Leaving Therapy Prematurely: "Feeling Better" Isn't Always a Good Reason to Stop Therapy

While it's understandable that people want to feel better, feeling better isn't always a good reason to stop therapy--especially when there is unresolved trauma that remains unaddressed (see my article: Why Do Clients Leave Therapy Prematurely?).

Sometimes people leave therapy because they're afraid to deal with the emotions that come up when they do deeper work in therapy. 

Many of them have never learned to deal with uncomfortable emotions so, rather than talk to their therapist about this, they leave, but their problems remain unresolved (see my article: A "Flight Into Health" As An Escape From Therapy).

Leaving Therapy Prematurely

Clinical Vignette

The following clinical vignette which is, as always, a composite of many different cases to protect confidentiality, illustrates why feeling better isn't always a good reason to leave therapy:

Bob

Bob, who was in his mid-30s, started therapy after his girlfriend left him. He was heartbroken and the breakup triggered feelings of abandonment from his early unresolved childhood trauma when his father left the family unexpectedly.

Bob began doing trauma therapy to deal with his current feelings of abandonment by his girlfriend as well as the earlier unresolved trauma.

After attending therapy for a few weeks, Bob met Marie at a party.  After a couple of weeks of dating Marie, he had all the "feel good" emotions people experience during the honeymoon phase of a relationship.

When Bob went to his next therapy session, he told his therapist he wanted to leave therapy. He said he no longer wanted to work on his earlier trauma because he was "feeling better." 

His therapist explained to Bob why it would be beneficial to complete the therapy. She told him that, even though he felt better at that point, his underlying abandonment issues were still present--even though he didn't feel them at that moment because he was head over heels for Marie.  

Bob decided to leave therapy against his therapist's advice. He was feeling great--until his relationship with Marie fell apart three months later when she told him she no longer wanted to see him.  Then, all his old abandonment feelings came rushing back and he felt worse than before.

When he returned to his trauma therapist, he returned with a much deeper understanding of what she told him before he left therapy a few months before.  This time he made a commitment to stay in therapy to work through his unresolved childhood abandonment issues. 

He understood at that point that "feeling better" due to external circumstances was not a reason for him to drop out of therapy.

Conclusion

It might sound counterintuitive that "feeling better" isn't always a good reason to leave therapy.  But when leaving therapy is based on external reasons and unresolved trauma doesn't get worked through, the trauma remains an underlying issue until it gets triggered again.

It might take longer than you anticipate to work through unresolved trauma, especially if there was a long pattern of childhood trauma, but keeping your commitment to work through these issues will help you in the long run to stop getting triggered.

Getting Help in Trauma Therapy

If you have been struggling on your own with unresolved trauma, you owe it to yourself to get help from a licensed mental health professional who has an expertise in trauma work.

Getting Help in Trauma Therapy

Living free from your trauma history can help you to live a more meaningful life.

About Me

I am a licensed New York psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Sex Therapist.

With over 20 years of experience as a trauma therapist, I have helped individual adults and couples to work through unresolved trauma.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

 

Are You Thinking About Canceling Your Therapy Session Because You're Having a Good Day?

In a prior article, I discussed scenarios where clients left therapy prematurely before they completed their work in therapy (see my article: When Clients Leave Therapy Prematurely).  In this article, I'm focusing on clients who think about canceling their therapy session when they're having a good day.

Are You Thinking About Canceling Your Therapy Session Because You're Having a Good Day? 

You might wonder why it would be a problem to cancel your therapy session when you're feeling good, and this is a legitimate question, especially for people who are new to therapy.

The following factors will help you to develop a deeper, more comprehensive perspective about therapy, which goes beyond being in crisis, and why canceling when you're feeling good might not be a good idea:

• Many people only seek help in therapy when they're in an emotional crisis.  Once the crisis is over, they leave therapy.  But even though you might not be in an emotional crisis anymore, if you have only focused on the latest crisis, you've only touched the surface of the problem.  Beyond developing insight into the problem, you need time and help to integrate and consolidate what you've learned about yourself and the situation.  You also need assistance to maintain new healthy coping strategies that you just learned in therapy.  If not, you're likely to find yourself in a similar (if not exact) emotional crisis again soon.  The people, places and particular circumstances might be a little different with the new crisis, but the underlying issues, which haven't been resolved, are probably the same (see my article: Remaining in Therapy Beyond the Immediate Crisis).

• When you consider canceling a session, you might be avoiding issues in therapy that are emerging and that are frightening to you.  Rather than avoiding these issues, speak to your therapist about it.  A discussion with your therapist could help you to understand what's frightening you.  It will also help your therapist to understand that you might not be ready to tackle these issues head on but, instead, you might need some preparation and the development of additional coping skills to be able to, eventually, work through the issues that are frightening you.  If your therapist is a trauma therapist, she can help you to break down the work into manageable pieces so that you're not delving too deep into the worst aspects of the problem before you're ready.

• Having a "good day" is often a welcomed relief, especially if you've had many emotionally challenging days before that.  However, one "good day" doesn't mean that your problems are all worked out, and "feeling good" isn't a good measurement by itself of your progress in therapy.  Change often comes by taking two steps forward and one step back, so a "good day" or two is often followed by a setback.

• Setbacks are a normal part of the therapeutic process and should be expected (see my article: Setbacks Are a Normal Part of Psychotherapy Along the Road to Healing and Progress in Psychotherapy Isn't Linear).

