Breaking Up With Your Therapist.

When Attition asked my advice (in a comment at Balancing The Scales, which, incidentally I have decided to use for my day-to-day fitnessy crap, featuring a post today about how far I'm willing to go to try to get fit), um, yeah, so where was I?

Ah, right.  So, Attition asked my advice on how to 'break up' with your therapist.  And I was going to just [be normal] email her back but then I thought, 'Hey! Here's a post about my job that I can actually write without violating patient confidentiality. Bonus!'  (Which, incidentally, shows exactly how I come up with these AWESOMELY INTERESTING topics for my blog. Gah. And also?  I actually thought 'Bonus!' which is so lame when I type it out, but there it is.)

So.  Here's begins my [boring ass dissertation] tutorial on breaking up with your therapist.

I am assuming here that, should you want to break up with your therapist, one of a few things may have occurred:

1. You've entered into the therapeutic relationship and after an initial honeymoon period (or initial hesitation that you talked yourself out of) you've discovered that your therapist isn't *the one* for you.  It's a relationship doomed to fail but you are hesitant to break it off and want to *let her down easy.*
2. You've been in treatment with someone for a while and things were going well and then there was some incident or misunderstanding, perhaps and you've been hurt or are upset/annoyed/angered by your therapist.
3. You feel that you've benefited the maximum amount from treatment and would like to pause or stop treatment entirely at this time.

The answer to the question about how to break up with a therapist is a complex one (did I just hear you groan?) and it depends upon the reason you want out. 

For instance, if your situation most resembles issue number 1, I'd call that a 'Goodness of Fit' issue.  And, IMO, Goodness of Fit is essential for a therapeutic relationship to work.  If you don't have it and you don't foresee having it in the future, it is best to end the relationship as soon as you know it.  Otherwise, you'll be sitting there, week after week, potentially building resentment and/or feelings of discomfort.  A good therapist will know all about this issue and will explore it briefly with you and perhaps offer ideas or a remedy but will ultimately probably already know that it is a mismatch.  A good therapist will also offer to help you find another clinician and/or will provide you with a referral and/or will let you go with a full heart and wishes of luck and good health, if you know what I'm saying.  If the therapist seems offended, irritated, angry or bitter, you were RIGHT. Your therapist isn't any good and it's best if you get the hell out.

Issue number 2, though, I think is different.  If you are in a solid therapeutic relationship and something happens (psych-speak = a 'rupture' in the relationship), it may be that the issues in the treatment are getting super-imposed onto the relationship.  It can also be that the therapist's feelings/thoughts/judgements got the better of him or her.  Or that the session didn't go where he/she thought it would.  These kinds of incidents happen in any kind of relationship and in my experience (on both sides of the proverbial desk), the working them through is key and can create a stronger, healthier relationship as well as can further the treatment.  In such a case, I would give the relationship a chance.  (Of course, this doesn't go for the kind of shit that asshole on the HBO show did.  If your therapist throws coffee at you, run and then call the police and press. charges.)

Issue number 3 can be tricky.  Let's face it, depending on what kind of treatment you're in, there's always more work that can be done.  I could see myself in treatment, neurotic-style working through my own issues, for a long time.  I'm fine without it, mind you.  It's just sometimes nice to have that outside person to talk to.  Someone who is there to hear you and you only.  But, whenever the patient feels done, IMO, the work is done.  Even if it's not.  So, if I were your therapist and our goals hadn't really been met, I might give you a gentle nudge to see what I'm seeing.  If that was a no-go, I would let you go, with a full heart and wishes for luck and good health, if you know what I'm saying. 

Basically, the relationship is about you.  It is for your benefit.  You are paying for the treatment and although a good therapist isn't there to tell you what you want to hear, that person has to be someone that you are comfortable with, that you can see yourself trusting and that you ultimately like.  A good therapist understands the need for a good fit, the need to establish trust and rapport, the need to make interpretations in a way that will be palatable for you.  They understand different personality types and are able to adjust their practice to fit the needs of those who come to see them. 

I know that therapists like that aren't always easy to find, though.

And if that's the case, you can feel free to leave the old break up on the machine.  It sounds like this: 'I'm sorry that I have to cancel our appointment for Friday.  I'll call you when I want to reschedule.'  That'll work too.

Just make sure to give 24-48 hours notice.

You know, you don't want to be a dick about it.

