When Does Therapy End?

They call it termination.
In the field of mental health, some do. So, when should your psychotherapy end? An important question, and some recent research has some pointers to keep in mind. It’s particularly important when you’re in a more “psychoanalytic” or “psychodynamic” psychotherapy. When working this way therapy tends to be less structured. Someone might come in with one complaint, yet unearth a number of other issues. In other words, it’s not always obvious when therapy should end. Here’s the press release issued by the Univerity of Haifa:

Sixty Percent of Psychotherapy Clients Felt Therapy Didn’t End on Time

Sixty percent of private practice dynamically oriented psychotherapy clients felt that their therapy either lasted too long or ended too soon, according to recent research conducted by Prof. David Roe, Head of the Department of Community Mental Health, Faculty of Social Welfare and Health Sciences at the University of Haifa. “While there is widespread agreement that an ideal termination of psychotherapy occurs naturally, with an agreement of the timing between therapist and client, our research reveals that more often than not – this does not happen” said Prof. Roe.

In the study, which was conducted in collaboration with Dr. Rachel Dekel and Galit Harel from Bar Ilan University and Prof. Shmuel Fennig of Tel Aviv University Medical School, 82 people who were in private practice psychodynamically oriented psychotherapy for at least 6 months (and average of 2 years), which had recently ended, were assessed regarding the way they experienced the timing of, reasons for and feelings about their psychotherapy termination.

The findings, which were recently published in three psychotherapy journals: “Bulletin of the Menninger Clinic”; “The Journal of the American Academy of Psychoanalysis & Dynamic Psychiatry” and “Psychology and psychotherapy: Theory, research and practice”, revealed that 84% of participants stated that they initiated the termination; the remaining 16% stated that termination was either by mutual agreement or initiated by the therapists.

The results of the study show that only 40% of the clients felt that the therapy ended at the appropriate time, 37% felt that it ended earlier than it should have and 23% felt that the therapy went on for too long.

The most frequent reasons for termination among those who experienced it as too early were financial constrains (34.5%) and mismatch with therapist (27.6%). Among those clients who experienced therapy as lasting too long, the most frequent reasons were: feeling uncomfortable toward the therapist (26.3%), hope that the treatment would improve (21.1%) and dependence on the therapist (21.1%).

In general, clients who reported that termination was on time were more satisfied with their therapy. Factors contributing to positive feelings about termination included perceiving the experience of termination as an expression of independence, reflection of positive aspects of the therapeutic relationship and a reflection of positive gains experienced in therapy.

“Whereas clinical lore has consistently suggested that therapists must help clients focus on the emotionally painful aspects of this period and the difficulty in separating, the emerging data suggest that it is equally important to relate to the clients’ positive feelings” said Professor Roe, “Results suggest that clients find terminating psychotherapy at the right time important and yet difficult to achieve, and that clients experience a wide range of feelings, many positive, during the termination phase, which call for a reconceptualization of the role of the therapist during this important phase of psychotherapy.”

This research has the ring plausibility to it — it sounds true. It certainly provides lots of food for thought. If you have any comments, I’d be quite curious to hear any thoughts.

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Kalea Chapman, Psy.D.

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2 thoughts on “When Does Therapy End?

  1. Excellent article. This is a topic I discuss with my new clients in the beginning of therapy. I believe it should be a collaboration between therapist and client. The client ultimately has to decide what is best for them.

    Like

  2. Pingback: What Is Psychotherapy, Part 2 « pasadena therapist

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