If you think you have worked through the problem that brought you into therapy, discuss this with your therapist rather than just leaving without telling her (see my article: Why Ghosting Your Therapist is Harmful to You).

Of course, the decision to stay or go is up to you, but your therapist can shed light on the process and help you to terminate therapy in a way that's healthy and helpful to you.

Getting Help in Therapy
Many people have outdated views of the therapy process (see my articles:  Common Myths About Psychotherapy: Going to Therapy Means You're Weak and Common Myths About Psychotherapy: Therapy Takes a Long Time).

Although there are certain people who enjoy coming to therapy, learning about themselves and having a time and place that's dedicated just to them to talk about what's going on in their lives, some people come to deal with a specific issue.  They might want to remove obstacles that are getting in the way of making changes, develop insight into certain emotional patterns or deal with an unresolved trauma that is affecting them now.

Psychotherapy has evolved over the last decade, and there are now experiential therapy modalities, like EMDR therapy, AEDP (Accelerated Experiential Dynamic Psychotherapy), Somatic Experiencing, clinical hypnosis and other experiential therapies that tend to be more effective than regular talk therapy.

If you're unfamiliar with these newer experiential therapies, feel free to browse the articles in my blog that discuss how and why these types of therapy are more effective (see my articles: Why Experiential Therapy is More Effective Than Regular Talk Therapy and Experiential Therapy, Like EMDR Therapy, Helps to Achieve Emotional Breakthroughs).

Rather than waiting until a problem develops into an emotional crisis, you owe it to yourself to seek help from a licensed mental health professional.

Once you have worked through your problems, you will have freed yourself from your history, and you will be free to live a more fulfilling life.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR, AEDP, Somatic Experiencing and Emotionally Focused (EFT) therapist (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples (see my article: How to Choose a Psychotherapist).

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Leaving Therapy Prematurely: Overcoming the Urge for a "Flight Into Health"

In a prior article, When Clients Leave Therapy Prematurely,  I wrote about clients leaving therapy before they've completed the work.  In this article, I'm focusing on a particular dynamic called a "flight into health" where a client avoids any further exploration of his or her problems out of fear with a temporary cessation of symptoms that brought the client into therapy in the first place.

Psychotherapy: Overcoming the Urge for a "Flight to Health"

Often, this "flight into health" is unconscious.  It is based on a fear of further in-depth work on the presenting problem.  At the time, the client is convinced that s/he is feeling better and no longer needs to come to therapy.

S/he is usually unaware that what's really happening is that s/he has convinced him or herself that everything is fine now.  But, usually, s/he is suppressing the symptoms, and the suppression of these symptoms can only be maintained for so long before they come to the surface again.

There are some clients who go through this time after time with different therapists and they are unaware of what they're doing, so they can be in and out of therapy many times.

In many cases, these clients haven't developed the necessary internal resources and coping skills to do the work (see my article:  Developing Internal Resources and Coping Skills).

Let's take a look at a fictional vignette, based on many different cases, to understand how this plays out:

Lynn:
Lynn had been in therapy several times as an adult.  Each time she started therapy, she came for the same reason:  to deal with a history of physical abuse by her mother when she was a child.

Psychotherapy: Overcoming the Urge For a "Flight Into Health"

Her pattern was that she would remain in therapy for several sessions, and when she and her therapist began to speak about how angry and sad she felt about the physical abuse, she would suddenly "feel better" and decide that she no longer needed to be in therapy.

Against her therapist's advice, she would leave, feeling somewhat relieved to have talked about the abuse.  But within a few months, she would begin feeling depressed and anxious about her childhood abuse and decide to try a different therapist.

From her perspective, the prior therapies "didn't work" because she began feeling anxious and depressed again.  She didn't realize that she had fooled herself each time into thinking her problem was resolved when, in fact, it wasn't.

Instead, on an unconscious level, she suppressed her anxiety and depression, and covered it over with a lot of activity to mask her feelings.  She would plan many trips, outings, and social events to keep herself distracted and exhausted.

But after a while, this defensive behavior no longer worked for her and she felt disappointed that her old feelings were back.

When she talked about her prior attempts to get help in therapy with her latest therapist, she expressed her sadness and disappointment that prior therapists were unable to help her.

When the therapist discerned what was happening, she explained the concept of "flight into health" to Lynn as a way to help Lynn to understand her history in therapy.  Somewhat skeptical, Lynn listened, but she didn't feel it applied to her.

She wanted to begin immediately by delving into her traumatic history.

But suspecting that Lynn might be having problems with containing difficult emotions, her therapist told her that it was important to start with building the internal resources to do the work.

Her therapist explained that, without the internal resources and the necessary coping skills, Lynn could become easily overwhelmed and want to leave therapy by convincing herself that she was "feeling better" when, in fact, not much had changed.

Her therapist spent several sessions teaching Lynn how to calm herself with a breathing exercise, the Safe Place exercise, and certain mindfulness exercises.

She also helped Lynn with various containment exercises, including a visualization exercise where Lynn imagined that, before she left each session, she could place her uncomfortable feelings and reactions into an imaginary box with a lid on it that was kept in the therapist's office ready and waiting for the next time that Lynn came to therapy.

Initially, Lynn felt impatient with this preparation phase of therapy.  But when they began working on a memory about the early childhood physical abuse, using EMDR (Eye Movement Desensitization and Reprocessing) and Lynn began to feel overwhelmed, her therapist reminded her to use her internal resources, including the breathing, internal resources and visualizations.

