I get an email newsletter called “One Great Story,” and on many days I get suckered in to reading what some unnamed person (more likely, entity) has decided is the one thing I simply must read that day. Recently, the story was about how apparently everyone was quitting therapy.
The essay’s premise was that after what was indisputably a heyday in therapy-land, some people are deciding that they’ve had enough of talking about their problems and want to just go back to living their lives. Melissa Dahl, a health writer and the author, shares that she herself started therapy after a miscarriage, found it helpful, but then stopped finding it helpful after a while.
This led her to get curious about other people who were quitting therapy, and the essay rounds up a number of folks who describe feeling like their sessions were just rehashing the same shit, different day, potentially to the point of over-focusing on their problems. She writes, “When I started therapy, I needed to talk through the miscarriage, but once I started feeling better, I found myself searching for reasons to feel worse.”
As a therapist, a patient of therapy, an advocate for therapy, and a wordy person, you might imagine that I’d have something to say about this piece, or at least it’s premise. And I do. But it’s complicated.
Let’s actually start with Dahl’s experience of recognizing that therapy was no longer serving her. She describes moving through the pain of her miscarriage and then therapy just kind of trudging on, seemingly without a lot of direction or new insights. This experience is hardly unique, and neither was how Dahl decided to end her therapy experience. She told her therapist she couldn’t afford it anymore.
As Dahl describes, this wasn’t a lie – she’d just lost her job and was feeling the financial strain of that – but it also wasn’t the fullness of truth. As therapists, we are no strangers to this rationale for quitting therapy – in part because therapy is genuinely financially out of reach for many people. But also because it’s the reason for quitting that almost no therapist will challenge or even try to “explore” in that way we like to do. Most of us feel icky enough about charging to begin with due to our own money mindset issues; only the most secure among us will have deeper conversations around it.
And that’s a sad fact, given that whole as therapists we know that while money woes are real as hell, there’s often more when people leave under those circumstances. Some of the deepest work I’ve done with patients has emerged when we started talking about money in the context of therapy, whether it’s a real issue or a red herring.
For Dahl, the red herring was a way to get off the hook of therapy with less friction, and I’m not criticizing her for it. But it does bring up a question in my mind, which is what might have happened had she told her therapist how she felt about their sessions?
I suspect it would have been one of two things. The first is that Dahl and her therapist could have had a reflective conversation on where they were in the process of therapy, perhaps reviewing the progress that she had made and agreeing that now was a good time to pause or end their relationship. As a therapist and as a patient, I can attest that these are often the best of conversations. They give both people an opportunity to do a look-back in ways we so often dismiss as important. If you don’t believe me, there’s research to show how helpful opportunities for reflection are in integrating changes.
The other possibility is that the patient sharing her feeling of stagnancy in therapy could have led to some new and important work in therapy, work that would actually feel invigorating and motivating to do. When this has come up in my therapies, sometimes it’s led to insights about the ways that someone might be holding themselves back from doing a certain part of their own work or how similar dynamics play out in other relationships – for example, starting to get settled into a real intimacy and then jumping ship because that feels scary and overwhelming.
There’s a third possibility, of course, and it’s important to acknowledge it. Dahl could have brought to her therapist the lack of momentum she was feeling and the therapist could have had a different take and Dahl could have felt misunderstood. That’s not a pleasant experience, by any means, and it’s one that might have resulted in Dahl still discontinuing treatment. What I’m going to suggest, and I get that it might not be a popular view, is that this still could have been a positive outcome. If (and I know nothing of this particular person’s psychology, so this is for the sake of example) she struggled to communicate more directly or make choices that might ruffle feathers, this act could have been a capstone experience in her growth.
Now, it’s important to note that Dahl had every right to so whatever the hell she wanted with her own therapy. She could have three months’ worth of termination sessions, shoot off an email, or completely ghost her therapist. All would be totally her prerogative. None of this is to suggest she owes the therapist anything. It’s her work and her real money.
The other side of this equation is, of course, the therapist. We can expect and hope that therapist is tracking to the patient’s goals and continuously thinking about what work is being done or not done, whether unfortunately or by design. We can expect therapists to be bringing this topic up too when it feels like therapy is stagnating or the same three topics keeps playing on repeat with no movement. The therapist should never be a passive observer to a therapy on life-support.
And that’s where Dahl’s article for me helpfully brings up two vital points, the first of which is that most therapy is not meant to be indefinite. There are models of therapy, of course, where patients might be in treatment regularly for decades. But most therapists, honestly, aren’t operating from those frameworks. For most of us, therapy does have an arc, and that actually lends to its power.
My own therapy has had lots of mini-arcs, in fact. I think about my therapist as my specialist, not my personal trainer. I find myself seeing her for a several months to several years at a time, and then I won’t for a while. I reach out when shit has hit the fan in an exciting new way or I’m recognizing old patterns resurfacing. We pick up again and we get back to work. Then we say goodbye for a bit.
This is, of course, not the only way to engage in therapy. Some people very much benefit from the personal-trainer model, and I respect that too. They appreciate having a more on-going thought-partner and accountability agent. But even in this model, one has to recognize that the intensity of the work is going to ebb and flow. Very few of us can do intensive therapeutic work in perpetuity.
The other observation that emerged as I read Dahl’s piece was noticing how all the folks who had quit therapy described getting tired of talking. I get that. If therapy is truly just talking, particularly about the same topics in the same familiar ways, it’s unlikely to move the needle. For therapy to create real change, it needs to be dynamic, which often means that in interweaves different ways of engaging with the core themes.
It’s hard to make blanket statements here with so many styles of therapy out there, but in my view, therapy is ideally helping us access healing not just through a cognitive or “top-down” approach, but also through the gateways of emotion and sensation and through real-life behavior change. When I’m with a patient and we’re talking in circles, that’s my cue that we likely need a pivot toward a different way of engaging. That’s often in the doing of something different, through a more somatic practice, like EMDR or IFS, or in engaging a different part of the brain, such as through a creative practice.
As I prepare to share this piece, I’m have this image of a throng of my patients telling me they want to quit therapy. I wouldn’t be honest if I said that didn’t make me nervous to imagine. But in my heart, I know that this isn’t a bad thing, whether it’s because we’ve done the piece of work that needs done for now or for a whole host of other valid reasons. I hope that I’m attuned enough to know if changing things up is what’s needed too.
What I hope even more is that we don’t see therapy as going out of fashion, because I hope it was never something we did because it was in fashion. Our data tells us it’s more important than ever to find ways to support ourselves and heal. And it is okay if that happens in seasons, non-continuously, or includes a lot of pivots.
