In my work, one of the hardest things I face is letting a client know that it’s time move on. There are many reasons for ending therapy, and I’m going to explain some of them so you can see how complex the decision can be. I’ll start with a couple of reasons why clients end therapy.
Why do clients stop coming to therapy?
Clients end therapy for many reasons. One of the most common is that they don’t feel comfortable with the therapy or the therapist. In my mind, that’s a very good reason because if you’re not comfortable or don’t feel safe, then you’re not going to be able to benefit as much. Many people who end therapy for this reason simply don’t keep a scheduled appointment or never call back for another. From my end, it’s frustrating and still understandable. I wouldn’t want to work with someone I didn’t feel comfortable with or felt I couldn’t trust.
Another reason clients leave is financial. Therapy is expensive, and insurance benefits aren’t always very good. Insurance policies may limit the number of visits, require a high deductible, or have a high co-pay. These are all barriers for people wanting to pursue therapy. Some therapists don’t accept insurance, for a variety of reasons, and that can cause difficulty for clients as well. Many therapists charge between $90 and up to $175 (or more) per session, and that’s a financial burden for many. Specialized services (such as testing) can cost even more. Honestly, if comes down to putting food on the table or gas in the car versus therapy, I don’t blame people for choosing food or gas. Survival comes first, and I understand that.
There are emotional reasons for stopping therapy as well. Fear of the unknown and of change, feeling vulnerable, feeling hopeless that things can change or that no one can help are all reasons that some people stop therapy. These emotions are powerful, and there is a reason that we feel them. However, they can keep us stuck and far away from our goals. When I have a new client, I will often tell them that I admire them for being there. I really do, too - it takes guts to walk into a stranger's office and talk to them about things that hurt or make you feel vulnerable.
Unfortunately, some clients have also experienced judgment, boundary violations, or other forms of abuse at the hands of therapists. While I wish I could say that all therapists are ethical and respectful, unfortunately that isn't the case. In these cases, clients learn that they can't trust the very people who were supposed to help them. Sometimes, they are afraid of retaliation, and sometimes they are angry - and sometimes both at the same time. They have been hurt. There is a reason that state licensing boards and codes of ethics exist, though, and that reason is to protect the public.
Another reason clients leave is financial. Therapy is expensive, and insurance benefits aren’t always very good. Insurance policies may limit the number of visits, require a high deductible, or have a high co-pay. These are all barriers for people wanting to pursue therapy. Some therapists don’t accept insurance, for a variety of reasons, and that can cause difficulty for clients as well. Many therapists charge between $90 and up to $175 (or more) per session, and that’s a financial burden for many. Specialized services (such as testing) can cost even more. Honestly, if comes down to putting food on the table or gas in the car versus therapy, I don’t blame people for choosing food or gas. Survival comes first, and I understand that.
There are emotional reasons for stopping therapy as well. Fear of the unknown and of change, feeling vulnerable, feeling hopeless that things can change or that no one can help are all reasons that some people stop therapy. These emotions are powerful, and there is a reason that we feel them. However, they can keep us stuck and far away from our goals. When I have a new client, I will often tell them that I admire them for being there. I really do, too - it takes guts to walk into a stranger's office and talk to them about things that hurt or make you feel vulnerable.
Unfortunately, some clients have also experienced judgment, boundary violations, or other forms of abuse at the hands of therapists. While I wish I could say that all therapists are ethical and respectful, unfortunately that isn't the case. In these cases, clients learn that they can't trust the very people who were supposed to help them. Sometimes, they are afraid of retaliation, and sometimes they are angry - and sometimes both at the same time. They have been hurt. There is a reason that state licensing boards and codes of ethics exist, though, and that reason is to protect the public.
Why would a therapist end therapy?
When a therapist ends therapy, there is usually a very good reason. I’ll save the best for last, and go through a couple before that. When a client starts therapy, most therapists will work with her or him on setting some goals. Over time, if these goals are not met or we see our clients getting worse, we are ethically obligated to refer to another therapist for care. This is a difficult boundary to see, and many clients do not want to end therapy for this reason. When therapy goes on for a long period of time, and the therapist does not see improvement, then it is probably time to refer. Some clients have difficulty with this decision and others may feel relieved.
