You’ve Decided to Stop Therapy. First, 11 Important Considerations.

Your best treatment is closely connected to how closely you stick to the evidence base.  However, you as the client always need to advocate for your best treatment.  Successful clients are assertive for their treatment, ask good questions, and sometimes even disagree with their professional.  This is healthy.  Client involvement and assertiveness is a fundamental part of making therapy work– at some level, you as the client must have the buy-in, interest, and willingness to make therapy work or you.  There are many good reasons to discontinue therapy work- and some bad ones.  

Reasons Clients Stop Therapy

After a decade and a half of providing therapy, I’ve seen a lot of different reasons why people stop therapy.  

2 “win-win” Rationales for Ending Therapy:

• Treatment is complete.

• • • Considering the best reason first, this is What both clients and professionals are looking for!

• Personal development and timing.

• • Even if therapy “on paper”  seems like a good idea, sometimes a person needs to grow or develop in other ways. The most obvious instance of this is with children and adolescents, but it is also applicable for adults- sometimes our growth comes from other routes at the time (please don’t neglect necessary treatment when indicated, but sometimes we need a pause or to take care of other things first).

11 (Potentially) Harmful Reasons Clients Discontinue Treatment (Keep Scrolling for Solutions):

• Cost, or other issues of access, like location or available hours.
  • It can be easy to just give up altogether on your treatment if you hit a wall and it seems like affordability or other access concerns are an issue.

• Feeling Better.
  • It’s human nature once we feel like a problem is solved to then move forward to the next big thing, crisis, or opportunity.  

• Dislike of Treatment.
  • This appears especially common with one of my core approaches: Exposure Therapy.  I really do get it; it can be very uncomfortable, takes hard work, and it also at times seems counterintuitive.  

• Dislike of A Therapist.
  • Maybe personalities don’t fit well, you feel tension, or there’s just something you don’t feel you can work with.

• Differing expectations.
  • Maybe one of the most common, when clients discontinue their treatment before indicated, they may have different expectations as to what is successful or what they would like to accomplish.

• Too difficult.
  • Similar to “Dislike of Treatment” above, when the going gets tough, sometimes clients call it quits.  And this isn’t always bad.  Sometimes you might just not have it in you at that time.  

• Impulsivity.
  • Simply put, it can be easy to not go to therapy and give into the impulse to stop.

• Not being completely open/honest with a provider.
  • Because we still rely mostly on self-report for psychological science, it requires you to be fairly accurate (not perfect) in reporting about yourself, particularly in areas that the treatment concerns.  Leaving out key pieces adversely affects outcomes.

• Bad therapy.
  • It’s a reality.  Truly, sometimes you get bad therapy.  We have a saying amidst my colleagues: bad therapy can be worse than no therapy. One of the reasons why is that a person thinks, for instance, that they truly tried CBT, and if they think the treatment failed or isn’t for them, they are more adverse or hesitant to later get appropriate or continuing treatment. 

• Wanting a different therapeutic relationship.
  • Whether a person can define it or it’s more of a nebulous reason, sometimes a person just wants a change.

• The treatment wasn’t explained well enough.

• • Therapists must take responsibility that they are human and sometimes poorly explain the treatment, what’s involved, outcomes based on evidence and what is required, and so forth.  Without proper education, clients can’t be expected to have realistic expectations and commit to the treatment as a provider might want them to do.

Research-Based Objectives Before Stopping Therapy

Particularly for therapy in areas that are well-researched and defined (Anxiety Disorders, OCD and Related, PTSD), unless you have high severity, low insight, or other complex factors, sticking to the approaches studied in randomized controlled trials (RCTs) will likely get most people similar results.  In OCD, the average “trial” is usually 16-20 exposure sessions (in the research trials they are typically 90 minute sessions), and the average person (80% of those who stay with it) achieves 60-70% symptom reduction (Abramowitz & Jacoby, 2015).  I’ll let you dig further if you wish into the broad category of Anxiety Disorder treatments and efficacy.

