Friday morning means therapy. For one hour every week, I work through some of the things that cause my anxiety and panic attacks.
It’s been this way since July last year – but one session, a few weeks ago, something was different.
For the first time, I sat down on the couch opposite my therapist and realised I didn’t have anything to say.
It made me think about whether I was ready for it to come to an end.
I started NHS therapy in July 2018 and after a 10-week block of 30-minute sessions, they recommended that I should have more intensive therapy but told me I would have to go back on a waiting list.
With some financial help, I paid for private sessions. I’ve had 10 of those now and they’ve been a massive help.
Breaking away from something that I waited on for so long, and that has had such a huge and transformational impact seems like a pretty big deal.
So how do you know when you are ready to stop?
According to psychologist, author and therapist Dr Kalanit Ben-Ari, it’s vital to assess what your goals were for having therapy and whether you have really met those.
Dr Kalanit tells Metro.co.uk: ‘You’ll know when you’re coming to the end when you know how to manage situations in a safe, connected and empowering way.
‘You’re able to react to situations and communicate without negativity, raising issues with self-awareness before they become problematic, taking ownership of them.
‘Your relationships with others are significantly improved and you know how to maintain healthy connections, allowing yourself to experience the emotions that come along with them.
‘It is important to experience all of the above – just feeling positive but ignoring issues or avoiding challenging topics doesn’t mean you should end therapy without giving it some serious thought.’
Textile designer Safiyyah had therapy after she developed postnatal depression. She was given a course through the NHS and by her 13th session, she felt it was time to move on.
She explains: ‘I felt it was the right time to end because I found I was having more good days than bad days.
‘Every week, we talked about what happened within that week and lessons I learnt from previous sessions. I was showing signs each week of actively putting into practice what I had in past sessions.
‘We gradually reduced from once a week to every two weeks, then every three weeks and then a final session.’
What if you are having fixed-term therapy?
Some people start therapy with an agreed number of treatments, which means you don’t have much choice about when it comes to an end.
According to psychotherapist Noel McDermott, therapists often have a good idea of the number of sessions required for each condition, which helps them decide on the number of sessions you need.
He says: ‘There are average numbers of sessions for certain types of conditions. For example, non-complex generalised anxiety disorder should resolve itself after about 12 sessions, but also can alleviate much quicker than that, this is especially true if you catch it early at the acute stage.
‘The general rule is with acute stage and no comorbidity with other issues, the quicker the issue will resolve with help. Where you have more the one diagnosis (comorbidity) such as PTSD and addiction, the more time it will take and in those situations you may have to decide what order to treat the issues in.
‘So for example deal with the using behaviours because that is the riskiest, before you deal with the trauma.’
Anna Blewett recently had the third course of therapy in her life, this time through Relate, which was given over six months but the end was discussed from the start.
Her first block of therapy when she was 19 ended abruptly after difficulties with the therapist and the second stint ended when she moved away, though she did feel it was coming to the end at the same time.
Having experienced other types of therapy, she felt that having a set time helped her commit and she felt ready to leave when it came to an end.
She says: ‘With Relate, I was really glad for how focussed the process was, and the process was laid out in the first session so there was no drift – always moving along a fixed-line.
‘That helped feel less overwhelmed by the tangle of issues we were unpicking, plus lessened anxieties about how much it’d all cost!
‘Coming to the end of a successful period of counselling feels good – I knew I’d made huge process, literally crossed a chasm and was heading off into the sunset on the other side.
‘I know plenty of people who have never reached that point with years of counselling, and though my issues were very minor compared to what some people are dealing with, I do feel some counsellors are happy to drift along within their clients’ comfort zone.’
Dr Kalanit adds that it’s important to have goals in mind and to work towards those to make a fixed number of sessions work.
‘From my experience, the amount of sessions a person needs depends on the commitment they’re willing to apply to the process.
