- Autumn Quiles, LCSW
When to End Therapy
There is a whole lot of advice floating around about when you need to start therapy. It's almost like people throw out "get a therapist" as a stock-phrase for families who are navigating hiccups in their lives. But once you take the plunge and get into the meat of it, the question of When to End starts to roll around.
First, I need to clarify that "When to End Therapy?" is not the same question as "When to Dump Your Therapist?" Dumping your therapist is a question that most families don't consider, until it noodles it's way into your mind. With respect to that question, if you are thinking about dumping your therapist, you probably should. Though, I always encourage people (little people and big people) to have an honest conversation about your feelings with your therapist before you walk out the door, because we are human too and most of us care too deeply for our own good.
The question of When to End Therapy is a bit harder to answer. Ideally, ending therapy happens when you, your kid, and your therapist, feel that your kid understands her issues, is capable of keeping her issues "in check" and you have a stockpile of tools to help your kid keep the issues "in check."
Sometimes, kids/teens have a very specific issue they need to make sense of. They are trying to make sense of a divorce and figure out how to emotionally navigate that divorce. They have moved and changed schools and this threw them for a loop. They were denied admission or kicked out or ostracized or bullied. These are temporary life setbacks or situations that they don't know how to manage.
These same kids may adopt a pattern of thinking- a pattern of seeing the world- that is causing them emotional distress in many situations. The child's beliefs, about themselves and their families and their environment is skewed. They approach every- old and new- situation with these sideways thoughts and they find themselves making poor choices over and over again.
It's kind of like the difference between a child coming to therapy because his current teacher hates him and he doesn't know how to get through the year, versus a child coming to therapy because his teacher hates him and that means he's stupid and everyone hates him and therefore he is a useless human being.
Typically, there are a lot of behaviors that accompany these problems. The child is fighting with his parents, can't keep friends, feels down on herself, is having behavior issues in school, is not eating/sleeping/playing like usual, etc. Sometimes the behaviors are pretty severe, like massive meltdowns, school refusal or a child harming himself or others. These behaviors are usually the trigger for families to start work with me.
It is important to know that these behaviors are a symptom of the child's underlying issues. They are the sneeze to a cold. The fever to a strep infection. The weight-loss to a stomach bug. One of the first thing a therapist works on is relief from the symptoms. Therapy is a tissue for the sneeze. Aspirin for the fever. Broth for the stomach bug. We help the child manage feelings so they don't become a meltdown, develop a plan for going back to school or help the child stay safe and stop self-harm.
The key point is: this preliminary work is only to alleviate the symptoms. More work is needed to treat the underlying reasons behind the behavior. Treat the actual cold, strep or stomach-bug itself- like you would with antibiotics or a change in diet. Work to examine, and make better, the child's perception of himself and the world so that he does not stay in a head-space that makes it possible for those symptomatic behaviors to return.
This work is much more subtle and much, much harder. It requires the child/teen, and her family, to examine how this pattern of thinking came into existence and what powers are keeping this pattern of thinking in place. This is the real and meaty work of therapy. This is why I make the proverbial Big Bucks.
Many families call me because they see symptoms. The scarier the symptom, the faster they make the call. I am good at getting symptom relief. Sometimes it takes the family a while to get the hang of it, but we get those self-destructive behaviors in check. Then, some families feel the work is done. They ask me, "Are we ready to End Therapy?" They believe that because the symptoms are gone, so are the underlying causes. Therapy is expensive and time-consuming and all that symptom-work was difficult. They want to be done. And, sometimes, families exercise their right to make the executive decision to Be Done, regardless of my opinion.
Many times, however, I hear from these families again. Symptoms have returned. Old behaviors have resurfaced. The child/teen is worse. I happily get up on the horse again and we battle the symptoms down again.
However, for families who are most interested in putting their child's problems in the past permanently, we must work on the child's underlying pattern of thinking. We must change their perception of the world and the parents must have the tools necessary to help their child right themselves if their thinking gets too skewed again. This happens after the "crisis" is over. This happens when the child's behavior is "normal" or "good."
The child/teen will tell us when this belief system is healthy again. We will see it, not only in the way they conduct themselves, but by the things they say about themselves and others. We will see it in the way they problem-solve. We will see it in the way they naturally seek out, and choose, growth and life and joy. They will move from surviving their daily life, to thriving... in all areas of their world- home, school and community.
This is when we End Therapy.