Inverse - 🧠 Let’s talk about when to end therapy

By Sarah Sloat

Hello! My name is Sarah Sloat and welcome to Sunday Scaries #129. Thanks for reading this chill newsletter for not-chill people. 

This week we’re talking about the fraught timeline for therapy. Do you have a mental health topic you’d like me to tackle in upcoming issues? Let me know with an email over to sundayscaries@inverse.com.

This week’s chill icon

This week’s chill icon is Fury, also known as Lick Fury (nice). Sunday Scaries reader Anne says this photo — a masterclass in chillness — was taken after “a hard day of therapy dog training.”

Have you encountered a chill icon (or icons) IRL or during your internet browsing? If so, I want to hear from you! Send an email over to sundayscaries@inverse.com and you may see them in next week’s newsletter.

Let’s talk about when to end therapy

Stigma around seeking therapy is dissolving — in fact, therapists are having trouble meeting increased demand. But as more people choose therapy, it begs the question: After you start going to therapy, when do you stop? 

Finding the right therapist and deciding what to talk about at the first appointment are deeply personal decisions that will be informed by individual needs and accessibility constraints. The decision to end therapy is similarly nuanced. Ultimately, successfully ending therapy is widely seen as one of the practice’s primary goals. Technically called “termination,” how to end therapy well is understudied — both from the therapist and the individual’s perspective. But there are best practices to help guide both.

The therapist’s job is to guide you toward greater clarity and help you meet your goals, but it is up to you to decide what is best for your mental health. It may be helpful to set out “how I’ll know I have achieved my goals” before you start therapy and come back to these intentions as you move forward.

“As a therapist, my job is to work myself out of a job,” therapist Jaime Castillo tells me. Castillo works with adults who experience generalized anxiety, obsessive-compulsive disorder, post-traumatic stress disorder, and phobias. 

“I talk about stopping therapy with my clients from the very first session when I ask them: ‘How will you know when you have gotten everything you need out of this process? What will be different in your life?’”

Begin therapy by talking about ending therapy

Castillo asks new clients to think about what success looks like because it helps the client know when they are ready to stop therapy and helps her understand their goals for therapy. Once those goals are met, Castillo revisits terminating therapy with her clients, she says.

Alyssa Mancao, a therapist and licensed clinical social worker, says she “personally believes that clients can remain in therapy for as little or as long as they would like depending on what they are working on.” But the medical model underlying therapy posits it has a start and end, she tells me, because it is at its basis, a treatment for a set of symptoms. Ending therapy is the same as completing a course of treatment for a health condition — but in the case of therapy, it is ultimately optional.

Joel Minden, a licensed clinical psychologist who specializes in cognitive behavioral therapy, emphasizes it's important for “clients to know that their participation in therapy is completely voluntary and that they’re welcomed to discontinue treatment at any time.”

How do you know it’s time to end therapy?

There are many different types of therapy to treat mental health issues. In turn, knowing when it’s time to end therapy — and then actually doing it — is going be different for different people. The therapists I spoke to explain most situations link back to one question: Does the client have the skills they need to manage the reason they started therapy? 

Celeste Viciere, a mental health advocate and therapist who practices cognitive behavioral therapy, points out there is no one way to do therapy and no set time limit. “People can come as much as they want or they can scale back or not come,” she says. 

She doesn’t ask someone to stop therapy, but if someone is coming in consistently and things are going really well for them, she asks them if they want to scale back their sessions because they now have the tools to empower themselves.  

“But it doesn’t mean that life is perfect when I say ‘going well,’” Viciere tells me. Instead, it means “you’re self-aware of what’s happening; you’re managing when things are coming up.”

Evaluating whether or not it’s time to decrease sessions, rather than ending them completely, is called the “maintenance phase” of therapy, explains Mancao. This may be when a client is coming in weekly but has little to discuss because of their overall progress in treatment, she says.

If a client feels they’ve made good progress toward their goals but is nervous about ending therapy, Castillo may “recommend decreasing frequency and seeing how that feels.”