‘It’s their awareness and ability to own what they’re going through and willingness to grow beyond their comfort zone. I have worked with couples who came to me at the start of divorce proceedings, so therapy was their final effort to salvage the marriage, and they managed to transform their relationship relatively quickly because they worked hard on the processes.
‘Whereas for some people, it can take much longer for them to see the importance of their contribution, and to actually apply themselves to make a change.’
How do you stop therapy?
Although slowly cutting down isn’t recommended in older models of therapy, psychotherapist Noel McDermott says it is becoming more common to take that approach if the client needs it, and it is usually ok to stay in touch with your therapist.
He says: ‘In modern therapy, it’s not such a big deal. It can be helpful in some cases to step down to fortnightly rather than just stop.
‘There isn’t a hard and fast rule here and I have the practice of keeping in light touch with some of my ex-clients for the first two years after the end of the work.
‘Generally, this is done by text and amounts to checking in and showing interest in how they are.
‘I’m generally very happy if ex-clients wish to stay in contact or even book individual sessions to catch up and show off about how well they are doing.
‘There are occasions when this isn’t appropriate clinically but it’s very much in the mix if it’s safe to do so.’
Some people might find it more useful to stop completely and you can discuss with your therapist what you need to do to continue your journey.
What do you do when you finish therapy?
Going from having a safe space to work through your problems every week to go out on your own is a big step.
When Chris Nunn ended his therapy sessions on the NHS, he admits that it was difficult.
He’d decided to stop because he felt the type of therapy wasn’t working but wasn’t prepared for how he felt losing that space.
He explains: ‘Looking back, I think I was looking to end things as I didn’t really “feel it” more than anything; as while it helped me explore negative feelings and beliefs, it never really got to the point of countering them or flipping them.
‘We hadn’t long renewed the “prescription” of sessions as I was still struggling but, about halfway through there, we did a mini check-in as I wasn’t making much progress and seemed to be going over old ground a lot.’
‘But my therapist was the only person I (sort of) felt comfortable talking to; so losing that was a bit of an issue.’
Jen Kaarlo has been going to therapy on and off for 20 years and when she stopped a recent block of private sessions, she channelled the time into new things to help her continue to manage her mental health.
She says: ‘At that point, I knew I was ready to stop therapy. I was able to carry on without it with the help of some friends that understood what I was going through.
‘I think I also channelled a lot of that energy into new things I hadn’t done before such as running a half marathon. when you’re feeling quite emotional it can be helpful to get your angst out on the pavement.’
Psychotherapist Helena Lewis adds that no matter how you conclude that it’s time to stop, there are several things to consider.
She says: ‘I would recommend speaking to your therapist about your options and ask any questions you may have. A good therapist will provide you with tools and resources to help with the transition.
‘Ending therapy can often feel anti-climatic. You won’t achieve a big epiphany and you will have developed and learned things throughout the course that you will still need to work on. Also, some people, especially those who have been in therapy for a while may experience separation anxiety, which will need to be managed.
‘I recommend sticking to a routine for a short while after finishing therapy and choose the areas that you particularly want to focus on and keep working on them.
‘Keep a diary to track progress and go over what you have learned in therapy. If your therapy has previously given you homework, try going over it to help understand what you have learned and to see improvements.’
And even though you have stopped this course of treatment, you can go back to therapy in the future in you start to struggle again.
Noel explains that you need to keep working with the things you learnt in therapy, but don’t be afraid to consider more sessions if you feel you need them.
Noel adds: ‘If you start to struggle again do first of all forgive yourself. One of the things you would ideally discuss with your therapist when ending is your personal ‘fire escape plan’ which is those symptoms and signs that suggest you need to get back into therapeutic support.
‘This plan should be graduated so that you don’t overreact at the first sign of trouble, so might include levels of symptoms and levels of support ranging from sharing more with family and friends, increasing healthy behaviours such as exercise right up to booking more therapy.’
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source https://metro.co.uk/2020/01/16/know-ready-stop-therapy-12067996/
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