By using her internal resources, Lynn was able to calm herself and contain difficult emotions.  She also made good use of the imaginary box with the lid that allowed her to imagine that she was leaving this traumatic memory and the difficult emotions associate with it with her therapist.  In other words, she didn't have to take it with her.

By the Lynn completed therapy, she felt the difference between her usual "flight into health," which was a defense against completing the work and actually overcoming the trauma.  In hindsight, she realized that whenever she thought she was "feeling better" before, it was only temporary.

Psychotherapy: Overcoming the Urge For a "Flight Into Health"

Lynn and her therapist went back to the traumatic early childhood memories again and Lynn no longer felt upset by them.  She felt compassion for herself as a child, but she no longer felt anxious or depressed.

Her therapist followed up with Lynn several months later, and Lynn told her that their work was holding.

Conclusion
While it's understandable that no one wants to dwell on traumatic memories, the reason why people come to therapy is that these memories are getting in the way of their leading the life that they want.

Emotional trauma doesn't resolve itself on its own (see my article:  ).

Without working through the trauma in therapy, it continues to have a strong impact on your current life.

A "flight into health" is an unconscious defense mechanism that clients use when their fear becomes  too much for them.  They convince themselves that they're "better" when, in fact, "feeling better" is a self generated feeling and only temporary.  Sooner or later, the problem makes itself felt again.

Preparation to do trauma work is essential to help the client to deal with the difficult emotions that can come up.  When clients have developed the necessary internal resources and tools beforehand, the trauma work is usually tolerable.

Rather than going from one therapy to the next, clients can complete the work and go on to lead more fulfilling lives without the affect of the earlier trauma.

Getting Help in Therapy
If you recognize yourself in this article, you owe it to yourself and your loved ones to get help with a therapist who can assist you with the necessary initial preparation.   The time spent doing on preparation before trauma work is well spent in the long run (see my article: The Benefits of Therapy).

Rather than spending the rest of your life carry the burden of your emotional trauma and having it get in the way of leading a happy life, you can learn to contain and tolerate the emotions that arise so that you can resolve the trauma (see my article: How to Choose a Therapist).

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Confusing Starting to "Feel Better" With Emotional Healing

People often to come to therapy after their own efforts to heal emotionally haven't worked for them and they realize that they need help from a licensed mental health professional.  

It's understandable that a big part of the reason why they come to therapy is because they want to feel better, and it's often the case that when they begin to talk about their problems, they start to feel better.  

But the problem arises when clients stop attending therapy as soon as they start feeling better as opposed to when they have emotionally healed by working through the problem (see my article:  When Clients Leave Psychotherapy Prematurely).

Leaving Therapy:  Confusing Starting to "Feel Better" With Emotional Healing

Since starting to feel better often begins during the initial stage of therapy, a client who leaves therapy before s/he has worked through the problem is leaving prematurely and will usually experience a "relapse" of the emotional problem because starting to feel better isn't the same as resolving the problem.  It's just a temporary alleviation of symptoms until the symptoms come back to the surface again.

Let's take a look at an example of this in the following vignette which is a composite of many different cases to protect confidentiality:

Jack
Before coming to therapy, Jack tried to deal with his panic attacks around his difficult boss by working out at the gym, attending yoga classes, and talking to friends about it.  But none of these efforts helped him (see my articles:  Workplace: Coping with a Difficult Boss and How Your Workplace Can Feel Like a Dysfunctional Family).

Leaving Therapy:  Confusing Starting to "Feel Better" With Emotional Healing

When he went to see his medical doctor, his doctor gave him a prescription for anti-anxiety medication for short term use and recommended that Jack see a psychotherapist to work out whatever underlying issues might be affecting him.

Jack discovered that the medication helped to relieve his panicky symptoms for short periods of time. But he realized that, after a while, he needed a higher dose to alleviate symptoms, and he didn't like becoming dependent upon medication.  So, although he preferred not to go to therapy, he followed his doctor's advice and contacted me for help.

After we talked about his family history, both Jack and I began to see parallels between his situation at work and his abusive father.  Both men were overbearing and verbally abusive.  Jack's father was also physically abusive with Jack when Jack was a child.

Just knowing this was a tremendous relief for Jack.  Until then, he felt that he was "going crazy" whenever he had a panic attack around his boss.

As Jack started to understand that he was reacting to his boss as if he were a child and his boss was his abusive father, he began to be able to separate his current experiences from his childhood experiences (see my articles:  Reacting to the Present Based on Your Traumatic Past).

At that point, Jack decided that he didn't need to continue in therapy anymore because he "understood" why he was having his panic attacks.  So, during a period of time when his boss was away on an extended business trip, Jack decided that he was "feeling better" and he would end therapy.

Leaving Therapy:  Confusing Starting to "Feel Better" With Emotional Healing

I tried to explain to Jack that the alleviation of his symptoms was probably temporary since he had not worked through the underlying emotional problems (his childhood history of being abused) involved in his current problem.  Understanding logically was the first step, but it usually doesn't resolve these types of problems.  There was also the fact that his boss was away so Jack wasn't getting triggered at that point by the boss's abusive behavior.

But Jack had made up his mind about leaving therapy.  So, I told him that my door remained open and he could return in the future.

Within a couple of weeks, after his boss returned, I received a call from Jack, who said that he was having panic attacks again. In one instance, he thought he was having a heart attack and he went to the ER.  After the ER doctors ruled out a heart attack, they told Jack that he was having a panic attack with heart palpitations, shakiness and sweating and he should seek help from a licensed mental health professional.

