Remember: A Poem on Recovering Innocence After Abuse
That period of wrapping up therapy and saying goodbye is known as “termination,” a word that evokes images of being fired from a job or being stalked by Arnold Schwarzenegger. But mental-health experts consider termination a crucial stage in therapy.
If handled properly, it provides an opportunity to re-examine the issues that led the client to seek help in the first place, to evaluate the therapy itself and to deal with feelings that might bubble up in the face of bidding farewell.
A so-called natural termination, in which the two of you agree to end treatment because your goals have been met, is difficult enough. Who, after all, likes to say goodbye, especially to someone who has helped you so profoundly and so intimately? But a premature termination, where a dissatisfied client leaves without much notice or a therapist departs before the patient is ready, can be downright traumatic.
“It’s always best if people can have time to pay attention to the process of saying goodbye,” says Carl Shubs, a licensed clinical psychologist in private practice in Beverly Hills. “If people leave too abruptly, it interferes with the process–they’re not able to deal with the sadness or anger, the mourning that occurs.”
Adds Sylvia Martin, a licensed marriage, family and child therapist in private practice in Sherman Oaks: “Termination is a time when people start to deal with all their losses. It can trigger feelings about old issues, or issues about the relationship between the therapist and client.
“If there is an old loss they have not grieved, they will tap in and experience the same feelings,” she says. “Maybe they had a feeling of abandonment when they were young and did not understand it. Or maybe they have not had the luxury before now of dealing with a loss–for example, going through a divorce with two kids.”
If it is the patient who says so long, a good therapist will try to determine if he or she wants out because the topics being discussed are becoming too painful. In those cases, the therapist will encourage the patient to remain, so as to work through the discomfort and resolve those issues.
Many times, though, the client is willing to slog through the hard stuff, but feels this particular therapist is less than able. Such was the case last year for Laura, 41, who works in the travel industry in Orange County and sought counseling for marital problems.
“I was therapy illiterate,” she recalls. “I had no basis for comparison. But I never felt I was getting help. I would drive home and think, ‘Why did I just go there?’ I didn’t expect a magic cure, but I was just begging my therapist, ‘Give me some tools to help me.’
“All she said was, I had to divorce my husband, which I wasn’t ready to do. I felt her attitude was, ‘You won’t take my advice, so I don’t know what to tell you.’ ”
Laura–who is still married and on better terms with her husband–found another therapist to her liking. But she stuck with her first counselor longer than she preferred to because, she says, “The last thing I wanted was to look for someone new to spill my guts to, to start over again.”
Indeed, for some people, leaving the current therapist is the easy part; it’s finding a new one that poses problems. Says Studio City writer Catherine Johnson, author of the book “When to Say Goodbye to Your Therapist” (Simon and Schuster, 1988), “Finding a new therapist is not like finding a new dentist. It’s extremely difficult to find a match.
“It’s a bit like finding a lover, or best friend, or a parent. You don’t just go out and find a new best friend. You have to find a real emotional fit, on top of basic competence.”
Lisa Moore, 34, a West Los Angeles advertising account executive, discovered that last year when she left the marriage and family counselor she had been seeing for 15 months because she thought the therapist had crossed the professional line and was becoming too friendly. After six weeks with a new therapist recommended by her physician, she decided to return to her former counselor.
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Maybe you don’t like your therapist. Maybe you do, but you’ve resolved the
issues that drove you to seek counseling in the first place. Or maybe those
issues remain unresolved, with few signs of progress. Maybe your sessions feel
as if they’ve morphed into very expensive chats with a friend.
For myriad reasons, people come to a point when they wonder if they should
break up with their therapist. And “break up” is the right term for it, because
quitting therapy can spur emotions as painful and complicated as ending a
How do you know if you’re ready to stop therapy? And how should you go about
it? First, any therapy that is abusive or destructive should be stopped
immediately, said Dr. Kenneth Settel, clinical instructor in psychiatry at
Harvard Medical School. Examples of abusive therapists are those who are
disrespectful or insensitive to certain issues; those who violate boundaries;
those who reveal too much about their own problems; and those who insist on
focusing on areas the patient didn’t come in for.
But assuming you’re not dealing with that, patients should approach ending
therapy as a chance to grow, Settel said. Rather than cut and run or avoid the
topic altogether — tempting routes for the confrontation-avoidant — it’s
important that patients, well, talk to their therapist about it.
