Queries Before You Break Up With Your Therapist

Ending and Unending Part 1 of 3

Two or three times a year, I’ll unwittingly schedule an initial consultation with a potential client who reveals that they are “thinking of leaving” their current therapist – and are meeting with me and several other clinicians as they shop for the quickest exit strategy.

Here is the deal: if you’re single, it’s not a great idea to date someone who is going to leave their partner any minute now, but just hasn’t told them yet. And it’s not a great idea for me to take your case when you are in an active relationship with a clinician who has committed to working with you, but hasn’t been told that it’s not working.

So: how do you know when you should break up with your therapist?

Unless there are some shockingly obvious ethical violations involved – in which case you are permitted to head for the hills without looking back – the answer is very simple:

Talk to them.

Ridiculously obvious advice about how to use the talking cure.

You may feel that the therapy has reached a state of impasse right at the edge of a wonderful milestone, a fantastic accomplishment: the moment when it is discovered, with absolute certainty, that you know more about your own needs than the therapist does. Many people become fearful or disappointed at this crossroads – certain that their therapist will feel diminished, injured, enraged, or may never be able to be of use to them again.

We all just prefer to have our minds read, don’t we? We don’t want to have to explain all the time. We want our partners, parents, and friends to guess exactly what we want for our birthdays. And we want our therapist to just “know” what makes us sad, upsets us, what we need from them. Why on earth are we paying them if not to be understood – magically, instantly, completely and without having to explain a thing?

If we have to tell someone what we need – or say that we don’t know what we want but are pretty sure we aren’t getting it – well then, it just ruins things somehow.

It disrupts the illusion that there is any way (after two years of age) to have our un-verbalized needs read and met by huge, magical, intuitive all-loving parents. And part of us thinks that should be quite doable somehow; because there was, in fact, a time in our lives when our needs were quite simple: food, human contact, sleep, diaper change. Simple needs, clear clues, good odds (1 out of 4) of getting satisfaction without having to say a word.

Subsequently, in adulthood, we all occasionally feel terribly, unduly burdened:

1) We first have to figure out our own complex, mature, interpersonal needs -

2) Then formulate a plan to take responsibility for them ourselves -

3) Next, we have to ASK for the need, or some part of it, to be met and cared for by others

4) We then have to weather the disappointment of rejection or the mere partial fulfillment of our needs –

5) Worst and last: We are then left to cobble together some plan to take care of the leftover hunger on our own.

Too, too many steps: It would be so much easier if our partners, care-providers, healers, loved ones, bosses, shrinks – would just guess correctly and spare us all that work.

Often, clinicians/therapists can be pretty good guessers. The more intuitive and experienced they are, the better they are at seemingly pulling our most subtle needs out of thin air. Still, they aren’t magicians and – even if they were – at some point they will need to start failing, or just stop guessing because it doesn’t serve our process of growth to keep waiting for the grown-ups to show us what we want. Our needs are our own responsibility to negotiate.

So, you have to talk to your therapist about your dissatisfaction even if you don’t like them very much right now. Even if you know they are limited, haven’t been of much help, or will never “get you.” Even if you know that you have made up your mind, like them well enough, feel they have done their best by you, and you don’t want to hurt them.

Even if you dread it.

Tell them you are unhappy or dissatisfied with the course of treatment, that you don’t feel sufficiently challenged, supported, listened to, pushed, understood, whatever.

Tell them.

You will learn a great deal about the viability of the relationship from their response. If, as you fear, they become defensive, angry, anxious, injured, avoidant, accusatory, or calmly and completely blame only you for the relationship’s failures – that is in itself very important data.

Perhaps this is not a good fit. Perhaps you are activating some counter-transferential difficulties for them that makes it hard to respond due to their own history and their own wounds. Perhaps they are narcissistically attached to being right, to giving you advice, to your dependency on them. Perhaps they are extremely healthy, excellent at what they do – but they are loyal to a model that you don’t find useful.

Even if it’s a total miserable dead-end, you will get to leave clean, like a grown-up, making a self-respecting choice, after eliminating any doubt that you could have worked it through.

You will also have seized a great opportunity to create a corrective experience: what if the “no-longer-good-enough” therapist displays sincere interest in your “bad” feeling? What if they are pleased to have the opportunity to grow, to change, to accommodate, to learn more? What if they deeply yearn to take responsibility for errors and mis-attunements they may have committed? What if they can apologize, and take their share of the responsibility without collapsing in shame? What if they value your feedback because it will give them information they don’t know, maybe even information about themselves of which they were unaware? What if they are grateful to you for showing them an unknown bit of their shadow and giving them a chance to integrate it?

