When it comes to therapy, when is it enough?
By Carol Sorgen
Reviewed By Brunilda Nazario
Feel like you've spent as much time with Shrinky as Woody Allen has? Wondering if you're ever going to get off the proverbial couch? Contrary to what you might think, therapists don't see their patients as lifelong meal tickets.
"In the course of treatment, you obviously touch on a lot of issues," says Leonard Tuzman, DSW, CSW, director of social work services at Hillside Hospital, a part of the North Shore-Long Island Jewish Health System in New York. "You could continue to work ad nauseum on all those issues, but at some point, patients need to take what they've learned in therapy out into the community. A therapist shouldn't foster lifelong dependency."
"The job of therapy is to make the therapist expendable," agrees Joseph Napoli, MD, associate chief of psychiatry at Englewood Hospital and Medical Center in Englewood, New Jersey. Just as you grow up and leave your parents, says Napoli, so should you be developing the necessary tools to leave your therapist and live your own life.
How Long Is Long Enough?
Just how long does that take though? That depends on what brought you to the therapist's office in the first place, and what type of therapy you've been receiving. Cognitive behavioral therapy, for example, is designed to achieve specific goals, says Napoli. If you're afraid to drive, then a number of sessions -- perhaps 10 to 20 -- are agreed upon at the beginning of therapy and the problem is addressed through a combination of talk therapy, relaxation techniques, and exercises designed to get you back in the car. Once your symptoms are gone, so is the therapist.
Therapy that is more self-exploratory -- that examines how you got to be who you are today and what effect that is having on your life -- will be more in-depth and, as a result, last longer, says Napoli. "As a therapist, you want to see that the patient is approaching his present circumstances as an adult ... that he has learned to look at his behavior and understand its meaning, and can do things to change the actions and circumstances that may have brought him to therapy in the first place."
But even long-term therapy usually comes to an end, whether that takes a year, or two, or more. If you and your therapist have a good relationship, deciding to end it is not a one-way street -- on either end. "This isn't something either person should decide on his own," says Norman Rosenthal, MD, clinical professor of psychiatry at Georgetown University in Washington, and author of The Emotional Revolution: How the New Science of Feeling Can Transform Your Life. "It's a decision that's made in collaboration."
If you're thinking of leaving therapy, says Rosenthal, ask yourself why: Are you not getting much out of it anymore? Or, on the other hand, have you accomplished what you set out to do? Do you feel that the world and your relationships in it will be manageable on your own? "The messages will come from within," says Rosenthal. "Listen to them."
What Is a Good Therapist?
A good therapist should listen to those messages, too, says Rosenthal, who asks his own questions when a patient says he wants to leave: Is this a sign of healthy independence? Has the person sorted out the major issues that brought him to me?
"Good therapists are results oriented," says Rosenthal. "Therapy has to be more than just hand holding."
Ending the relationship doesn't have to be abrupt, says Rosenthal. If you've been going once a week, taper off to every other week, then perhaps to once a month. You and your therapist can agree on the length of time this transition period should last.
"I don't make a big deal out of termination," says Rosenthal. "Patients come in, they deal with their issues, and then they move on. If other issues arise sometime later on, they can always come back then."
What if you think you need more therapy but this therapy, or therapist, just isn't cutting it anymore? That happens too, Tuzman tells WebMD. "If you're not making the changes you were hoping to make, you might need to see someone else." That doesn't mean you should leave in a huff though. If something's bothering you about your therapist, tell him.
"Therapists are people, too," Tuzman says. "Something could be going on in your therapist's life that affects the way he's dealing with you. Talk about your feelings and get his feedback.
"Look at all the possibilities, however. Are you really angry with him, or are you resisting looking at something that makes you uncomfortable?"
Even if you do feel you're ready to try your hand out there in the real world without the safety net of a therapist, don't be surprised if ending therapy comes along with a host of conflicting emotions.
"When therapy is complete, you realize you're an adult," says Tuzman. "You begin to trust yourself."
But just as you feel pride that you're ready to meet life's challenges on your own, you may also grieve the loss of the bond you've created with your therapist, says Napoli. "It's a unique relationship," he says. "You've bared your soul to this person, without his judging you."
"Leaving your therapist is a bittersweet experience," Napoli continues. "You're moving on but you're losing a relationship that has meant a lot to you."
Ending therapy should mean a success story though, says Rosenthal. "It's a chance for you to say, 'I think I can move on right now.' Getting out into the world and feeling good about it is what therapy is about."
Published March 8, 2004.
SOURCES: Leonard Tuzman, DSW, CSW, director, social work services, Hillside Hospital, Long Island, N.Y. Joseph Napoli, MD, associate chief, psychiatry, Englewood Hospital and Medical Center, Englewood, N.J. Norman Rosenthal, MD, clinical professor of psychiatry, Georgetown University, Washington; author, The Emotional Revolution: How the New Science of Feeling Can Transform Your Life.
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