Whilst I’ve spoken about the end of psychotherapy before and its importance in one of my Clinical Psychology Reflections books, I wanted to talk about it again from a different angle because endings are important in therapy. So in today’s podcast episode we explore why clients and us as current or future therapists know that it’s time to never psychotherapy for a client. This is a great episode for anyone interested in clinical psychology.
Today’s episode has been sponsored by Clinical Psychology Collection. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it.
Note: as always nothing on the podcast is any sort of official or professional or medical advice.
What I Am Shaking My Hands Off In This Episode?
Now I want to fully admit this, and especially after my recent lectures, that I was forgetting on purpose a hell of a lot of real things that goes on in the clinical psychology workplace. So please, don’t think I’m stupid and naïve because of this podcast topic and to be honest, very little of this episode applies if you work or want to work in the public sector. Since in the public sector and the NHS in the UK, you give your client 6 sessions maybe 8 if you beg your boss and that’s it.
It doesn’t matter if those sessions work or are actually at the end of the therapy for the client. You have six sessions and that’s it.
Therefore, please know that I’m talking about in an ideal world this is how you know you’re at the end of the therapy. Or this works if you’re in the private sector, but I still believe it’s important to learn about so all of us are at least aware of these signs.
How Psychotherapy Works?
Whilst I know a lot of the podcast audience are psychology students and professionals I still want to recap this topic briefly in case there’s anyone who isn’t too familiar with what exactly psychotherapy is. Therefore, psychotherapy is a uniquely collaborative environment centred around learning since the psychotherapist teaches and works with the client to give them new skills, concepts and knowledge that could help the client to navigate their lives a little easier (American Psychological Association, 2012). For example, a client might get help to improve their emotional awareness, finding a purpose, improving their problem solving or improving their interpersonal relationships.
In addition, therapists use different approaches and types of psychotherapy depending on the demands of the client (or in the public sector you’ll get what you’re given). For instance, psychodynamic therapy is where you explore your underlying wishes, fears and fantasies as well as your unconscious thoughts (Brown et al., 2014). This form of therapy is effective at improving and addressing people’s relationships. Whereas Cognitive Behavioural Therapy investigates a person’s maladaptive thought processes and dysfunctional behaviours. Making it great to treat anxiety, depression and other mental health conditions.
Additionally, whilst different therapies target different aspects of a mental health condition, they all have three things in common or at least share similar aspects. They all involve a relationship between a client and a therapist, they involve the implementation of goals and health promoting actions as well as they involve setting both expectations and goals in each therapy session (Wampold, 2014).
How Do We Know If It’s Beneficial To End Therapy?
Again, unless you’re in the public sector, deciding to end therapy is a decision that should always be made carefully by both the therapist and the client. Ending it too soon is problematic because the client’s difficulties might return quickly and the client will not benefit from the therapy if it isn’t completed. Equally, there’s no point continuing with the therapy if there’s no need for it.
It is always best to decide if the time is right to end therapy with a conversation between the psychologist and client, and they need to both agree this is the right time. This is a collaborative process after all.
As a result, now we’re going to cover three questions that might help you as the therapist or client to decide if the time is right.
Is The Treatment Relationship Going Awry?
This is the first question I wanted to ask because at the end of the day, a therapeutic relationship is still a relationship. All relationships can go wrong at times and they can form, be maintained and break down. The therapeutic relationship is not immune to this breakdown.
Interestingly enough, if this conflict does activate then this is normally the start of a “real” therapeutic relationship and the therapy itself. Since if the therapist struck a nerve then this is an area that is often reflected in the client’s real world relationships and this conflict spreads to other contexts.
Therefore, speaking and working through this conflict is important and of course, this requires a lot of trust from the client.
However, what you don’t want as a therapist, is for this conflict to be because of a lack of skills on your end. Such as, a therapist needs to maintain and hold emotional boundaries with the client so this doesn’t lead to confusion about who’s difficulties are being assessed and solved.
If this is the problem and a client can talk to their therapist about this, and if the conflict still isn’t being resolved. Then it might be an idea for the client to find a therapist who has the skills they require.
Is The Client Running Away?
When therapy actually starts properly, it is natural for clients to get scared and as psychology students and professionals, we have to acknowledge that fact. As well as it’s important to bear in mind that a client’s past behaviour can predict their future behaviour because if a client has ghosted or left people in their own life, then they want to do the same to you as their therapist.
Clearly if a client does do this then these behaviours are maladaptive and avoidance-focused. As well as the client might do this because the therapeutic relationship feeds into their fears of abandonment and continue their cycle of avoidance, because the therapy will end at some point and that’s scary. But the client needs to ask themselves, what exactly are they running away from?
And hopefully, they can be convinced (hopefully without any external involvement) that it’s important to stick around so they can find out what they’re running away from.
Is The Client Improving?
Typically, this final question is asked in such a biomedical model way that I hate it, but it is important. As a result of the client came to us because they had a mental health condition severe enough to get a diagnosis, so this was causing them disruption in their daily lives.
Therefore, when they leave the therapy room (in an ideal world) they would be better, they would know how to live with their condition because you cannot get rid of mental health conditions and they would be able to live a clinically “normal” life.
However, some clients start to question therapy when lives get tough, when they make a little bit of process but not as much as they like, or when they believe they haven’t made any progress at all. When this happens they should of course talk to their therapist and there should be a conversation as to why this might be the case and it is possible that the client is experiencing psychological resistance. Possibly leading to avoiding emotions and/ or rejecting the change that therapy brings.
If this is happening then it’s good for clients and therapists to know that this could be a part of a larger emotional as well as cognitive process people call ambivalence. This happens for a range of reasons but being able to recognise when ambivalence is happening and acknowledge it is important. As this is the first step for the client overcoming the resistance with the help of their therapist.
Clinical Psychology Conclusion
I know I ignored a lot of real-world public sector things in this podcast episode, and that is an important detail for the UK audience at the very least, but this is what should happen in an ideal world. As well as I’m sure that the members of the audience working in the private sector can tell us stories about clients ending the therapy when they really shouldn’t have.
This is sadly nothing new.
However, this is important for us to remember as future or current psychologists, because if we work with clients then there will be a point in our careers when we have to ask this question. And we will have to gently tell the client that they really shouldn’t be ending the therapy because there is still work to be done. Maybe those three questions will help you and your client come to a shared realisation or maybe this episode was just good background knowledge for a rainy day.
I don’t know but what I do know is that at the end of the day, we can only go so far and if a client truly wants to end therapy because they aren’t ready for the change. Then there is nothing we can do to help them until they’re ready.
I really hope you enjoyed today’s psychotherapy podcast episode.
If you want to learn more, please check out:
Clinical Psychology Collection. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it.
Have a great day.
Clinical Psychology References
Brown, J., Scholle, H. S., Azur, M. (2014). Strategies for measuring the quality of psychotherapy: A white paper to inform measure development and implementation. U.S. Department of Health and Human Services Assistant Secretary for Planning and Evaluation Office of Disability, Aging and Long-Term Care Policy. (ASPE)
Wampold, E. B. (2015). How important are the common factors in psychotherapy? An update. World Psychiatry, 14, 270-277. https://doi.org/10.1002/wps.20238
Understanding psychotherapy and how it works. (2012, November 1). American Psychological Association. Retrieved November 4, 2022 from https://www.apa.org/topics /psychotherapy/understanding
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