What if they treat your concerns, your anger, and your disappointment as if they are important and valid? What if they have enormous empathy for the hopelessness that has emerged in your relationship? What if they can still care about you and remain intact in themselves, in the face of your negative feelings? What if they have felt blocked and frustrated as well but were not yet able to identify it? What if this discussion is able, in and of itself, to break through the logjam?

Even better: What if they are proud of you? Impressed by your self-regard, and your ability to stay loyal to your own experience? What if they want to help you keep strengthening this newly discovered muscle?

What might that mean to you?

Or perhaps they can at least agree that the clinical relationship has not been a good fit, and the therapy can end honestly and mutually? What if they can release you to a new scenario, a new therapist, and still feel proud of whatever you were able to accomplish together or the integrity that you both showed at the resolution of the relationship?

What if you don’t need to protect them from your feelings, needs, wishes, desires?
What if you never did?

I’ve been in many relationships, personally and professionally, where the greatest growth came from the way we left each other. The real failure is not the necessary ending of a therapeutic relationship; it is missing out on the opportunity to be further healed by leaving well.

copyright © 2011 Martha Crawford

12 responses

  1. I feel as if you are saying things I think all the time and so want all my patients, all anyone’s patients to know about. I have started referring some patients to your blog. If they go, it opens up all kinds of discussions. I’m feeling really inspired by reading what you are writing.
    As to this latest post, I find the most frustrating thing is when a patient quits therapy unresolved, without discussing things. Sometimess I know what’s gone wrong and sometimes it’s a mistake. Another frustration in being a therapist is when a patient quits for reasons he or she thinks are very clear but there has been a misunderstanding. I wish all my patients believed that they did’t have to protect me or themselves from that sort of confrontation.
    Thanks so much for this blog. I’m referring colleagues to it as well.
    Julie in San Francisco

  2. Thoughtful, incisive. Such a good balance of knowledgeableness and humility. Thanks again, shrink!

  3. Hello,

    At the top of this post you’ve written “Therapy Ending and Unending Part 1 of 3″ – I’m struggling to find parts 2 and 3.
    But in case they’re as yet unwritten, perhaps I could ask you to write about what it feels like as the therapist, when a patient just leaves from one week to the next without an overt indication that that is what they were going to do. I’d be most interested in what the shrink thinks…

    • On Leaving and Being Left is part 2, Back to the Wild is part 3.

      Hmmm – it happened more commonly when I was in clinic settings with clients who were pressured by “the system” into treatment that they hadnt chosen for themselves…- In my own practice I have usually have some sense that there is something happening in the therapy that is out of balance, the alliance has been lost or harmed by an error, or sometimes the client is simply not ready to face the issues that are emerging – and I try to create an environment for clients to feel that they are allowed leave, and will be welcomed back if their feelings or readiness changes. I supppose it depends on how and why the treatment was disrupted –

      I also allow clients to self-regulate, and arrange contact, take breaks, engage and disengage as they can tolerate, as long as it feels productive for both of us.

      I can’t say that this circumstance has happened to me in recent memory -(but as soon as I type that – Im sure someone on my caseload this week will suddenly terminate without informing me!) – I try to actively discuss the ways that the therapy may be frustrating, upsetting or failing them in someway and set up the expectation from the first session that I will be glad to help them leave if they ever feel they need to – and create opportunities to leave with good will – offering other referrals etc.

      Thanks for reading.

      M.

      • Thank you very much for your response – the more I read your blog the more I enjoy it!

        And I found parts 2 & 3 by clicking on a tag “Leaving Therapy” I hadn’t seen previously in the left nav. Reading them made me feel both better and sadder – a weird combination!

        One of your lines (I think in #2) about your first therapist dropping his end of the rope when you let go of yours really struck a cord (sorry, couldn’t resist!) with me. I plan to think about this idea & reread your posts until it provides me with the liberation it provided you.
        Thanks again.

      • I think what I found liberating was that I knew, utterly, that my analyst cared about me, but, in service of real growth for me academically, professionally, he could let me go.

        It established for me that I was was cared about, but not needed- and untangled those two concepts for me for the first time.

        Thanks for your comments!

  4. I think this should be required reading for anyone entering therapy. So much of my work and healing centered around learning to identify, understand and express my needs (I had a very patient, compassionate therapist who gently taught me how to ask, and even more importantly, learn I could survive hearing a no occasionally.) You have such a gift for articulating things that I have learned are true but wouldn’t be able to express. Thank you.

    • Thanks so much, for your comments, encouragement, and support, and ping backs. I’m very glad to hear that some of what I write speaks to others experence as well – and hopefully serves to assist therapists and clients in coming through some sticky patches together.

      I do think its important to talk to clients at the beginning of the process of how they might feel later on, and I try to emphasize the opportunity to leeave differently is one of the gifts of therapy.

      Best,
      Martha

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