In therapy, the relationship between the patient and the therapist is a
vehicle for understanding the patient’s issues, Settel said. So the way you end
therapy can be a way of examining how you say goodbye to people, and the
feelings involved in leaving and loss.
Ask yourself why you want to move on. When did you start feeling that the
therapy was no longer helpful or productive? What happened that made it
different? Was there a change in you, in the topics being discussed, in the
therapist? Confronting that tension can be a turning point because it forces you
to work through obstacles, Settel said.
“Ending therapy can be very therapeutic,” Settel said.
Though the patient-therapist relationship can have a weird power dynamic —
you’re paying, but the therapist is the expert and knows your every demon —
patients should feel they have control of the process, said Lynn Bufka, a
psychologist and head of the department of practice, research and policy at the
American Psychological Association. Patients should feel empowered to ask
questions, steer the sessions to focus on particular issues and let the
therapist know what’s not working.
The tricky part is making sure you’re not leaving therapy just because it’s
unpleasant or difficult, which oftentimes it has to be, Bufka said. More than
make you feel better, therapy is supposed to help you understand yourself
On the flip side, therapy shouldn’t be some indefinite appointment you keep
as part of your routine. There should be regular discussions about what you’re
trying to accomplish and whether you’re meeting those goals.
“I hope that I’m going to work myself out of a job,” Bufka said.
There is such a thing as staying in therapy for too long. One warning sign is
if a patient has to run all decisions by his or her therapist, which can signal
dependency, Bufka said. Another concern is if the therapist relationship is
taking the place of building other relationships.
Another downside of staying in therapy for too long is that you don’t have
the opportunity to practice the skills you’re developing independently, Settel
said. If the therapy was aiming to help you build internal skills of
self-observation, stopping therapy can encourage growth because it forces you to
internalize the process.
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If you think it’s hard to end a relationship with a lover or spouse, try breaking up with your psychotherapist.
A writer friend of mine recently tried and found it surprisingly difficult. Several months after landing a book contract, she realized she was in trouble.
“I was completely paralyzed and couldn’t write,” she said, as I recall. “I had to do something right away, so I decided to get myself into psychotherapy.”
What began with a simple case of writer’s block turned into seven years of intensive therapy.
Over all, she found the therapy very helpful. She finished a second novel and felt that her relationship with her husband was stronger. When she broached the topic of ending treatment, her therapist strongly resisted, which upset the patient. “Why do I need therapy,” she wanted to know, “if I’m feeling good?”
Millions of Americans are in psychotherapy, and my friend’s experience brings up two related, perplexing questions. How do you know when you are healthy enough to say goodbye to your therapist? And how should a therapist handle it?
With rare exceptions, the ultimate aim of all good psychotherapists is, well, to make themselves obsolete. After all, whatever drove you to therapy in the first place — depression, anxiety, relationship problems, you name it — the common goal of treatment is to feel and function better independent of your therapist.
To put it bluntly, good therapy is supposed to come to an end.
But when? And how is the patient to know? Is the criterion for termination “cure” or is it just feeling well enough to be able to call it a day and live with the inevitable limitations and problems we all have?
The term “cure,” I think, is illusory — even undesirable — because there will always be problems to repair. Having no problems is an unrealistic goal. It’s more important for patients to be able to deal with their problems and to handle adversity when it inevitably arises.
Still, even when patients feel that they have accomplished something important in therapy and feel “good enough,” it is not always easy to say goodbye to a therapist.
Not long ago, I evaluated a successful lawyer who had been in psychotherapy for nine years. He had entered therapy, he told me, because he lacked a sense of direction and had no intimate relationships. But for six or seven years, he had felt that he and his therapist were just wasting their time. Therapy had become a routine, like going to the gym.
“It’s not that anything bad has happened,” he said. “It’s that nothing is happening.”
This was no longer psychotherapy, but an expensive form of chatting. So why did he stay with it? In part, I think, because therapy is essentially an unequal relationship. Patients tend to be dependent on their therapists. Even if the therapy is problematic or unsatisfying, that might be preferable to giving it up altogether or starting all over again with an unknown therapist.
Beyond that, patients often become stuck in therapy for the very reason that they started it. For example, a dependent patient cannot leave his therapist; a masochistic patient suffers silently in treatment with a withholding therapist; a narcissistic patient eager to be liked fears challenging his therapist, and so on.
