This month’s column is a continuation of last month’s column in which I talked about the basics of finding and contracting with a therapist. This month I will talk about evaluating the therapist you chose, deciding to continue or discontinue, changing therapists, and deciding when it is time to leave therapy.
A therapist should be someone you can really open up to and speak honestly with. He or she should help you to both understand your behavior and help you change problematic behaviors. They should help you see yourself clearly and give you the tools to help you change.
When I meet a new client I am as active in the first session as I am in the following sessions. I ask questions, give feedback and share my impressions with my clients. At the end of the first session I ask the client if he or she wants to continue working with me. If the answer is “yes” and I think I can help them, then I give them 3 more appointments with the understanding that we will mutually evaluate our work together on that third session (as well as along the way) and that I will ask them for feedback for me as their consultant, to make sure I am working well for them. While every therapist is different in their style, it is very important that you feel you are an equal partner in the team. If you don’t feel that way, that becomes an issue in your therapy. Is it you, the therapist or the dynamic between the two of you?
If you decide you can’t work with the therapist you have chosen, tell them. Be honest, say what you think and feel, and see if you can work it out with them. After all, you have already invested your time and efforts in this relationship. If you try and are not happy with the results, tell them you are terminating. Don’t just fade out. Therapists are mandated to give you the names of three other therapists or agencies in the area for you to contact. Ask for that referral list.
If you start interviewing new therapists before leaving the last one, tell the new one(s) that you are still in therapy with someone else and what the time table is for terminating. It is unethical for a therapist to contract with a new client who is still a client of someone else before they officially leave the first therapist.
Once you settle on a therapist, make sure you understand the therapy contract which defines the role of the therapist and the client, agree with the treatment plan and talk about your diagnosis. The diagnosis is a medical description of the cluster of symptoms and challenges you have reported to your therapist. It is used to describe your claim to your insurance company and it also influences the course of your therapy.
So when is it time to leave therapy? For some, it will be whenever the insurance company says so. For others, it will be a process of achieving goals and then stepping down the visits from weekly to twice a month, to monthly, then ending as the goals are met. It is ideal to have the client make the decision and not the insurance company.
Many of my clients have come and gone from therapy with me for years. I may initially have seen them for a year or longer and now they come back periodically for “tune-ups” as circumstances come up in their lives. They may come back for one session or several months. And as I tell all my clients: “The goal of therapy is to get out of therapy. It’s a tool, not a lifestyle.”