Leaving Therapy:  Confusing Starting to "Feel Better" With Emotional Healing

Jack said that this was, by far, the worst panic attack that he had ever had and it frightened him to the point where he was now constantly worried that he would have another panic attack.

We resumed our work that week.

I began by helping Jack to develop internal resources, which are basically coping skills (see my article:  Developing Internal Resources in Therapy).

After helping Jack to develop the internal resources to do the therapeutic work, we started doing EMDR therapy (Eye Movement Desensitization and Reprocessing), a mind-body oriented type of therapy to work on the current situation as well as the underlying issues that were getting triggered by his unresolved childhood trauma (see my articles:  What is EMDR?, How EMDR Works: Part 1: EMDR and the Brain, How EMDR Works - Part 2: Overcoming Trauma and EMDR: When the Past is in the Present).

As we worked together, Jack learned to manage his panic-related symptoms.  More importantly, over time, the EMDR therapy helped Jack to work through the unresolved childhood abuse he experienced with his father that was getting triggered with his boss (see my article:  Mind-Body Psychotherapy: The Body Offers a Window into the Conscious Mind).

He no longer had panic attacks because the underlying traumatic issues triggering the attacks got worked through so they were no longer there to be triggered (see my article:  Experiential Therapy. Like EMDR, Helps to Achieve Emotional Breakthroughs).

Leaving Therapy:  Confusing Starting to "Feel Better" With Emotional Healing

Not only did Jack "feel better," but his boss's abusive behavior no longer frightened him.  In fact, for the first time, Jack saw that his boss was really an insecure man who bullied employees to bolster his own low self esteem.

Rather than freezing in panic, Jack's attitude about the work situation was that, although it was unpleasant, he no longer felt threatened by it.

A few months later, Jack found a better job where he felt happier, respected and well compensated.

Summary
Just like "Jack," many clients think that their work in therapy is over once they understand their problem and they start to "feel better."  Unfortunately, this usually doesn't last, especially when emotional trauma is involved.

An intellectual understanding is a good start, but it's not the same as actually working through the problem, as "Jack" discovered.

The working through process necessitates working on a deeper level than just having a cognitive understanding.

EMDR and other mind-body oriented types of therapy, like Somatic Experiencing and clinical hypnosis tend to be more effective and efficient than regular talk therapy when the problem involves emotional trauma (EMDR: When Talk Therapy Isn't Enough).

Of course, everyone is different and these types of therapy aren't a quick fix but, as an experienced therapist, I have found that EMDR and other mind-body oriented types of therapy tend to work faster to resolve trauma.

Getting Help in Therapy
If you have tried unsuccessfully to work out your problems on your own, you owe it to yourself to get professional help from a licensed mental health professional (see my article:  How to Choose a Psychotherapist).

Rather than continuing to suffer on your own, you could work through your problems so that you can lead a more fulfilling life.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

In addition to providing mind-body oriented psychotherapy, I also use talk therapy with clients who would benefit from it.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Remaining in Therapy Beyond the Immediate Crisis

Many people, who might not otherwise have started psychotherapy, come to therapy when they're in an emotional crisis.  They recognize that they're in serious trouble and they seek help from a licensed mental health professional, which is a positive step.  But some people, who have deeper psychological issues that go beyond the current crisis, often leave therapy once the current crisis is resolved--only to find themselves in crisis again because they haven't dealt with the underlying emotional issues (see my articles:  Overcoming Trauma: When the Past is in the Present and Leaving Therapy Prematurely).

Remaining in Therapy Beyond the Immediate Crisis

When people don't deal with the underlying issues that create one emotional crisis after the next, they're bound to continue to have the same problems until these issues are worked through (see my article:  Overcoming Childhood Trauma That Affects Your Adult Relationships).

People who leave therapy prematurely often don't see the pattern to their emotional problems, but an experienced psychotherapist, who explores the history of the problems, can often see that there is an underlying theme that continues to get repeated.  It might be different people involved or a different situation, but the underlying theme is often the same.

Having one emotional crisis after the next can be debilitating, anxiety-producing, and discouraging.  For someone who does not have psychological insight into him or herself, it might seem that the cause of these crises are external and s/he might look for external solutions as a quick fix (see my article:  Beyond the Band Aid Approach to Resolving Psychological Problems).

Experiential therapy, like EMDR, Somatic Experiencing or clinical hypnosis, are especially effective in helping therapy clients to become more aware of possible underlying issues that are getting repeated in their lives, whether it involves relationship issues or other problems in their lives (see my article:  Experiential Therapy, Like EMDR, Can Create Emotional Breakthroughs).

To illustrate how this dynamic plays out, let's look at a composite scenario, which is made up of many different cases to protect confidentiality:

Lisa
Lisa began therapy after the breakup of her most recent relationship.

Lisa talked about how she and John were very happy during the initial six months of their relationship.

The relationship was going well during the initial six months

But after that initial happy period, as the relationship became more serious, Lisa began to have fears that John wanted to end the relationship--even though he assured her that he didn't want to end it.

Lisa began to have fears that John wanted to end the relationship, despite his assurance

Lisa talked to her friends about this, and they asked her why she thought he wanted to end it.  But she couldn't come up with anything specific, other than her own feelings about it.  She didn't know why she was feeling this way.

