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This is a post I wrote almost two years ago.  I thought I would repost it because I had some things I wanted to add.  I will add them at the end.

All therapy comes to an end. The question is what to do when the therapy ends abruptly or the patient has been wanting to leave for a while. But what if it is the therapist who wants out of the relationship and does things unconsciously to get the patient to end the relationship? Like missing an appointment, double booking or even being hostile to a patient. It is always unconscious.  Therapist’s are people too. They have their own psychological wounds.  Sometimes a therapist will tell a patient they don’t need therapy anymore. I believe, it is always up to the patient to decide that.  If a patient seems to be coming less and less I might bring up the idea of working toward an ending. 

I think a proper termination is always the best way to end. However, it doesn’t always go that way. When patients leave abruptly and give a reason it is rarely the reason given.  They may blame it on parking, money or even “ not getting anything” out of therapy any longer.  Or because of schedules the therapy may evaporate. Either way, exploration for the departure is always best. Maybe the work was getting to deep.  Maybe my patient felt uncared for.  Maybe an addiction had resurfaced and she was too ashamed to bring it into session.

I have come to understand that patients leaving abruptly or starting with a new therapist before our work is completed can be from something unaddressed between the me and my patient.    The decision to leave can can arise out of their anger that the therapy isn’t bringing them the happiness they thought it would.  The patient will blame me most of the time. They might say something like “I have been doing this for a few years and I am not getting any better.” They usually say something to me  like “ you  are a nice person or I really like you, but I don’t think it is working” which translates to it being my fault. It is my fault in that something I said has made her feel like she can’t talk to me about her feelings. It is not up to me to “make them better.” It is up to me gently listen and hopefully we can repair our relationship. 

When I was neophyte psychotherapist,  I would have tried to convince my patient to stay. Now I know better. If she really wants to leave I will say OK.  I usually will leave the door open for her return.  

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