Research on Termination of Therapy: Too Much or Not Enough?

Medical news today reports that “sixty percent of private practice dynamically oriented psychotherapy clients felt that their therapy either lasted too long or ended too soon, according to recent research conducted by Prof. David Roe, Head of the Department of Community Mental Health, Faculty of Social Welfare and Health Sciences at the University of Haifa”.

This research, on 82 people in therapy for an average of two years, assessed the whole matter of the ending of their therapy, and the results give some pause for thought to therapists who proclaim that the termination of therapy happens when the client is ready. While 84% of participants stated that they did initiate the termination, 37% felt that it ended earlier than it should have and 23% felt that the therapy had gone on for too long.

The most frequent reason for too-early termination was given as financial constraints (34.5%). I find this sad, and a reminder to me as a therapist to be open and concrete about financial matters with clients. I operate a sliding scale system whereby my clients choose what to pay between set parameters, and I stress to them that they can move up and down the scale as they need or wish to throughout therapy. I would not like to think of anyone who is coming and finding that our counselling relationship is working having to stop for purely financial reasons. It may be the case that money is the last taboo in therapy, and that clients find it difficult to be honest about not being able to afford therapy anymore. It may be that this would be a fruitful area for discussion — new circumstances and new priorities. It may be that the therapist can be a little flexible about payment, once a relationship is underway. It can be difficult to budget for therapy when you rarely, in private practice in a psychodynamic or person centred counselling relationship, can predict in advance “how long it will take”.

Over twenty-seven percent of those who finished “too early” stated a mismatch with the therapist. This is another issue over which some shame or embarrassment may be felt, but a good therapy relationship is dependent on a real sense that the therapist is right for you at that time, is hearing and understanding you properly and facilitating your growth, or just ‘being real’ in some way.

Among those clients who experienced therapy as lasting too long, the most frequent reason was “feeling uncomfortable toward the therapist (26.3%)”, which I interpret as the client putting the therapist’s (imagined) feelings before their own. This points to a very real need for therapists to demonstrate that they are resilient and not dependent on the client for their self esteem. Over twenty-one percent of those who stayed too long reported that they were hoping that the treatment would get better, pointing to a great reservoir of hope in the client which may be generally underestimated by therapists. Dependence on the therapist accounted for a further 21.1%.

The researchers pointed out how positively the 40% of clients who did feel they ended at the right time felt about those endings. They felt ending therapy to be an expression of independence and a reflection on the positive gains made in the therapeutic relationship. This stands in contrast to a possible psychodynamic emphasis on the ending as a necessarily difficult severance for the client, needing careful handling, rather than a cause for celebration.

Maybe what needs more careful handling are the ways in which therapists communicate to their clients that they are free and safe to bring up such issues as no longer being able to afford therapy, or feeling unsatisfied with therapy and wanting to make changes. I believe that usually, in an environment free of shame, such issues can be worked out.