Despite John's assertions that he wanted to remain in the relationship, Lisa became increasingly anxious that John was going to break up with her.  She was preoccupied with her fears both day and night.

Remaining in Therapy Beyond the Immediate Crisis

Over time, Lisa struggled with her anxiety.  And when it became unbearable for her, she felt she could no longer endure waiting for what she felt was inevitable, so she ended the relationship with John, preferring for it to be finally over rather than feeling like the breakup was hanging over her head.

Initially, Lisa felt a tremendous sense of relief that she wasn't worried about John breaking up with her.  The pressure was off and she felt like she could breathe again.

But after a few weeks, she felt like she had made a terrible mistake:  She loved John and she realized that he loved her too.  She missed him and she wanted him back, but when she called him to tell him, he told her that he was hurt and angry that she didn't trust him when he told her that he didn't want to break up, and he didn't want to take her back.

This is what brought Lisa into therapy.  She was upset with herself for allowing her fears to overtake her to the point where they clouded her perspective.  She was even more upset that John wouldn't take her back.

Remaining in Therapy Beyond the Immediate Crisis

As we explored her background, she revealed that both of her parents were in and out of her life from the time she was a young child.  Both of them had problems with alcohol and they were in and out of rehabs, but Lisa didn't know this when she was a young child.

She just knew that, at various times, each of her parents would leave suddenly and she would be sent to live with her aunt, who resented taking care of her.  Lisa never knew when one or both parents would leave and she grew up feeling insecure and constantly abandoned.

Exploring Lisa's history of relationships prior to John, it became evident that she experienced the same fears in those relationships and she also ended them in a similar way.

Lisa was able to understand her fears of being abandoned and see how her fears of being abandoned carried over into her relationship with John.  But, at that point, it was only a preliminary intellectual understanding.  Lisa didn't have an emotional understanding of it.

I explained to Lisa how EMDR works and recommended that we process her earlier trauma, which was getting triggered in her as an adult (see my article:  How EMDR Works: EMDR and the Brain).

Lisa agreed, but a few days before we were going to begin using EMDR, she heard from John.  He was missing her a lot and he wanted to get back together again.

When Lisa came in for her next therapy session, she was very happy.  She told me that she and John were going to "start over" and put the past behind them, so she didn't feel the need to continue in therapy.

Even though I attempted to explain to Lisa that starting over with John wouldn't change the emotional issues that continually got triggered whenever she was in an intimate relationship, Lisa left therapy.

Several months later, I heard from Lisa again:  She had broken up with John again when her fears that he would leave her became too overwhelming.  Once again, after the initial relief, she regretted it.  But this time John said he wouldn't take her back, and she felt devastated.

When Lisa came to therapy this time, she made a commitment to complete therapy.  Using EMDR, over time, we were able to work through Lisa's fears of being abandoned (see my article:  Overcoming Fear of Abandonment).

Remaining in Therapy Beyond the Immediate Crisis

She and John didn't get back together.  But when she entered into her next serious relationship a year later with a man named Ted, she was no longer afraid of being abandoned.  She was able to allow herself to be open and caring without her old fears, and the relationship flourished.

Conclusion
As many people do, Lisa left therapy as soon as the immediate crisis passed.

Having only an intellectual understanding of her problems, as opposed to a deeper emotional understanding, Lisa thought that all she and John needed to do to overcome their problems was to have a fresh start.

But Lisa's underlying issues (and whatever issues John might have been dealing with at the time) were still there to get triggered again and to undermine the relationship as soon they got close again.

These underlying emotional issues are often unconscious and respond best to experiential therapy where the client can develop an emotional understanding of the problems as well as a way to resolve them.

Getting Help in Therapy
Attending psychotherapy is a commitment of time, money and effort.

It's tempting to leave therapy once the immediate crisis has passed and you begin to feel a little better.   But when there are recurring underlying issues that are having a major impact on your life, taking the time to work these issues out in therapy can help you to stop engaging in the same dynamics that are creating problems for you.

Although you might not see the underlying issues, an experienced therapist who uses an experiential type of therapy can help you to overcome these issues so they no longer have a negative impact on your life.

Rather than continuing to repeat the same unhealthy patterns, with help in therapy, you could be leading a more fulfilling life (see my article:  How to Choose a Psychotherapist).

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Asking For What You Need in Therapy

Many clients who are in therapy have difficulty asking for what they need from their therapists.  This is especially true for clients who have a history of being physically or emotionally abused.  Often, because of the abuse, they're out of tune with their needs and, as a result, they might not know what they need.

Asking For What You Need in Therapy

Even the most empathically-attuned psychotherapist might miss the fact that s/he isn't working in a way that meets the client's needs, which is why it's so important that, every so often, the therapist and client reevaluate their work together.

Usually, this discussion is initiated by the therapist, but a client, who feels s/he isn't getting what s/he needs, can also initiate this conversation.

Here are some tips that may be helpful in getting what you need in therapy:

Tips on How to Get What You Need in Your Therapy:

• If your therapist doesn't take time periodically to review the work you're doing together, you can take time to reflect on your own how you're feeling about your therapist and your work and then tell your therapist that you would like to talk about this.  Most therapists will be open to this.

• Don't assume that if your needs aren't being met that it's your fault.  This is an assumption that many clients, who have been abused, make in their therapy.

• If you're unclear about the way your therapist is working, ask about it.  Your therapist should be able to give you an explanation in simple terms that you can understand.

