ShareThisBy GAIL ROSENBLUM
Years ago, marriage and family therapist Brier Miller was working with a couple who had made terrific progress. So Miller knew it might be time to end the counseling relationship.
Yet, she hesitated. This couple, she said, were like "a predictable tea party. They come in. I enjoy them."
As a compromise, she told them: "I feel like we're either done or there's something really important we're not talking about." Turns out, they weren't talking about "the buckets of issues" they had about their sexual relationship.
Miller worked with them for another year, doing what she considers "a hugely significant piece of work." And then she said goodbye.
Still, the experience caused Miller, past president of the Minnesota Association for Marriage and Family Therapy, to do some "soul-searching" of her own.
Sometimes, she said, "it's the therapist who can't let go."
She has a hunch why this is. While most therapists are well-trained on the front end _ digging skillfully into a client's history and relationships, challenging and cheerleading _ one stunning reality is how little guidance they are given on the back end. In other words, when is a therapist's work "done?" When is it time to say goodbye and send the transformed client back into the world? And how, exactly, do you do that?
"There's lots of talk about engaging and building a good therapeutic rapport," Miller acknowledged, "but there's little conversation about untangling that great rapport. The therapist may assume that it will take care of itself, but often it doesn't."
The American Association for Marriage and Family Therapy and American Association of Pastoral Counselors (AAPC) aren't terribly enlightening. Therapeutic relationships should continue, according to their guidelines, "only so long as it is reasonably clear that clients are benefiting from the relationship."
Huh.
The Rev. Douglas Ronsheim, a Presbyterian minister and executive director of the association, agrees that knowing when to end a relationship with a client is "tricky." That's why it's important to have some goals and objectives," he said. Those goals can be general ("I want to stop feeling depressed") or specific ("I want to quit my job"). Either way, when the goal is reached, both parties know that it's time to part, or renegotiate the terms of treatment, he said.
With his own clients, Ronsheim begins talking about the end right from the beginning. "I often ask, within the first or second session, 'How will you know when it's time to stop?' That gives (the client) the idea that this relationship will end."
Not everybody is happy with that. Some clients are offended, telling Ronsheim: "You're trying to get rid of me before treatment even begins!"
Miller agrees that it's not uncommon for clients to feel that their therapist is abandoning them when talk turns to wrapping up. "They may feel angry or hurt. 'Why do you want to let me go?' " Sometimes clients who have been making outstanding progress begin to slip back, she said, with original symptoms re-emerging. Children might start acting out. The question for the therapist, she said, is: "Is this a need for more therapy, or an opportunity to practice saying goodbye?"
To be fair, sometimes the client is more eager to move on than the therapist.
The reason may be pragmatic: Why mess with a regularly paying client? Or it's ego gratification. A thriving client is a source of pride and easy conversation. On the other hand, if a client isn't progressing, or is regressing, a therapist might feel compelled to keep trying: If we just spent a few more sessions together. ... Preferable, though, is probably finding the client another professional partner who's a better fit.
Walter Bera, founding director of the Kenwood Therapy Center in Minneapolis, offers a heartening statistic: Half of clients who go to a competent therapist, he said, experience "significant relief" from issues as complex as depression, anxiety and relationship problems in five or six therapy sessions. Another 30 percent will be "OK" at the end of six months. In either case, follow-up sessions are recommended to maintain progress and prevent relapse.
The smallest group, 10 to 20 percent, are no better after a year, although some do report a bit of a lift after a few years. This last group tends to be people struggling with the toughest life challenges: abusive relationships tied to economic dependence, or alcohol and drug use, despite repeated therapy.
For most, then, therapy could be just what the doctor ordered.
Bera says it doesn't matter very much whether a client sees a social worker, psychologist, psychiatrist or pastoral counselor, or whether the issue is grief or anger, infidelity or impotence, divorce, job loss, parenting challenges or 1,000 other modern-day realities.
What really matters is whether they connect, whether together they create a relationship of "trust, openness and understanding."
