When To Leave Therapy?


This is complicated…I started psycho-analysis with my therapist over 6 years ago. She diagnosed me with Major Depressive Disorder without Atypical Reoccurance. I have also been diagnosed with PTSD by my Psychiatrist (am on 30mg Cymbalta daily) and Internist. Basically I had a sad, difficult, traumatic childhood with terribly abusive, neglectful parents, where physical and sexual abuse were daily happenings. There is one particularly bad event in which I disassociated. So for almost 40 years I reflexively disassociated, and my therapist and I have worked with that to the point where I don’t do it as often nor as completely. I am very high functioning and have been married for over 15 years to a very successful man. We have 3 children, 1 from my previous marriage.

In a nutshell, I want to end therapy. I have discussed this with my therapist for the past several months and she is adamant that we continue our sessions twice a week. BTW, I pay out of pocket. I feel like I’m in detention. My moods are so improved that I don’t have suicidal thoughts anymore, etc. I offered to stay in 1xweek, and she said in order for our work to continue it had to be twice a week. I think once a week is a solid commitment. Anyhow, my husband is starting to believe she (my therapist) has a crush on me, for many reasons. I’m saddened and confused by her rigid 2xweek rule. So, I left her message and said I was taking a break. I know I need to be in therapy still. Also, a huge dilemma is that we work over the phone as I moved out of her state about 5 years ago. And since I received such poor parenting I decided it’s best that I see a therapist in person. Thanks in advance for your professional input.



This Disclaimer applies to the Answer Below
  • Dr. Schwartz responds to questions about psychotherapy and mental health problems, from the perspective of his training in clinical psychology.
  • Dr. Schwartz intends his responses to provide general educational information to the readership of this website; answers should not be understood to be specific advice intended for any particular individual(s).
  • Questions submitted to this column are not guaranteed to receive responses.
  • No correspondence takes place.
  • No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Schwartz to people submitting questions.
  • Dr. Schwartz, Mental Help Net and CenterSite, LLC make no warranties, express or implied, about the information presented in this column. Dr. Schwartz and Mental Help Net disclaim any and all merchantability or warranty of fitness for a particular purpose or liability in connection with the use or misuse of this service.
  • Always consult with your psychotherapist, physician, or psychiatrist first before changing any aspect of your treatment regimen. Do not stop your medication or change the dose of your medication without first consulting with your physician.

Indeed, you are presenting a very complicated situation.

First, I must tell you that you have every right to end therapy when you decide that it’s enough. Given the fact that you now live out of state, it’s ridiculous to continue a “psychoanalysis” over the phone. That is my opinion.

I can only speculate about what your therapist’s thinking could be because I do not know her. There are several possibilities: 1. Maybe she has dependency problems and cannot allow her patients to leave? 2. Maybe she has cash problems and sees her patients as a source of money above and beyond any other consideration? 3. Maybe she believes you really should remain in psychoanalysis because you have not resolved transference issues. Of course, if that were true, she should have referred you to someone in the state in which you live. 4. There are some therapists who, because of their own unresolved issues, must turn their successful cases into failures? 6. One of the criticisms of psychoanaysis as a therapy is that it is very vabgue and there are no agreed upon criteria for when treatment is done. Sigmund Freud saw his patients for one year, five days per week and then the treatment ended. Anyway, remember, this is all speculation on my part and I really do not know what the story is with your therapist. But, you have every right to end treatment.

By the way, at the start of treatment it is proper procedure for the therapist and patient to set goals to achieve so that there is an agreed upon way of knowing when treatment is over.

In other words, your work with her is done. You live out of state, you feel and function much better and you do not see the need for twice per week therapy any longer. It makes perfect sense to me.

If you want to see a therapist once per week and where you live that is your choice. There are also different types of therapy. For one, there is something called EMDR and its supposed to work well with PTSD. There is also Cognitive Behavioral Therapy. Finally, you could maintain your medication regimen and see how you feel without psychotherapy.

If you want a vacation from therapy, please remember something: If and when you want psychotherapy again, there are short term, once per week therapies like the two that I mentioned. There are also support groups around the nation.

Good Luck

More "Ask Dr. Schwartz" View Columnists