was very hard to say good-bye to because I had quite enjoyed working with her, but it was still fairly fine - I knew it was coming of course and we got some good closure. But the first one I saw I just clicked with so deeply - and when I wound up leaving the clinic, I actually looked up her practice (since I knew she'd been planning to practice in this area) to see if I could continue my work with her. I was very glad that that did end up working out, because I trusted her more deeply than I've ever trusted another therapist, before or since - which made it so much safer to be able to get into the hard things, and to hear some of the hard truths from her.

    But yeah - when you're seeing students, who only intern for a year, you go through several termination sessions. And I agree, they are very valuable things. I was surprised at some of what I got out of them.

  2. This is a good post - I thankfully finally feel connected with a therapist but have had to 'let others go' in the past. Being flaky, missing appointments and not returning calls made me feel bad but this one woman was impossible to talk to. I felt like I held almost everything back due to her judgmental comments and that isn't a healthy relationship!