11 Solutions Before Dropping Your Treatment

If you’re wanting to thoughtfully consider solutions with your best outcomes in mind, keep reading:

• Cost, or other issues of access.
  • Talk it through.  If it doesn’t work, it doesn’t work.  But, I find more often than not that those who are willing to ask questions, explore, and research can often find low-fee, free, or support group options and more.  Who better than a therapist who knows the community well?!  Face it head on- and you’ll be more likely to get good treatment.
  • Be willing to stay flexible, though, because none of us can have everything we want (aka, don’t fall into the trap of requiring a clinician who comes to your home for visits, takes your insurance, is a female between the ages of 20-40, likes skiing, and their favorite color is blue.  It’s possible to be too picky and unrealistic).  

• Feeling Better.
  • If you feel better, consider if that is because you have made tangible, sustainable progress you can maintain.  Do you have more treatment to complete?  A simple way to know is to ask your clinician what they think, and do some of your own research.  Many of my clients feel better within several sessions, but there is typically further to go in a treatment plan for most disorders.

• Dislike of Treatment.
  • Examine whether dislike is just a part of the normal process (e.g., “I dislike being vulnerable about issues sensitive to me.”)  While a good therapist can work in many ways to support you, like integrating Acceptance and Commitment Therapy (ACT) into the process, there is some suffering that’s inescapable from all discipline and hard work.  

• Dislike of A Therapist.
  • Does your dislike of a therapist impact treatment?  Are they not good at their work, or talk too much or don’t stick to the evidence base?  Are they inflexible when you need more?  Liking a therapist by personality is not a requirement for good treatment, if you can tolerate it and/or learn to work with that.  There is no “perfect” fit, but there is such a thing as a bad fit.

• Differing expectations.
  • The simplest way to get on the same page is to bring up a topic or issue.  Your therapist might be recommending, say, weekly frequency for sessions.  Instead of simply ignoring these requests, ask them for the rationale and if they think you can accomplish your stated goals with your desired frequency, for example.  Though your clinician has most of the responsibility in defining treatment, it is a relational process, meaning that it involves people with communication. 

• Too difficult.
  •  I get it.  Therapy can be hard.  Some therapy is calming, soothing, and relaxing.  Things like Exposure Therapy are not.  Talk it out, explore if there are easier, more doable ways to approach.  
  • Junior clinicians are especially likely to make the mistake of not “titrating” your treatment at a level you can handle.  This is a key point of having a provider who can walk with you- to help you be realistic as to what you can and can’t do at the moment.  Consider a more experienced person if you run into too many roadblocks of energy, motivation, or upkeep.  If you would like to do what is recommended but just can’t, there are still options.  

• Impulsivity.
  • It’s tricky when one of the areas that therapy can help with is decreasing reactionary responses that pull people away from their values.  So if you give up impulsively on therapy to help with impulsive responses, you might find a “catch 22.”  However, a key workaround is simply bringing this into the therapy process and setting up supports, accountability, and finding a therapist who utilizes approaches like Motivational Interviewing (MI),  Motivational Enhancement Therapy (MET) and Acceptance and Commitment Therapy (ACT) to help with staying invested.  

• Not being completely open/honest with a provider.
  • Surprisingly, letting a therapist know there are areas you don’t want to talk about or just can’t talk about right now can help them to be patient and support you where you are at.  And sometimes you might consider sharing “hierarchically,” where you work up to it in a graduated way.

• Bad therapy.
  • Fire the therapist.  Dig deeper, look at professional organizations and who is associated with them, like using a provider finder through:
    • IOCDF
    • ADAA
    • ABCT

• Wanting a different therapeutic relationship.
  • If you’re looking reasonably at rationally wanting a change, then do so with intention and integrated with your actual beliefs and values.  Approaching this with assertiveness and confidence according to good treatment planning can serve you well.

• The treatment wasn’t explained well enough.
  • This is on the provider.  Challenge them!  That’s okay; ask good questions.  They are human too, but if they claim to be specialized or expert in any specific area, holding them accountable to let you know the rationale for the treatment (or if there’s a rationale to hold off on letting you know at the time) is appropriate.  

Go Get Your Best Treatment

This fairly extensive list won’t include every situation or consideration. I hope you will ask good questions and consider what is best for you.  Let me know in the comments if there’s any other reasons you can add to this list!