One of my favorite brands, Thinx, has a pretty fantastic blog on their website. Their guest writers contribute articles about feminism, mental health, intersectionality, and demystifying menstruation. But recently, an article about breaking up with your therapist stuck in my craw.
It’s not what you think – I wasn’t mad because the writer was teaching my clients how to ditch me. I actually think that most of her points about leaving a mental health provider who isn’t serving you were spot on. What upset me was that she got the “how to” part very, very wrong.
The author, Larissa May, is a blogger and mental health advocate, and her take on what therapy should look like and when to end it come from her own experiences as a consumer of these services. This isn’t wrong – a HUGE part of finding the right therapist is about trusting your gut. But what it means is that she’s written an article from her experiences.
As someone who has been a therapist to over 1,000 clients and a therapy client to over a dozen therapists, I wanted to provide more balance.
First, how does therapy work?
Research shows, and my personal experience reflects, that therapy is helpful for one main reason: the therapeutic relationship. I’ve written about this before in a post about how to find a therapist.
In short, the first step is to find a therapist who feels like a great fit. If at your first session or two, something feels off, like your therapist is judging you harshly, or doesn’t get you, or there’s just a weird energetic clash, follow May’s advice and break up with them by email or voice message. At this point in the process, you’re still “shopping”.
But once you find someone who feels like a good fit, therapy works, by and large, because it’s both a space where you can be a different kind of honest with someone, and a microcosm of your other relationships. When used well, and with a skilled and trusted therapist, this means that therapy can be a kind of a laboratory to try on different approaches you might not necessarily use in your other relationships.
A different kind of honest
“You were late for our session today,” a long-time client told me. “I was sitting in the waiting room and watching the clock, and we started 7 minutes late, and I was thinking it’s probably because you don’t like me, and also that you’re probably going to still try to end on time and make our session shorter. So I’m really pissed off at you.”
If you said this to someone in your life who wasn’t your therapist, their most automatic, human response would be to respond defensively. They might say, “it was only 5 minutes late, and chill out, we’ll go 5 minutes over to make up for it.” Or, “you’re usually the one who’s late for things, so I didn’t think it would be a big deal.” Or, “shit, you’re so sensitive. It was a few minutes. Just deal with it, it doesn’t mean anything.”
But therapists are trained to have these harder conversations, and hopefully to take the feedback as constructive grist for the mill. I could have responded to this client in a lot of ways, but what I actually said was, “You felt really abandoned by me when you were sitting in the waiting room. We usually start on time, so when I was late today, it felt like a reflection of how I feel about you, especially after our tough session last week. I absolutely didn’t mean to make you feel that way. Can we talk about it?” (And of course I gave her an extra 7 minutes at the end of our session.)
And the session was so productive! We talked about other times in her life when she’s felt abandoned. We looked closely at how she deals with those situations by ending the relationship before the other person can ditch her. We talked about anger as a protective mechanism and how feeling mad or frustrated seems safer than feeling hurt or rejected.
The opportunity to practice radical honesty like this is one of the great superpowers of the therapeutic relationship. These kinds of conversations would feel unsafe (or just unsavory) in other settings, but they create incredible opportunities for growth in a therapy relationship.
A microcosm of your other relationships
Because therapy is, at its core, a relationship, if you stick around for any meaningful period of time, the way that you interact in your outside relationships will show up in therapy. If you tend to turn everything into an argument, that will happen in therapy. If you tend to get going when the going gets tough, that will happen in therapy.
But therapy is a really different kind of relationship than your other relationships. A skilled therapist won’t respond as a jilted friend, partner, or family member. They’ll respond with curiosity and help you to unpack your responses. When you react to uncomfortable feelings by getting angry at your therapist, your therapist will say, “I’ve noticed that when we talk about challenging things, you sometimes lash out at me. I’m curious if that shows up in other areas of your life?” If you have a hard session and then cancel the next two, your therapist might call you and say, “I’m wondering if maybe we opened up too much too quickly last time. Would you be open to coming in and talking about how we can slow down, and what our last session brought up for you?”
A lot of what enables this to be true is your therapist’s training in responding to these kinds of interactions. But it also has a lot to do with the “therapeutic bubble”, which I’ve written about before in the context of dual role relationships and why your therapist won’t have coffee with you. (This is also why May’s point about wanting a therapist who calls you between sessions to make sure you’re okay is wrong. That can be nice if it happens occasionally and in an appropriate way, but a lot of therapists won’t do it, because it runs the risk of blurring boundaries and going outside that bubble.)
Think of therapy as a safe way to explore the ways you respond to difficult situations, and to try out different types of responses.
