How Do You Determine When to Stop Psychotherapy?
Deciding when a client is ready to conclude their psychotherapy journey is a nuanced process, so we reached out to a diverse group of mental health professionals for their expert perspectives. From assessing client readiness to reflecting on therapy needs, here are insightful responses from fourteen psychotherapists and therapists on this critical decision-making process.
- Collaboratively Review Progress
- Assess Goals, Skills, Support Network
- Ability to Manage Well-Being
- Consider Productiveness of Sessions
- Continuous Silent Assessment
- Termination is Personal
- Transition Into Maintenance Phase
- Achievement of Goals or Stagnation
- Evidence-Based Progress Review
- Reflect On Client-Therapist Fit
- Regular Reviews Inform Discharge and Aftercare
- Termination Is A Gradual Process
- Client Self-Sufficiency and Confidence
- Reflect On Needs
Collaboratively Review Progress
Determining when a client is ready to end psychotherapy involves assessing several factors. These include symptom improvement, achieving treatment goals, and the client's ability to cope independently. Research suggests that about 50% of therapy clients experience significant improvement within eight sessions, while longer-term therapy may be necessary for deeper issues.
It's crucial to collaboratively review progress with the client, ensuring they feel empowered and equipped with skills learned in therapy to manage ongoing challenges effectively. Open dialogue and mutual agreement on discontinuation help ensure therapy concludes at a point that feels right for the client's continued well-being.
Assess Goals, Skills, Support Network
As a trauma therapist, I help clients reduce symptoms (e.g., insomnia, rumination, tearfulness) with emotional-regulation skills. I also offer somatic- and mindfulness-based therapies (e.g., Brainspotting and Internal Family Systems) that have been proven to heal trauma. Additionally, I support clients in reaching their goals for living more fully. This might include leaving a toxic work environment and starting a career that is driven by purpose and passion. It could also mean saving a strained relationship or recovering from a breakup to build a long-lasting, loving relationship that uplifts you. Sometimes the focus is on cultivating self-love and the confidence to pursue your dreams. The goals could also be building a community of friends or chosen family that inspires and supports you through hard times. Ultimately, clients graduate from therapy when they have reached their goals, are no longer plagued by trauma, and have the skills and support network to thrive.
Ability to Manage Well-Being
A client may be ready to stop psychotherapy when they start bringing less information and fewer worries into sessions, exhibit reduced dysregulation, and consistently use therapeutic practices in their daily life. When the therapist reviews the treatment plan goals set at the beginning of therapy and sees that these goals have been achieved, it might be time to decrease the frequency of sessions. Typically, clients transition from weekly sessions to biweekly, then to monthly, and finally complete their treatment. This gradual reduction ensures that the client maintains their progress independently while still having periodic support. Ultimately, a client is ready to stop therapy when they are living the life they wanted to live, feeling empowered and capable of managing their well-being on their own.
Consider Productiveness of Sessions
When it comes to stopping psychotherapy, it is a very individualized and personal decision. There is no black-and-white answer, but I always recommend recognizing that no decision (stopping or continuing) needs to be final. What I tell my clients is to ultimately ask themselves if they feel they are still getting benefit out of our meetings or if they feel they continue to attend out of routine. If the answer is the latter, that is usually a sign for me to at least bring up the topic of discharge. Ironically enough - often when this conversation comes up, that's when some important therapy content comes up! But after all is said and done, if it is clear that the sessions are not being utilized in a particularly productive way, then that is a sign to consider discharge. I can and do suggest this, but I often leave that judgment call up to my clients.
Continuous Silent Assessment
Determining when a client has reached a level of development that would lead to their termination is one of the most important skills a psychotherapist needs to learn early on in their career. This process requires the clinicians and client to have an ongoing conversation surrounding the client's initial goals upon entering therapy, and regular reassessment of their progress throughout their journey.
Once the client has reached their goals, and sessions tend to be slowing down or becoming less fluid over time, it may be time to have the termination conversation. This conversation is one that is collaborative; take care to let the client express their internal experience to you—then find a way to reflect to them all of the accomplishments and growth they have made. There is a very high likelihood that this conversation is going to be uncomfortable; this person has been seeing you for quite some time, and there have been a lot of hard situations navigated in the therapy space. This is all a part of the journey, and something that needs to be reflected back to the client—it is completely okay to feel "weird" about the termination session. This is the best time to advocate on behalf of all of your client's work and reaffirm the reality that they are ready to fly out of the nest; this is a direct result of all of their hard work.
The art of knowing when a client is finished with their psychotherapy work is one that is assessed silently in every session—when the clinician experiences an instinctual sense of readiness on behalf of their client, and the mental health assessments/goals of the clients are met, it is time.
Termination is Personal
Your journey through therapy should be guided by treatment goals. These goals are determined with your therapist in your initial sessions and reflect what you would like to accomplish through the course of therapy. As you complete these goals, you can revisit whether there is more to address, or if completion of those initial goals resolves what you were looking to accomplish through the therapy process. For some individuals, therapy is brief and solution-focused and resolves in weeks or months. Depending on your diagnosis, you may also find that there isn't a right time to 'stop' psychotherapy, and treatment continues at varying frequencies more long-term. For example, you might have a monthly 'maintenance' type visit to maintain the progress you achieved in more active therapy. Just like other aspects of treatment, termination is personal, and there is no approach that works for everyone.
