Elena has just gone through two intense years in her life. Finally, after very painful moments and a significant change since the first day she sat in my office, the moment of discharge. Elena is leaving happy and with a promising future ahead of her. We are very happy for her.
Miguel, after five sessions, says that The therapy is causing you “discomfort” and you are not seeing the expected improvement. Although we tried to explain to him that the initial discomfort is logical in the first phases of therapy and that perhaps he has become impatient with excessive haste, Miguel decides abandon therapy. Both are two different ways of ending the visit with the psychologist and today we will talk about when to end the therapy and whether to do so as a discharge or as a withdrawal.
What are the phases of therapy treatment in psychology?
1) Assessment: In the first sessions the patient's request is heard and a psychological evaluation of their possible problems. For most patients, taking the step of going to the psychologist's office is a complicated decision and that is why it is important to meet with a psychologist warm and empathetic atmosphere, where their pain is understood. All of this can take 2-3 sessions, depending on whether the patient is an adult, adolescent or child.
2) Explanation of hypothesis: During the feedback session, in a single session, the information obtained during the application of tests and questionnaires in the previous phase is returned to the patient if he is an adult or to his parents (if he is a minor). Problem behaviors are identified and the context in which they occur, the risk factors and the maintaining variables. With all this, the best individualized and personalized treatment for our patient, which is how we work at .
3) Therapy: It is the most important phase of treatment and Its main objective is for the patient to learn strategies, skills and techniques necessary to deal with the case that brought him to therapy.The duration may vary depending on the type of person, the problem to be treated, among other factors.
4) Follow-up: At this stage, most of the thoughts and emotions that were causing the patient pain have already been worked through, so that he or she can begin to control them. Thus, The patient is able to increase his/her daily and enjoyable activities. and to see all the situations that were constituting a problem from another perspective. Therefore, the patient is encouraged to start spacing out the sessions. We also work on the relapse prevention so that the patient can anticipate possible future problems. And also, to become aware that he or she may have negative or intrusive thoughts again, may feel sad or anxious again. Knowing that the difference is that you already have enough tools that can be applied in these cases and for the rest of your life.
5) Ending or closing: occurs when the frequency, duration and intensity of the problem that brought you to the consultation has decreased. This is a very important moment in therapy that affects both the patient and the psychologist. How the therapy ends will determine how the entire therapy is remembered. It is necessary to agree with the psychologist the end or closure of the therapy Since when the patient unilaterally decides to end the process, the risk of relapse increases. Obviously, the fact of abandoning a therapy with a psychologist for whatever reason, as we will see later, does not imply that another one cannot be started with another professional.
What is the difference between joining and leaving therapy with a psychologist?
These are two concepts that should not be confused. Thus, discharge from therapy means that a positive change has occurred for the patient in which he or she has learned from his or her own conflict after facing it and effectively uses the therapeutic tools. However, the most common scenario is abandonment for various reasons that we will see later. Let's analyze the two circumstances separately.
Main reasons for abandoning therapy
- Change in patient prioritiesSo whatever brought you to the consultation no longer worries you, but that doesn't necessarily mean that it has been resolved.
- Impatience. Many patients, apart from having been informed, believe that after 3-5 sessions their problem should already be resolved since what they are looking for are immediate results but do not wish to carry out the process.
- Excessively high expectations. Which generates frustration and therefore, demotivation. It is related to the previous point.
- Denial to go deeper in some areas. The patient comes to the consultation with a conflict that he initially wants to resolve, but despite this, he may start to say “I don’t want to talk about this”, “I’ve already overcome this” when in reality this is not the case. Therefore, there is a patient who refuses to talk about his symptoms and a psychologist who needs him to release his emotions, so that the therapy is abruptly stopped and generates frustration and demotivation in the patient, who will end up giving up.
- Belief that further therapy is no longer neededThere are patients who give up just when they start to improve. However, most of them arrive after dragging the pathology for a long time and when the change begins it can be scary, like everything that we cannot control by ourselves.