• If you feel the work is going too fast and you're having difficulty coping between sessions, talk to your therapist about this so the two of you can come up with ways that you can cope better between sessions.  It might also mean that you spend more time processing what's going on between you.

• If you feel the work is going too slow, tell your therapist about this.  S/he will can explain the way the two of you are working together and, if needed, might make changes in the work.  Also, this can help to clarify whatever beliefs or misconceptions that either of you might have about the work.

• If you feel you and your therapist haven't developed a rapport after working together for a while, it might be that the two of you aren't a good fit.  It might also mean that, due to your history, you might have problems trusting and it might take you a while to develop a therapeutic alliance with any therapist.

• Be aware that, due to ethical boundaries, your therapist can't be your friend or have a personal relationship with you outside of your sessions, even after you complete therapy.  So, if part of what you think you need or would like is for your therapist to be your friend, this won't be possible.  At the same time, it's common for clients to develop these feelings, including sexual attractions, for their therapist (see my article:  Psychotherapy and the Erotic Transference).  Even though you might be disappointed at first that you can't have a personal relationship with your therapist, a discussion about your feelings can be helpful in highlighting what you need in your life and how you can go about creating it outside of the therapy room.

Too often clients abort therapy prematurely because they feel too vulnerable or ashamed to have these kinds of discussions with their therapist (see my article:  When Clients Leave Psychotherapy Prematurely).

But, usually, even though you might not be accustomed to talking about your needs and it might take courage on your part, being able to talk about what you need helps you to develop self confidence and often helps to improve the therapy.

Also, if part of the problem is that there has been a misunderstanding or rupture between you and your therapist, there is a chance for repairing this rupture, which can create a stronger therapeutic alliance between the two of you (see my article:  Psychotherapy: Ruptures and Repairs in Therapy).

Getting Help in Therapy
Asking for help isn't easy, especially if you've spent most of your life denying your needs or being unaware of your needs.

Asking For What You Need in Therapy

Rather than continuing to ignore your emotional needs, if you're concerned about your therapy, speak to your therapist.  Even if you're feelings are vague, a skilled, empathic therapist can help you to clarify and express your feelings.

About Me
I am a licensed New York City psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Fear of Being a Disappointment to Your Therapist

I was talking to a friend recently, and she mentioned to me that she was thinking of leaving therapy because she was afraid she was going to be a disappointment to her therapist.  She's been with this particular psychotherapist for more than a year.  She told me that they have a great rapport, but she was worried because she was considering returning to her ex-husband, and she feared that she would be a great disappointment to her therapist if her therapist heard about it.  So rather than talk to her psychotherapist about it, she was contemplating leaving therapy rather than risk seeing the look of disappointment on her face.

A Common Fear for Clients in Psychotherapy
After we talked about it, my friend, whom I'll call Mary (not her real name) gave me permission to write about this in my blog because it's such a common problem for many people in therapy, especially when they really like their therapists.

Therapy is a place where, ideally, you can talk about anything.  Yet, so many people hesitate to tell their therapists about decisions they're about to make because they fear looking bad in their therapist's eyes.  They become so filled with shame and fear that they'd rather leave therapy prematurely than deal with this issue.

Clients Feel Too Ashamed to Talk to Their Psychotherapist About Certain Topics
When new clients come to me for a consultation in my psychotherapy practice in NYC, I usually ask them what their prior experiences have been in therapy.  It's not unusual to hear that they had a therapist that they really liked, but they left because they felt ashamed about something that they did or were about to do.  Often, it involves going back to an ex or making some other decision that they think will disappoint their therapist.  Often, their abrupt departure from therapy is still a loss for them that has not been worked out.

If clients have been raised by overly critical and shaming family members, this is even more likely to be a problem for them as they imagine that their therapist will think less of them.  Often, this is a projection of old, unresolved emotional wounds.  And, they would rather leave their therapist prematurely than see disappointment in his or her eyes.

Talk to Your Therapist About Your Fears
Since my friend had not left therapy yet (she was only thinking about it at the time), I urged her to talk to her therapist about her fear.  This took a lot of courage on my friend's part.  But, afterwards, she was very glad that she did it because that session affirmed the bonds of their therapeutic relationship.  Rather than seeing disappointment in her eyes, my friend saw caring and compassion.  It was a very healing experience for her to know that her therapist still cared about her regardless of what she was contemplating about her ex.  In fact, my friend realized that she was the one who was judging herself and projecting this onto her therapist.  This realization caused her to stop to explore the issue of reconciling with her ex further without being burdened by guilt or shame.

There's a good article in Psychology Today on how to communicate with your therapist by Ryan Howes, Ph.D. that could be helpful to you: "How to Give Feedback to Your Therapist".

Thinking that you might be a disappointment to your therapist can be a painful experience.  Most skilled clinicians have dealt with this issue before and can help you to navigate through it.  Rather than leaving therapy in haste, I usually urge most people to talk to your therapist about whatever it is you fear will make you a disappointment to him or her.  These are often the best sessions in therapy when they are handled by an experienced licensed clinician.

About Me

I am a licensed NYC psychotherapist, hypnotherapist,  EMDR and Somatic Experiencing therapist. 

I work with individual adults and couples.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Photo Credit:  Photo Pin

Why Do Clients Leave Psychotherapy Prematurely?

This article will focus on the topic of when clients leave psychotherapy treatment prematurely. Of course, there are times when the time is right to leave psychotherapy. One reason could be because you've met your treatment goals, discussed ending treatment with your therapist, and you both agree that it's time for you to end treatment. 