Transition Into Maintenance Phase
As a betrayal trauma clinician, I work with clients who have discovered that their partner has a secret life of sex addiction. The aftermath of discovery is traumatic (big T trauma) to the individual, the couple, and often the entire family system in some way. Once clients work through the initial stages of crisis, repair work begins. Clients typically begin to lessen the frequency of therapy once they have established supports outside of the therapy room. Once clients are able to manage emotions, activating moments, and feel successful in boundary setting and execution, I will re-evaluate using outcome measures before recommending a pause in treatment. Once a pause in treatment is successful, clients will decide to return on an as-needed basis, think maintenance phase.
Achievement of Goals or Stagnation
It's time to end therapy either when a client has met all the goals they hoped to achieve, or when the therapy is no longer useful in moving a client toward those goals. If a client has grown in all the ways they were hoping to, and therapy is not stretching them emotionally anymore, sessions might start to feel more like social catch-up time. At that point, it's time to reflect on the work together and make a plan to say goodbye.
In a situation where a client isn't making progress toward their goals, the decision of when to end therapy is less clear-cut. Of course, it's important to remember that clients always have the right to decide for themselves if it's time to stop therapy, with or without having a "goodbye" or "termination" session.
Sometimes feeling stuck is a normal part of the work, even when a therapist's skill and vibe are a great match for someone. But if I'm working with a client and it becomes clear that they need a therapist with a different approach or different expertise than I can offer, I'll start a conversation with them about finding another therapist for them to work with. We'll talk about what they've been finding helpful or not helpful about therapy with me, which can clarify what they need from their next therapist in order to get where they need to go.
Evidence-Based Progress Review
Determining when to stop psychotherapy is a nuanced process that requires careful consideration of the client's progress and goals. In my practice, I focus on a compassionate, strength-based approach, emphasizing evidence-based techniques like CBT, DBT, IFS, and ACT. I regularly assess the client's progress through collaborative discussions and measurable outcomes related to their initial treatment goals. When clients demonstrate significant improvement in managing symptoms and achieving personal goals, and they feel confident in their ability to utilize coping strategies independently, we begin to discuss tapering off sessions.
Additionally, I consider their stability in daily life and the ability to maintain mental well-being without frequent therapeutic support. The decision to stop therapy is always made collaboratively, ensuring the client feels empowered and supported throughout the process. Ultimately, the goal is for clients to achieve balance, harmony, and a sense of self-efficacy in their lives.
Reflect On Client-Therapist Fit
There are a few different things to consider when determining if it is time to end a client's treatment episode. Have they reached the goals they set with you at the start of treatment? This is an ideal termination. Other reasons for termination are just as important; has the client reached a plateau in your care, and is it time to help them seek alternative therapists or methods of treatment that may serve them better and offer a differing perspective for their goals? Another reason that is often overlooked is to examine if the professional and the client are a good fit. Reflecting on your relationship with the client can help determine if your skills and approach are helpful; if the client's needs are not within your wheelhouse as a professional, or if your style or approach to treatment is not good for the client, it is time to terminate care and help them find a more appropriate provider. This can be a difficult thing for a provider to do.
Regular Reviews Inform Discharge and Aftercare
I think it really depends on the client's stated goals and what they are hoping to achieve with ongoing therapy. Typically, we collaborate on treatment objectives and review them every 90 days, so there are some objective measures that inform the process, but it inevitably comes down to a conversation in what is hopefully a trusting therapist-client relationship to determine an effective discharge and aftercare plan. Framing discharge as a client's success versus something to be feared is essential to ethical and competent clinical practice; a dialogue that starts at the very beginning of my work with clients and continues through the last treatment plan review.
Termination Is A Gradual Process
Determining when psychotherapy should end is usually best approached as a collaborative process between therapist and client. We want the client to feel that they have achieved their initial (or updated) therapeutic goals, which often center around improved emotional regulation, better coping strategies, or the resolution of specific issues happening in their lives.
Other indicators of a client's readiness to end therapy include the client reporting a greater sense of overall well-being, increased self-awareness, and a notable improvement in their primary relationships. If the provider has incorporated some form of regular progress reviews in sessions, then these milestones are easier to identify, ensuring that both the therapist and client are on the same page.
Additionally, before pausing sessions, the client should feel confident in their ability to manage similar future challenges independently by applying the skills they've learned. A review of the client's journey and the celebration of their achievements can reinforce this progress and boost confidence. Termination is ideally a gradual process, allowing for booster sessions if needed to support the client's transition, and with a solid understanding that the therapist stands ready to welcome the client back into treatment if need be.
Client Self-Sufficiency and Confidence
Deciding when a client is ready to end psychotherapy involves several key factors. Above all, it's a collaborative process where the therapist and the client assess their progress toward the initial therapy goals. Moreover, the client is experiencing significant relief from their original symptoms and increased confidence in managing current and future life challenges using the tools gained in therapy. Additionally, the client feels more stable, resourceful, and self-sufficient. It's important to regularly talk and assess how the client thinks about ending therapy and to track progress together. This helps make the transition out of therapy go smoothly. The ultimate goal is for the client to feel confident and capable of taking care of their mental health before ending therapy.
Reflect On Needs
It can be hard to know when it's time to stop therapy. Some signs you might be ready to take a break or stop therapy include feeling like you don't have much to talk about anymore, feeling like you have solid tools to manage your symptoms and distress outside of sessions, and finding yourself not looking forward to sessions. It's important to note that there is not one correct time to stop therapy, and everyone has different needs. Sometimes, pausing therapy allows us to reflect and practice our tools independently before returning in the future.