Comments

[Mary]

I have done the "breaking up with the therapist" thing once (with the actual person who listened to me talk, except she didn't which is why I broke up with her), and ended up with a great person who listened to me. I am getting ready to break up with my psychiatrist (I have to have one who can prescribe the drugs) because she refuses to believe that perhaps the drugs aren't working and should either be changed, or increased. She is willing to do NEITHER of those things... so my last appointment with her is in a couple weeks - so I can break up with her. The first time I did that, it was so empowering. Maybe this time it will be as well!?

[Amanda]

Or you can do what I did and just not reschedule after your therapist cancels on you and then ask for your records. I did this with my son's psych. She would always dismiss what I had to say as if I were "just another crazy mother." Too bad our 2nd and 3rd opinions proved me right. I find it hard to take the word of a person who is a child psych that has no children of their own. To me, it's like all of their knowledge comes from books, and not from practical application. It also didn't help that we could only get in to see her once every 6-8 weeks and it was at least that long again if we had to reschedule for any reason even if I called weeks in advance.

Maybe you should start a new post day called "Ask The New Girl." LOL

[the new girl]

Bea: Yes, there ARE. And I would not classify the first therapist's behavior as SUBTLE. I would classify it as COMPLETELY INAPPROPRIATE and a reportable ethical violation.

In my book, when therapists do things like complain about their spouses or compliment a person's looks ((shudders all around on both of those)) it shows, at best, a blatant disregard for the boundaries essential to provide effective treatment and/or, at worst, a boundary crossing that violates (or has the potential to violate) a patient.

I also find the other therapist's behavior unconscionable, as trying to get a patient (a new one at that) to disclose information by guilt, intimidation and/or repeatedly pressing is Double Asshole Behavior, especially from a therapist (who is supposed to know better).

Sorry for the second post. Stories like that really, really piss me off.

[bea]

A friend of mine switched therapists after her male therapist started crossing that line: he would complain about his wife, compliment her on her looks... It was subtle, but enough to freak her out. So she changed to another therapist in the same practice and at her first appointment the entire focus was on grilling her about her reasons for switching. She declined to give a reason, and the rest of the appointment focused on her "history" of switching therapists, with lots of overt and covert attempts to bully the reason out of her. It struck me when she told me about it as behaviour that was certainly unethical and possibly even illegal. Are there codes of conduct that govern this kind of thing?

[attiton]

Thanks!! F-everyone's-I, I'm in group 1. There wasn't even a honeymoon period. I just thought I could work with it.

My past therapist was more of a Freudian type (NYC, natch), but this California-behavioral-type therapist is all, "You know, here's what you could do about this...couldn't you just say that?" And, I'm all, "I DON'T NEED YOU TO TELL ME HOW TO BEHAVE, I NEED YOU TO LISTEN TO ME!!!"

Others might need what she's offerin', but not me. And, now that I say it, that's exactly what I needed from you, TNG. Huh.

I will do what you say. I know you are right. I am now emboldened. Send me a bill from your anonymous Internet name to mine. :)

[The New Girl]

Kai: I DON'T KNOW. I don't think that I've ever heard of that. I am hoping that there was some explanation and not just, 'don't come back.'

Odd.

[Princess Hippopotamus]

This makes me want to go GET a therapist just to see what kind of situation I could get in to, and then find out if 1, 2 or 3 best describes it!

This is pretty useful stuff. Anyone have any library questions I could answer?

[Keila]

this happened to me two years ago. I started to go to therapy for many reasons and the therapist was like how can I phrase this - a bitch. When I would bring up an incident that happened two months prior (the whole reason I was there) she would be like, that is in the past not important. TWO MONTHS AGO LADY - shit is still raw and I want to talk about it - hence why I am here.

Then she would go into long winded examples that always turned into stories about her family. Then she would complain and complain about how little money she made at this specific practice and then she would eat during my session!!!

I had to tell her good bye, switched over to her boss and since then I have been happy as pie.

If you are not getting results or are not comfortable - then you gotta drop them.

K

[Natalie]

Okay, so do you have any advice for FINDING a good therapist that will be a good match for you? The last time I went to therapy was when I was trying to salvage my marriage and the first thing I was asked when I walked in was if I wanted drugs. The answer was no, but if I go again I don't want someone who is going to think of drugs as the first answer.

[moo]

very nicely written. I had NO IDEA you were a therapist. If I had, perhaps I would've tempered my comments a little.

But probably not.

[Kai]

Is there a remedy for when your therapist breaks up with YOU? I went twice and was asked not to return! Is it normal to get kicked out of therapy???!

Great post and a lot of help for people who don't know how to "break up"...I may use this technique on my hairdresser!