Asking for your needs to be met
Just like in any relationship, the onus of responsibility is on you to ask for what you need. This is about learning to be assertive, and the core skill here is boundary setting. These are important things that will serve you well in every relationship.
Being assertive and setting boundaries can be really, really hard, but can also pay dividends. You can ask your mother to stop criticizing your weight, and you can tell your best friend that it drives you bananas when he’s late for everything, and you can lovingly ask your partner to pick her socks up off the floor.
And my hope is that your mother and your best friend and your partner are able to hear these asks, understand that they’re coming from a place of love, and try to adjust their behavior accordingly. As I wrote about here, they might not be able to do a complete 180, but the important thing is that they take baby steps and try.
But sometimes people disregard your asks in a way that’s really dismissive or hurtful. Your mother might say, “oh, but it’s my job to make sure you’re healthy, and someone needs to tell you these things.” Your best friend might say, “ah, but it’s part of my charm, and no one else seems to care, and I think you’re just being oversensitive.” Your partner might say, “babe, take me or leave me, I’m just a carefree socks-on-the-floor kind of lady, and if you can’t deal with that, you should find someone else.”
And if that happens, it really stinks. But it’s also information, and now you are empowered to integrate that piece of information into everything else you know about the person and move forward accordingly. You can ask yourself, “were they having a bad day, or is this disrespect part of a larger pattern?” You can decide, “how important is this really to me, and how much space do I want to give this person in my life?” And you can make space to keep yourself emotionally safe.
The same principles apply with your therapist. Ask for what you need. Tell them, “it felt crummy when you said ___”, or “when you asked me ___, it felt like you were judging me”, or “the way you reacted when I talked about ___ reminded me of my hypercritical stepfather.” Or say, “you know, I really liked our first 6-8 sessions together, but lately it feels like I come in here and talk, and all you do is nod. Is it possible for you to be a little bit more hands-on and interactive?”
This can be an immensely healing conversation. It may be the only safe space you have to voice these kinds of needs. And if it’s not – if your therapist reacts in a way that feels hurtful or dismissive – THEN it’s time to protect yourself and move onto someone else.
How to break up with your therapist, for real
I will be the first to admit that I am more (gently) confrontational than the average bear, but if you have an established relationship with your therapist, I think that it’s important to be honest about why you’re leaving. Yes, you can send an email to your therapist. If your therapist is part of a group practice, you can go through an administrator, like a scheduling person, and just ask them to take you off of your therapist’s schedule.
But if you do those things, I think you’re missing out on a genuinely important opportunity.
Remember: therapy is a microcosm of your other relationships. Ending a relationship that isn’t serving you is a valuable life skill, and one that will serve you well in a lot of areas of your life: friendships, romantic relationships, even the workplace.
If your therapist has done something truly damaging, like make a sexual pass at you, or violate your confidentiality, or make you feel like an attribute such as your sexual orientation or race makes you “less than”, you should report them to their licensure board. But if it’s just not a fit, you owe it to yourself to have one last hard conversation.
Best case scenario, this is done in person. But if you don’t want to pay for a last therapy session, the second best option is to leave your therapist a voicemail letting them know you need to talk to them, and then having the conversation by phone.
Then:
Tell them that you are going to be finding a different therapist, and let them know why. Remind them of when you asked to have your needs met, and tell them you still feel like it isn’t working out because they’re unable or unwilling to meet your request.
This is the kindest way to end your relationship with your therapist. And it’s good to be kind because, speaking from experience, your therapist probably cares about you a great deal. But that’s actually not the main reason that having this hard conversation matters. It actually matters because it helps you find closure.
This is such an important skill set to practice. Most people I know have had friends and family members quietly slip out of their lives, or ghost them completely, and it really sucks. But it also sucks for the person doing the ghosting, because you’re left with a lot of “what-ifs” and a lack of closure. So, just like every other phase of therapy, this is an opportunity to practice skills that are important in other areas of your life.
If this sounds incredibly hard to you, you’re not alone. But it can pay dividends when you need to set boundaries in other areas of your life.
Next steps
If your last therapist wasn’t a good fit, or wasn’t willing or able to meet your needs, I encourage you not to give up. A lot of people who have negative experiences in therapy say that therapy doesn’t work for them, rather than saying that the specific therapist didn’t work for them.
If you’ve just broken up with your therapist, I recommend looking for someone who feels like a better fit before giving up on the institution of therapy on a whole. If you’re looking for a good place to start, here is a blog post I wrote awhile ago about how to find a therapist who’s a good fit.