“In most cases, clients end up feeling great about how well they are able to manage their emotions on their own with a longer time period between therapy sessions,” she says. 

Castillo looks for these signs to tell if a person is ready to stop or take a break from therapy: 

• They aren’t triggered by past trauma as often
• Their anxiety feels more manageable than it did before
• They feel ready to rely on other supports such as friends, family, church, or other peer groups to manage stressors

Mancao offers some other signs that can also suggest a client may be ready to end therapy: 

• Stronger mental health
• Ability to implement the coping skills they’ve learned in treatment 
• Overall improvement in functioning “which leads to increased satisfaction in life and relationships,” she says

How long does therapy take to work?

How long someone should spend in therapy depends on the type of therapy they choose and their personal goals. For example, Castillo explains that a person with mild to moderate anxiety disorder “might require a few months of therapy, whereas someone with a complex trauma history might require a couple of years.” 

Minden adds that it might take two to three months if a person comes to therapy with a specific issue they want to address, such as a relationship conflict or trouble coping with a major life transition. 

“For individuals with ongoing struggles, it can take much longer to develop new skills, change behavior, and manage difficult thoughts and feelings,” he says. 

“It’s also the case that some clients are interested in time-limited treatment while others value the long-term support they get from an established therapeutic relationship. If the client and therapist are good about clarifying the purpose and direction of therapy, it can be much easier to create a timeline and evaluate whether to stop treatment or keep going.” 

The few academic studies on ending therapy support this sentiment. For example, a 2021 study on young people in therapy found that when therapeutic outcomes didn’t improve but therapy ended, this resulted in setbacks like “feelings of loss and abandonment.”

“This was compounded by unrealistically high public expectations about the impact of therapy on outcomes and trying to strike a balance between fostering hope and managing expectations, within a context of inflexible service structures and resource constraint,” the study authors write. 

In a 2017 feature published by the Society for the Advancement of Psychotherapy, the author notes that termination can be framed as a loss or a transformative experience. It is a loss if the client feels unready for the therapy to end, and transformative if termination is framed as a time for growth and an opportunity to use new insights and skills. A 2013 study suggests termination is more likely to end well if clients and therapists join in their efforts to make it a positive experience. 

Viciere typically sees clients over a long period of time, and she tells her clients they can come back whenever they want. But she also wants her clients to not second-guess themselves if they find they are ready for therapy to end. 

“You’re going to be okay,” she says. “Remember: You’ve been to therapy, you’ve been talking about these things, and if you’re leaving the therapists’ office and implementing the tools that you’ve learned, then you’re giving yourself what you need.” 

Minden describes it as a “wonderful moment” when a client decides to stop therapy because it shows they’re prepared to address challenges on their own with the coping strategies they’ve learned. 

But because “life can present new and unexpected challenges” he always encourages them to get in touch if they need to. 

“If you are embarrassed about reaching out for support, go easy on yourself, just as you might with a friend or a family member who decided to go back to therapy after a break,” he says. “Counter the self-critical talk with encouragement and remind yourself of the benefits of seeking professional help when life gets difficult.”

Now look at this oddly satisfying thing

This beautiful sight was shared by Sunday Scaries reader David.

Have you noticed any beautiful patterns in nature? If so, I’d love to include your photo as a satisfying image in upcoming newsletters. If you’d like to share, send an email over to email to sundayscaries@inverse.com. 

What I’m reading this week

Distract yourself from the scaries with these reads:

• The oral history of ‘Mars Attacks,’ Tim Burton’s misunderstood sci-fi masterpiece. Ack, ack, ack! 
• Is coffee before workouts good or bad? The benefits of caffeine, explained. Here’s some good news for people who love bean juice. 
• How did life arise? New study offers fundamental evidence for a disputed theory. What early life has to do with the “Lost City.”
  

And if it’s midnight and you’re still feeling the scaries . . . 

• Read the saga of Jorts the cat.
  

Thank you for reading! If you’re socializing during the holidays, get ready to do so safely by reading this first.

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