Another reason could be that you know that the psychotherapist that you're seeing is not the right therapist for you. It's not a good match, and you're sure that this is the reason and you're not leaving treatment for one of the reasons that I've outlined below. But ending psychotherapy treatment is a topic for another article.

When Clients Leave Psychotherapy Prematurely

Why Do Clients Leave Psychotherapy Treatment Prematurely?

Clients Leave Psychotherapy Treatment Prematurely Because They Feel Annoyed About Something Their Therapist Said:
It's not unusual for there to be ruptures in psychotherapy treatment. After all, a therapeutic relationship is like many other types of relationships between two people. There are bound to be misunderstandings at times. A client might misunderstand something that the therapist has said. A therapist, being human, might not always be perfectly attuned to a client and might say something the represents an empathic failure. But rather than leaving treatment prematurely without saying something about it to the therapist, unless what has been said is egregious, it's much more valuable for a client to talk to the therapist about it at the next session.

Why is it worthwhile to tell your therapist if she has said something that hurt or annoyed you? Well, for many people, growing up in families of origin where they didn't have a chance to express themselves, it's an opportunity to be heard in a way that they've never been heard before. So, it can be a very empowering experience to assert yourself in this way. Also, often, after a rupture has been worked out in psychotherapy treatment, the treatment advances further than it might have without it.

Clients Leave Psychotherapy Treatment Prematurely Because They Feel "Stuck" in the Treatment Process:
When you begin psychotherapy, you're in the initial phase of treatment. During this phase, you and your therapist are getting to know each other. If you're new to therapy, you're also learning what it means to be a psychotherapy client and how the process works.

As I've mentioned in prior articles, some clients come to therapy expecting a "quick fix." Even when they come to treatment with complicated, multi-layered problems, they expect that their problems will be resolved in a few sessions. While there are certain problems that lend themselves to brief treatment, many problems do not. So, if you're feeling "stuck" early on in treatment, it might be that you're feeling impatient with the beginning phase of treatment.

It might also be that your treatment has reached an impasse because of some obstacle in the treatment either with you or with the therapist or between the two of you. But, before you leave treatment prematurely, it's best to talk to your therapist about how you're feeling. 

Then, not only are you able to express your feelings, but you can also find out how your therapist assesses the treatment at that point. Maybe the two of you need to change how you're working. Maybe there needs to be adjunctive treatment for a while with a second therapist. 

This is often the case with trauma, where regular talk therapy isn't enough and you might need to work briefly with a second therapist who does EMDR (Eye Movement Desensitization Reprocessing) or clinical hypnosis. Whatever the reason, it's a good idea for you and your therapist to have a check-in talk with each other every once in a while to evaluate the treatment.

Clients Leave Psychotherapy Treatment Prematurely Due to Financial Reasons:
It's not surprising that many clients have to think carefully about whether they can afford to attend psychotherapy, especially because it's getting harder and harder to find psychotherapists on managed care panels, and many people are now paying for their therapy out of pocket. But rather than leaving prematurely, if you're having financial problems, it's best to let your therapist know.

Many therapists work on a sliding scale basis and your therapist might be able to reduce your fee. Your therapist can also help you to look at your money issues. Money can be a complicated subject. Often, clients will say they can't afford to be in treatment when there are really other underlying issues. At times, it's easier to look at a concrete issue like money than to look at your fear of being in treatment. Other times, it might be a matter of looking at your priorities. 

Are you spending $10-20 a day on cigarettes? If you stopped smoking, not only would you have money for therapy, but you would also preserve your health. Are you spending money on other frivolous purchases as a way to momentarily boost your mood? If so, maybe that's something that you need to look at with your therapist.

Clients Leave Psychotherapy Treatment Prematurely Because They Become Fearful When Therapy Starts to Delve into Core Issues:
Compared to the other issues that I've discussed so far in this article, this is the most complicated issue. Why is it so complicated? Well, first, when clients become fearful of talking about core issues, they often don't realize that this is what's going on. 

It might be completely unconscious for them. They might think that they want to leave for other reasons that are really unrelated to what's really going on with them. 

This is often the time when clients might say that they can't afford to come to treatment any more or they don't have time any more. While these might be issues, it's always worthwhile for you and your therapist to explore if what's really operating is that you've gotten to a point in therapy where you're dealing with deeper, core issues and this is frightening you.

You might wonder how this could happen. After all, you might say, "Don't people come into psychotherapy treatment to work on these issues?" While it's true that clients start psychotherapy because they want to work on a problem and they're often motivated at the beginning of treatment, it's also true that many clients get frightened when the therapy actually starts to delve into the very issues that they came to work on. This is very common in psychotherapy.

Sometimes, clients take a "flight into health," meaning that they tell themselves and their therapists that they're feeling better now (when they're really not) and that they don't need therapy any more. This is a common reaction. When this happens, the challenge is to stick it out in therapy and to be willing to explore this with your therapist.

It might not be obvious to you that this is what's happening. But, often, if you step back and you're able to detach yourself from your fear of addressing your core issues, you and your therapist can work through this treatment impasse. Are you really feeling better or are you in denial and telling yourself this because you're too frightened to deal with core issues?

Maybe it means that the two of you need to address your fear of delving into the problem before you actually delve directly into your core issues. Maybe the two of you need to take a different tact in treatment or change treatment strategies. Whatever is needed in this situation, it's better to talk to your therapist rather than leaving treatment prematurely.