- Lack of perseverance in household choresTherapy is a 50/50 task between the patient and the psychologist. To achieve this, the latter gives the former “homework” to do between two sessions. If the patient does not do it, the treatment is delayed and therefore, high expectations are not met, leading to frustration and demotivation that lead to abandonment.
- Bad therapeutic alliance patient-psychologist. It is due to different causes: the psychologist has not explained well how the therapeutic process will be to the patient, there is no good connection between them, the patient does not respond to the treatment due to lack of motivation or unmet expectations.
- Attitudes of the psychologist. Although it is true that in most cases where patients drop out, they claim that the psychologist is to blame, it is correct to say that there may be problems of professional competence, the personality of the psychologist, contradiction between what he says and what the patient needs…
- Economic issues. This is also one of the most common reasons for abandoning therapy. However, although it is true that there are psychologists whose fees are high, it is also true that in many other cases, this is not the case. It is a matter of searching.
What are the main consequences of abandoning therapy?
- Feeling of loss. Especially if it has been done suddenly and it brings about negative emotions such as sadness or frustration.
- Don't close the door with a slam of the door. In other words, if you are going to leave Explain your reasons to your psychologistlisten to theirs because they can also be valid and especially because they are objective. Therefore, it is important that you go to the appointment and tell them that you want to leave therapy, they will understand you. But never do it by chat or WhatsApp. Think that it is the same as leaving slamming the door and it could be that in the future you would have to knock on the same door again knowing that the psychologist would attend to you as if it were your first visit.
- It is not finishedIf you tell your psychologist assertively that you want to stop treatment, he or she will probably ask you to come to one or two more sessions to be able to finish something you were doing, or to focus on a current problem situation. They are not in any way trying to convince you to continue in therapy, but rather to give you tools that may be useful to you, even if you are going to change professionals.
How do we know if we have reached discharge?
When we are about to finish therapy, we must take into account whether the objectives for which we came to the consultation have been met. Always leaving the door open for future contact, if necessary using the same space to work on new conflicts. The indicators of a future discharge would be:
- Disappearance of symptoms. The patient notices that the symptoms that led him to the consultation begin to disappear, they are no longer distressing or worrying him, so they have been reduced or eliminated. However, this may be a superficial change.
- Progress evident because the patient has changed what he wanted. It is possible that symptoms different from the current ones appear, due to stressors or difficulties of daily life but that can be faced with the tools learned in therapy. At this time, the psychologist and the patient agree that The time has come to end the therapyAlthough it may seem like a treatment that takes years, unless there is a personality disorder or a multifactorial problem, this can take several months. The end of therapy is not necessarily definitive but you can always make another appointment at specific times when these stressors increase. In this case, you should not worry but return for a timely follow-up.
- Stagnation. It can occur for various reasons: patient resistance, becoming defensive when faced with the possibility of conflict, not doing household chores, poor communication between the psychologist and the patient, little understanding about the objectives to be achieved… In any case, knowing that psychological therapy can be long depending on the problem and that emotional work can initially cause discomfort and manifest uneasiness since it makes us leave our comfort zone, I recommend that you be patient and put into practice everything you have learned in the sessions.
- The psychologist ends the therapy. In these cases, the patient may feel that he or she still has things to say, but perhaps it is no longer necessary to do so within the framework of psychotherapy, since its ultimate goal is to obtain sufficient tools and knowledge of oneself, giving him or her greater autonomy and increasing the ability to relate to oneself, to others and to the world around him or her.
- The therapy is no longer effective. If the patient finds the sessions repetitive, finds nothing new or useful in them, or finds them boring, it is also time to end the therapy.
It is important that both the patient and the psychologist carry out a joint analysis before ending the therapy and determine whether the proposed objectives have been achieved. When the end of the therapy is by mutual agreement, The registration process can be initiated as a discontinuation of the biweekly sessions to one every three weeks, then one every three months, and finally, one every six months and one every year.
It is the follow-up process in which specific topics can be touched upon or even, detect possible symptoms of relapse in timeIt is also necessary to take into account that the end of the therapy does not mean that we cannot resume it after…