End Of Transition

Posted by fxckfeelings on November 8, 2012

Although stopping long-term intensive psychotherapy can leave you in a state of mourning and fear, particularly if it occurs during tough times or against your wishes, it’s unrealistic to expect that returning to therapy will make everything right again. Instead, give yourself time to adjust to change and reassess your ability to stay functional and positive. Then, if you think it’s necessary, find a therapist who’s a good, supportive coach and use him or her for a different kind of therapy that keeps your head straight without stirring up your deeper feelings. If you’re certain that you have to be “in therapy” to get helpful support and are helpless without it, then the therapy you’re in is helping you a lot less than you think.
–Dr. Lastname

In my early 20s I spent 4 years in therapy (which I think in and of itself says a whole lot about the not good place I was in my head). Therapy ended, not because I was ready, but because I moved. I am now 46, and in the years since I continued to work through a lot of things on my own, with my therapist’s voice in my head, if no longer in actual therapy sessions. In January my grandmother took a turn for the worse, with both health and cognition, and we had to place her in full nursing care. She has always been one of the most influential and positive forces in my life, so I had a hard time dealing with this. It sent me spiraling down into my 4th lifetime episode of depression. I’ve started back on Prozac, which I now realize I need to stay on for the rest of my life to try to prevent future recurrences, and I’ve spent the last 10 months in therapy with my former therapist via phone sessions as we now live 1,000 miles apart. I have finished working through a lot of stuff in that time, meaning I’ve changed my attitudes and perceptions and behaviors, which has changed my life, inner and outer. I wish I’d figured it out 25 years ago, during that first round of therapy, but better late than never. It’s been a hard year. My grandmother died 7 weeks ago. The grief hit me more than I ever imagined. I thought I’d prepared in those months when she was slowly dying, but I was wrong. What is the saying—Where there is no struggle, there is no strength? Good growth has come of the pain—I have returned to college, and I am training for my first full marathon in January. I am at a truly good place in my head and was ready to end therapy, so two weeks ago, with my therapist’s blessing, I had my last session. I knew, though, that ending therapy because I am truly ready is a celebration, but that it would also be a loss. It is currently hitting me harder than I imagined. How do I get through this and find a place of healthy acceptance of this transition?

While it’s unfortunate that stopping intensive psychotherapy after many years is hitting you hard, it’s not surprising. As you well know, loss is painful, be it the death of a loved one or the end of a source of support.

That said, your pain doesn’t mean your psychotherapy has been less complete than you thought or that you stopped it too soon, just that you can be a solid, resilient person and also be very sensitive to loss, both because of temperament and circumstances.

Even if your sense of loss is causing more than pain by interfering with your ability to work or be a parent or friend, you may not need to resume the kind of psychotherapy you had before. That’s because it was aimed at inner change, which you’ve accomplished, rather than current symptoms, which are probably neither preventable nor permanent.

Assuming that you’ve achieved that goal, what you need now (if you need it at all) is a rehabilitative treatment that helps you cope with recurrent symptoms. That kind of therapy is seldom regular or weekly and its goals, which are more modest, are to help you function as well as possible, despite problems that are not considered curable.

The frequency of sessions for this kind of treatment varies greatly. Infrequent sessions might be sufficient for someone who is highly motivated and able to supplement treatment with reading and other behavioral and cognitive “exercises,” while frequent sessions are good for learning a new skill or providing support during an acute crisis. In general, the frequency of treatment depends on how well you’re doing and whether you feel you need a refresher.

Needing the second kind of therapy doesn’t mean you failed the first, just that you’ve graduated from the first and accept the fact that you sometimes need help managing recurrent symptoms.

In addition, the second kind is usually covered by health insurance whereas the first is not. So if you find yourself slipping into a vicious circle of negative thinking or behavior, and particularly if it endangers your work or family relationships, feel free to make use of the second kind of therapy, looking for a therapist who will act like a “trainer” or rehabilitative specialist who can help you cope with a chronic condition. Reaching out for help of this kind is always legitimate and often just what you need.

Celebrate ending therapy, by all means, and respect the way you’ve survived hard times and developed a positive way of looking at yourself and life. If you find yourself slipping, however, don’t be surprised—life remains hard—and don’t stop the celebration.

Reach out for help, learn from what happened, and continue on the good course you’ve charted for yourself. Letting go of your old therapy is hard, but don’t let the weight of that loss make you lose sight of everything you’ve gained and have yet to accomplish.

STATEMENT:
“I’d like to think that therapy has helped me overcome my weaknesses, but I’m aware that many sources of pain remain beyond my control and that the point of therapy is to accept that fact. I know when I need rehabilitative treatment and I will use it whenever I think it’s necessary.”

If it weren’t for my psychotherapist, I don’t know how I would have made it through the past five years. I’ve been suicidal and bulimic and sometimes I can’t get out of bed for several weeks at a time. Seeing her weekly has made a huge difference, but I’m far from out of the woods. I’m holding a job, but I’m still depressed and it doesn’t take much to put me into a spin. The problem is my insurance company that says it won’t pay for me to continue to see my therapist and that it’s time to terminate. My goal is to persuade my insurance company that therapy is a lifeline or to figure out some other way to keep myself together.

As important as it is that psychotherapy has given you hope and confidence, it’s equally important for you to maintain a sense of its subjective side effects. So, while a long period of frequent therapy has evidently eased your loneliness and helped you control negative behaviors, it has also caused doubt and a sense of loss when you are separated from therapy for more than a few weeks or during a crisis. This doubt easily escalates into a fear that you will be worse off than when you started, when, in fact, the opposite is probably true.

What generally happens is that patients who lose regular, frequent contact with a therapist find that they’ve learned and absorbed more than they thought, that they remember what they were taught with greater intensity, and that they have greater strength to fight off negative thoughts and behaviors. It’s not unlike losing a good parent or friend; you may feel initial loss and fear, but you also have an ability to keep them living in your actions and thoughts (see the account above).

So don’t panic or despair if events force you to stop or cut back on psychotherapy before you and your therapist feel you’re ready; remember, the whole point of therapy is to help you accept such losses while not getting overwhelmed by despair. What you and your therapist may hope is that you will continue treatment until you feel confident and are unlikely to be shaken by losing a special relationship. Keep in mind, however, that losses often occur before you’re ready for them, and the lesson of therapy is to remember why you should keep going and taking good care of yourself until your confidence returns.

Meanwhile, there are kinds of therapy that can help you manage your doubts and fears without resuming regular, weekly treatment. Assuming you know that you’re not really going to fall apart and that you can benefit from a relationship that is more based on coaching and training than on sharing deep feelings, you can find, and get funding for, the rehabilitative kind of treatment described above that strengthens your tools for remembering your strengths when you don’t feel strong.

If you put aside your fear of stopping treatment and instead decide, on the basis of your experience, how frequently you need treatment to keep you functioning, you’re ready to negotiate with insurers and/or figure out how much rehabilitative treatment is worth paying for when your resources are limited.

You’ll not only find that reducing or stopping weekly treatment is survivable, but that you can learn and grow from the experience while using a different kind of treatment to strengthen your sense of perspective when you think it’s necessary. If your current therapy has truly been helpful, then you should have the tools to bridge the gap between sessions and survive.

STATEMENT:
“Stopping treatment before I’m ready feels like stepping off a cliff, but treatment has taught me that I am prone to that feeling and that I am actually much less helpless than I feel. I will survive this transition, observe carefully what I do with it, and come to my own conclusions about how much additional treatment I really need.”