Since this is one of the most complicated issues as to why clients leave treatment prematurely, it's worthwhile to look at a composite vignette. As always this vignette does not refer to a particular client, but represents many clients who have this problem in common.

Alan:
Alan began psychotherapy because he had problems making a commitment in his relationship. He knew that this was a life long problem for him. Whenever he got close to a woman that he was seeing, he got frightened and left the relationship, even if he cared about his girlfriend very much.

A year prior to Alan starting psychotherapy, Alan began dating Paula. According to Alan, the first few months were great. But as the relationship started to get more serious and Paula wanted more of a commitment from Alan, Alan began to feel that old familiar fear again. He began giving himself all kinds of reasons why the relationship with Paula wouldn't work out in the long run. He never talked to Paula about what he was feeling, but he felt a mounting panic whenever she talked about the possibility of their moving in together.

Alan really loved Paula, and he didn't want to ruin their relationship because of his fears, so he came to therapy. During the first few months of therapy, Alan learned ways to cope with his panic so that he didn't act on it and end his relationship with Paula due to his fear. At that point, Alan actually enjoyed therapy. But when his therapist began exploring Alan's childhood issues in a highly dysfunctional family, Alan began thinking about leaving treatment.

Even though Alan knew that his life long relationship issues were related to his feeling abandoned as a child, when it came time to deal with this issue in treatment, he became frightened. At that point, he began cancelling therapy sessions or coming to his therapy sessions late so that there wasn't enough time to delve into these issues. He didn't realize that this is what he was doing. He always thought that his cancellations and latenesses were legitimate and unrelated to his feelings about what he and his therapists were talking about.

When his therapist spoke to him about his cancellations and latenesses as it related to what they were working on, Alan couldn't see the connection at first. He couldn't see that he was sabotaging his own treatment. So that, with so many cancellations and short sessions, the therapeutic work began to stall, and Alan and his therapist reached an impasse in treatment.

In order to have good treatment, clients need to come to their sessions on a regular basis. When a client misses too many sessions or comes to sessions late, the client can bring about the treatment impasse. A skilled therapist can point this out to a client, but if a client is unable or unwilling to see this, the client can end up sabotaging the treatment--often in the same way that he or she sabotages personal relationships.

While this was happening, Alan thought about leaving his therapist a voicemail message or sending an email that he thought treatment wasn't working and he was leaving. But Paula convinced him that this wasn't the way to end a therapeutic relationship and it would be better to talk to his therapist in person.

So, reluctantly, Alan came into his next session and told his therapist that he wanted to leave treatment. His therapist was able to reflect back to Alan just how anxious he had become once they began talking about his childhood. She also told him that this was not unusual.

When Alan heard this, he was able to relax a little and think back as to when he began cancelling sessions and coming in late. He realized that it coincided with talking about when his mother disappeared from the family household. His mother left when Alan was four, and Alan never saw her again. No one knew of her whereabouts. His father tried to manage as best as he could but, with five children, his father was often overwhelmed, he began drinking excessively, and Alan often felt alone.

When Alan got older, he thought of himself as being "independent" and "not needing anyone." But it was clear to his therapist that this was a pseudo independence. It was a defense against opening up his heart and getting hurt again. Alan had never recognized this before. When his therapist discussed this with him, it resonated with him, and he felt it to be true. He also knew that this was a breakthrough for him in his therapy. So, he decided to stick it out in treatment and not to run because of his fear. Whenever he felt the urge to flee from treatment, he talked about it with his therapist and each time he gained new insights into himself.

He also realized that when he felt fearful in therapy and he was tempted to leave, he was going through a parallel process in his therapy that was similar to how he felt in his relationship with Paula. In addition, he realized that his issues were complicated and treatment would not be brief.

Over time, as Alan continued to explore his childhood issues, he continued to gain new insights into why getting close to Paula was frightening for him. Rather than fleeing from his relationship with Paula or fleeing from his therapist, he learned to stay in these relationships and to manage his anxiety while he worked through his problems.

If You're Thinking About Leaving Treatment, Talk to Your Psychotherapist in Person:
Many clients feel too uncomfortable about talking to their therapists in person about leaving treatment. They will often leave a voicemail message or send an email. But when clients leave treatment in this way, they are short changing themselves and the treatment process (see my article: How to Talk to Your Therapist If Something is Bothering You About Your Therapy).

It's worthwhile to remember that the therapeutic relationship between a client and a therapist is still a relationship, albeit a professional relationship. You owe it to yourself and the treatment to talk to your therapist in person if you want to leave treatment or you're thinking about it.

Clients who leave voicemail messages or send emails to end treatment often regret it afterwards. Even if there are legitimate reasons to leave treatment, they've had no closure to the relationship. And it's not surprising that these same clients do similar things in their personal relationships by avoiding direct communication with people in their lives when there are unpleasant or uncomfortable things to talk about.

I hope this article has been helpful to you or someone that you know who might be thinking about leaving psychotherapy treatment prematurely. There are many other reasons why clients leave treatment prematurely, but the issues that I've discussed above tend to be the most common reasons.

About Me

I am a licensed NYC psychotherapist, hypnotherapist EMDR and Somatic Experiencing therapist.  

I work with individual adults and couples.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist

To set up a consultation, call me at (917) 742-2624 during regular business hours or email me.

Also, see article:  Returning to Therapy