Of course, you may ask why therapists in such cases do not call a timeout and question whether the treatment is stalled or isn’t working. I can think of several reasons.
To start with, therapists are generally an enthusiastic bunch who can always identify new issues for you to work on. Then, of course, there is an unspoken motive: therapists have an inherent financial interest in keeping their patients in treatment.
And therapists have unmet emotional needs just like everyone else, which certain patients satisfy. Therapists may find some patients so interesting, exciting or fun that they have a hard time letting go of them.
So the best way to answer the question, “Am I done with therapy?” is to confront it head on. Periodically take stock of your progress and ask your therapist for direct feedback.
How close are you to reaching your goals? How much better do you feel? Are your relationships and work more satisfying? You can even ask close friends or your partner whether they see any change.
If you think you are better and are contemplating ending treatment but the therapist disagrees, it is time for an independent consultation. Indeed, after a consultation, my writer friend terminated her therapy and has no regrets about it.
The lawyer finally mustered the courage to tell his therapist that although he enjoyed talking with her, he really felt that the time had come to stop. To his surprise, she agreed.
If, unlike those two, you still cannot decide to stay or leave, consider an experiment. Take a break from therapy for a few months and see what life is like without it.
That way, you’ll have a chance to gauge the effects of therapy without actually being in it (and paying for it). Remember, you can always go back.
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Open our eyes and the world can seem a scary place. Open our minds and the choices can overwhelm. Open our hearts, and we may feel a need to lessen the pain. Look to our souls to choose a path. Remember the joy, remember the discovery, Remember all we h…ave learned, Remember the friendship, remember the love… With feeling. Remember the pain, for what it taught us About ourselves, about our world. But, remember with mindfulness, And let the hurt go. In the darkest and coldest of nights, Our fearful or angery expectations will not serve us. But our dreams of a brighter warmer day Will illuminate a path to that dawn. Hope heals, hope sustains, Hope can warm cold hearts and open closed minds. To forgive ourselves, to forgive others, To dream of a better world that yet may be, This is love. To act on love, To be willing to strive and sacrifice For the growth and healing, Of ourselves and others, Is to be responsibly human. With such humans I have fought alongside for what I believes is just and fair, With such humans, I have wept, With such humans I have laughed, With such humans I have even vented and stormed. I have seen more than my fair share of bright warm days. Now, not by choice I must go. Without expectation that I will see days as bright or warm, Or coworkers as responsibly human. But with hope that I may be able to appreciate, How bright those tomorrows may be, And how responsibly human those future coworkers may be, Or, may yet become. When we look to the future, We create paths of energy That draws those futures to us. Always dream of brighter days… Especially in the dark cold nights. See More
By: Matthew Groff
Expert on Mental Illness Reveals Her Own Fight
Published: June 23, 2011
Marsha M. Linehan works with seriously suicidal people, having faced the same struggles when she was younger.
We find each other when we are ready to face some of the abuse that happened to us. We search for others in order not to feel so alone ourselves. We enjoy the camaraderie, the feeling of being understood and our common bonds. There is a unity, a common bond and an understanding that we don’t feel with everyone.
I felt different for so many years. I felt like I didn’t fit in, like I didn’t belong and I thought there was something wrong with me. I felt guilty for not being grateful, for not being happy and was ashamed of the depressions that I struggled with. I didn’t realize they were born out of the childhood abuse events that had not been taken care of properly.
I sought others who had suffered abuse worse than the abuse that I suffered so I could tell myself to stop complaining about what happened to me. This did not help me at all. I only talked about one abusive event in my life and I shrugged my shoulders when I even thought about some of the violence that I lived in, as if to say “ah, it was no big deal”. I had attempted to talk to a few professionals about my past, but I was often met with a neutral attitude, which really just affirmed to me that I was making too big a deal out of my story. I had always been told by my family that I was dramatic. One day when I was at the end of my rope, I decided to try one last mental health professional and something happened that became the beginning of my recovery.
Last week I published a blog post on the blog “Emerging from Broken” about the first session I had with that same therapist who eventually took me from shattered and broken, to wholeness and freedom. At the time of this writing there are 29 comments on that post. It really stirred up some feelings within my readers, and I thought I would share it with you here as well.
I called it “My Therapist Winced when I told him…..” I hope you stop by to read it and the comments that it generated from other survivors too.
Wishing you Freedom and Wholeness,