Another situation that might lead to a therapist stopping therapy or referring to another provider is when a client does not cooperate with the treatment. Here’s an example. The work I do in therapy is based on skills training, working with unhelpful thought patterns or emotional reactions, and dealing with problem situations or relationships. If I work with a client who does not want to work with these, or refuses to do so, then I’m simply not able to help. Yet another situation occurs when a client’s situation changes or reverts to a problem that I am not trained to treat. Substance use/abuse is one of those problems. Unwillingness to work on those behaviors means that anything I do will likely not work, because the substance use gets in the way of coping effectively.
One of the most frustrating situations for me happens when I find out that a client has been taking advantage of me. I used to have a very generous sliding scale (as low as $25/session) and found out that a few people were taking advantage of that generosity. While I take some blame for this – I now require income verification and use household income as the guide – I also do not like being taken advantage of. Thankfully, this situation has been very rare, and I have learned from it. My sliding scale is much more in line with other professionals and I require that verification of income before I agree to accept sliding scale.
Another situation that might lead to a therapist stopping therapy or referring to another provider is when a client does not cooperate with the treatment. Here’s an example. The work I do in therapy is based on skills training, working with unhelpful thought patterns or emotional reactions, and dealing with problem situations or relationships. If I work with a client who does not want to work with these, or refuses to do so, then I’m simply not able to help. Yet another situation occurs when a client’s situation changes or reverts to a problem that I am not trained to treat. Substance use/abuse is one of those problems. Unwillingness to work on those behaviors means that anything I do will likely not work, because the substance use gets in the way of coping effectively.
One of the most frustrating situations for me happens when I find out that a client has been taking advantage of me. I used to have a very generous sliding scale (as low as $25/session) and found out that a few people were taking advantage of that generosity. While I take some blame for this – I now require income verification and use household income as the guide – I also do not like being taken advantage of. Thankfully, this situation has been very rare, and I have learned from it. My sliding scale is much more in line with other professionals and I require that verification of income before I agree to accept sliding scale.
The last reason that we might end therapy is the best: There are clients who feel they have healed enough, reached their goals, and simply don’t need therapy anymore. These clients have worked hard, integrated new patterns of thinking and being into their lives and have moved on to a place where they feel confident in taking on the world without my support. In these cases, I am simultaneously very happy and somewhat sad, as I have usually developed a close, supportive relationship with them. Many of these clients have let me know over time that they are doing well – and that is incredibly fulfilling. Some come back for an occasional “booster session,” and that’s ok too. That tells me that they are basically doing well, and might need some minimal support to get through a rough patch. I have to admit, though, I love seeing people walk out of my office feeling better about themselves and their world. It’s one of the main reasons I do this work.
Please note: The information contained in this blog is not meant to be therapy or treatment. These entries are provided as information only. If you wish to talk with Dr. Burlingame-Lee about the services she offers, you may call her at (970) 776-6043 or send an email message to: thepowerofeachother@outlook.com. Dr. Burlingame-Lee’s services include individual and group therapy, life and creative coaching, and workshops and seminars on a variety of topics including self-esteem, coping skills, body image, and journaling.
If you are experiencing a crisis or emergency situation, please call 911 or go to your nearest emergency room. You don’t have to be alone, and there are people who care and will help.
Copyright 2014 by Dr. Laura Burlingame-Lee
Please note: The information contained in this blog is not meant to be therapy or treatment. These entries are provided as information only. If you wish to talk with Dr. Burlingame-Lee about the services she offers, you may call her at (970) 776-6043 or send an email message to: thepowerofeachother@outlook.com. Dr. Burlingame-Lee’s services include individual and group therapy, life and creative coaching, and workshops and seminars on a variety of topics including self-esteem, coping skills, body image, and journaling.
If you are experiencing a crisis or emergency situation, please call 911 or go to your nearest emergency room. You don’t have to be alone, and there are people who care and will help.
Copyright 2014 by Dr. Laura Burlingame-Lee
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