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Short-term or long-term, gestalt or psychoanalysis – sessions continue for a while … and end. But who determines when it is time to end therapy?
“Is it time to stop or still continue? I can’t make a decision,” says 38-year-old Natalya. – And still once a week I come for a consultation with a psychotherapist. At the same time, I still have the feeling that the main part of the work has already been done and I no longer need help. But I do not dare to stop our meetings … “
How do you know when it’s time to end your psychotherapy? This is a simple question for which there is no simple answer. Psychoanalysts and psychotherapists in various fields are sure that the patient’s doubts are a sure sign that the time has not yet come to stop the sessions.
And they all say that stopping therapy is a difficult process.
First of all, because we are talking about the end of the relationship of two people. “But often the sessions are interrupted when the patient simply stops coming, despite the fact that the psychologist believes that it is necessary to continue the work,” says psychotherapist Tatyana Bednik with regret.
We asked psychotherapists from different schools and directions to talk about how to constructively and painlessly complete psychotherapy.
Temporary or permanent cooperation?
In most psychotherapeutic schools, the end of therapy is agreed upon at the first meeting. This applies to short-term and long-term therapies (behavioral, cognitive, gestalt therapy, transactional analysis…).
In this case, the psychotherapist and the patient enter into a temporary union, psychotherapist Christophe Andre explains: “They set a specific goal for this joint work (fear, phobia, communication difficulties, procrastination …) and agree on the duration: 5 meetings, 6 months, a year, two years … ” .
As a rule, when the goal is reached, the therapy ends. 28-year-old Anna overcame her shyness in 12 sessions: “I still have a bunch of other problems, but at that moment I just needed to get rid of this particular one.”
For psychoanalysis, on the contrary, it is much more difficult to determine the end time of work.
“I went to a psychoanalyst with a general undefined ailment and with the sole purpose of improving my well-being,” says 48-year-old Natalia. “I knew it would take a long time, and I didn’t care how long. The further I go, the more I feel the need to continue. But until when?
Since “absolute mental health” is an illusion, even Sigmund Freud, the founder of psychoanalysis, asked the question “is there a natural completion of psychoanalysis, is it possible in principle to bring such an analysis to an end”1. Nevertheless, he admitted that the course of treatment can be completed under two conditions:
- the symptoms, fears or obstacles that prompted the patient’s referral no longer cause him suffering;
- working with the unconscious allows you not to be afraid of the return of the problem.
Thus, “Neither I nor any of my colleagues will ever tell you: ‘Psychoanalysis is complete’,” explains psychoanalyst Jean-Pierre Winter. We just can’t know. And we cannot be sure that the patient will not take these words as a rejection of him. Everyone must decide for himself when to stop visiting a psychoanalyst. But don’t do it too soon…
Overcome urge to run away
“It’s hard to resist the temptation to jump off a moving train,” says 42-year-old Victor of his experience. Twice in the past year he has started psychotherapy. In any therapy, there is a moment when it seems that you are running in circles, notes Vitalina Chibis, a psychoanalytically oriented psychotherapist.
“It is not clear what else can be done and where it will lead. Certain changes are already being felt, but they are superficial and largely aimed at pleasing the psychotherapist, ”she clarifies. It is at such moments that there may be a reluctance to deepen the work.
“I met with a psychotherapist twice and thought I had dealt with my problems. In fact, I was treading water. In the following months, I again slipped into a style of communication that was familiar to me and unbearable for loved ones. I returned to therapy only when I finally decided to talk about the main problem, which I simply tried not to think about and which controlled me, my behavior, my life.
“Such a premature termination of meetings with a psychotherapist often means that “somewhere in the process of transference there was a problem,” says Jean-Pierre Winter. Transference was discovered by Sigmund Freud.
The patient in the relationship with the therapist recreates the desires and feelings that he had for his parents
He re-experiences anxieties, resentments, internal conflicts, unfulfilled expectations, strong emotions in the safe conditions of psychoanalysis. “Due to the fact that the analyst does not evaluate or condemn, but listens carefully and accepts his feelings, the patient understands himself better.”
The patient-analyst relationship is strictly limited, and this makes it possible not to confuse the therapeutic relationship with the real one. And yet every patient inevitably re-experiences the excitement associated not with the therapist, but with the person he represents. “I left my analyst in anger because I got the impression that he did not respect me,” Mark, 38, regrets.
Tatyana Bednik explains: “Abrupt cessation of therapy can be one of the ways to recreate the scenario of the past, in which, for example, what was started never ended. In such a case, the task of the psychotherapist and analyst is to help the patient understand the reasons for his desire to quit therapy and thus avoid self-deception.
Feeling of freedom
“One day I clearly understood that everything was really over,” recalls 33-year-old Christina. “The reason why I came to therapy almost a year and a half ago has ceased to torment me. For the first time in years, I was able to calmly communicate with my mother and clearly say “no” to her when, out of habit, she continued to interfere in my life. I don’t quite understand the mechanism of what happened to me, but it happened.”
How to distinguish healing from a false result? According to Vitalina Chibis, in general, “you begin to feel better, you understand that you can live without your psychotherapist.” Painful symptoms subside.
“It is very important,” says Christophe Andre, “to gain some degree of freedom in relation to these symptoms. For example, you can still be afraid of something, but stop being a slave to this fear.” Visible improvement is the result of working on the invisible: beliefs, resentments, images that create problems in behavior or relationships.
Psychoanalysis considers another phenomenon as a signal for the end of the course of therapy: “cessation of transference”
“Jacques Lacan said that there are three stages of psychoanalysis,” recalls Jean-Pierre Winter. – At the first stage, when I speak, it is not really me, and I am not addressing the person to whom my words are addressed. At the second stage, I already speak, but still I do not address my interlocutor. At the end of the course, I really communicate with my interlocutor, the psychotherapist.”
The founder of transactional analysis, Eric Berne, formulated the same thing differently. “He believed that the course ended when the patient was able to perceive his psychotherapist as an adult, and not as a guardian or controlling Parent in the context of the three states of the Self,” explains transactional analyst Vadim Petrovsky.
From the point of view of transactional analysis, there are three states of our “I”: Parent, Child and Adult. These states affect our needs and our behavior. In fact, therapy is completed when the patient, through the personality of the psychoanalyst, manages to settle all scores with those whom he represents and reconcile reality with images.
Last session…
Behavioral and cognitive therapy, Gestalt therapy, transactional analysis, and some other types of psychotherapeutic assistance include one or two final meetings at the end of the course. “The day before, I reread all the notes made during our meetings. The patient also sums up his results, and I tell him about the progress he has made,” explains Tatyana Bednik.
“There is a certain solemnity to the last session,” remarks Christophe André. “I have to make sure that the patient has taken well to everything we have been working on. Finally, I give him some supportive advice for the future.” Sometimes the patient and the therapist agree to meet after 6 months to take stock.
Nothing like this happens in psychoanalysis. Jean-Pierre Winter says: “Sometimes, at the beginning of the session, the patient declares that he will not come again. Or he mentions the desire to finish the analysis and at the same time reveals a whole palette of internal reasoning that can contribute to his healing.
Christina recalls her last session with humor: “It was a little strange. We had nothing more to say to each other … simply because there was basically nothing more to say! We shook hands warmly. And that was the end of the job.”
The last session has a sad connotation. The end of the story of the relationship between two people
“I am also sad, but a sense of pride prevails, akin to what a mother experiences when she sends her child into adulthood,” notes Christophe André.
And then what? “And then I cried for three hours,” Christina admits. – I restrained myself not to rush to the phone and make an appointment for another appointment. And only the next day I felt that I had turned this page of my life.
Jean-Pierre Winter confirms: “Immediately after the sessions are over, something is bound to happen. The psychoanalyst is not told this, but indirectly he finds out. And for him, this is also an important experience!
Some patients sleep for days on end, some have a sharp pain in the joints. Some people have incredible dreams, and they don’t know how they can not tell their psychoanalyst about it. And then it turns out that it is possible. It became possible.
“My psychologist doesn’t want me to stop therapy”
“I wanted to end our meetings, I told the therapist about this during our session on Thursday, he did not agree with this decision,” says 29-year-old Svetlana. “Nevertheless, I stopped visiting him…” Does a psychotherapist have the right to object to the departure of his patient?
“Regardless of whether the therapy is completed or not, you have the right to stop it at any time, and no one can interfere with this,” says psychotherapist Christophe André. But the psychologist also has the right to disagree with your intention and tell you about it.
“Rejection is difficult to interpret in isolation from the situation and from the form in which it was formulated,” says psychoanalyst Jean-Pierre Winter. Often in the process of psychoanalysis, the intention to leave speaks only of the patient’s desire to make sure that the psychoanalyst is interested in continuing the work, that the patient is interesting to him.
In other words, he threatens to leave in the hope that he will be held. The therapist’s role in this case is to “reveal the metaphorical level of the patient’s demand for the end of the sessions: is he trying to break up with his therapist, instead of, for example, breaking up with his mother?” Jean-Pierre Winter continues.
In any case, not wanting to wait for the green light or the consent of your therapist to end the sessions can serve – but not always! – a good indicator.
1 Z. Freud “Finite and Infinite Analysis” (MG Management, 1998).