WAIT WAIT WAIT Before you break up with your therapist...

We spoke in an earlier post about the important elements for success in therapy, one of which was finding a therapist that was a good fit.

With the rise of mental health platforms run by tech corporations that have a wide social media presence, there has been a new vogue of treating your therapist like online dating, the minute something is uncomfortable you should get out, swipe left, keep shopping, there’s always another one ready to pop up and take their place.

Wait! Hold on just a minute. 

There may be some valid reasons to terminate your relationship with your therapist, but there may also be some good reasons to stay that you may not have considered.

When to go
As therapists, we frequently hear horror stories of past therapists- be it unethical practices, unorthodox practices, or interventions that did more harm than good. A therapist that crosses boundaries to have sex with a client, or exploits the therapeutic relationship for their own gain, or abuses their power are all serious causes for concern. If a therapist is displaying overtly unethical or illegal behavior, then the relationship needs to end.

Ruptures in rapport: A Forgivable Offense?
Most complaints about a prior therapists usually arise not because the therapist is inherently bad, but because of differing perspectives/worldviews, cultures, generational differences that lead to feeling, hurt, invalidated and misunderstood. For example, a client not liking the words chosen or boundaries set, or feeling uncomfortable with being held accountable in session, the therapist breaching trust by fulfilling their legal obligation to make a hotline report, or recommending medication or hospitalization; or a therapist making a human error in scheduling, missing an email or call, looking sleepy, forgetting something client previously said, being distracted, conflict over a billing error, snacking during session, seeming too casual or not casual enough, or perceiving the therapist as not on their side enough. These slights, however unintentional can hurt, but whether or not it is worth ending the therapeutic relationship over may be complicated.

​Ruptures in rapport are common, especially as the relationship deepens and therapy reaches newer levels of trust and patterns of earlier relationships begin to play out in the therapeutic relationship. While most licensed therapists are well meaning and do their best to serve their clients with the tools they have, they are also human and have their flaws. Some are wounded healers who are still in the middle of their own journeys, others come from a place of privilege or have not sufficiently done their deconstruction and decolonizing work. Both may inadvertently harm the client. Ideally, therapists should spend some time in their own therapy as well as supervision and consultation doing self-of-therapist work prior to seeing clients, if not on an ongoing basis. 

Ruptures as Opportunities for Corrective Emotional Experience 
Therapy is a microcosm of the rest of the world, meaning that problems that play out in the external world often find a way to play themselves out in the therapy room as well. Challenges in the therapeutic relationship are opportunities for a corrective emotional experience that one may not otherwise have had with others in their life. For example, if you are upset with you therapist for something they said or how they handled a situation, your ability to confront them can be the first time you may feel able to use your voice and challenge someone who has hurt you, but in a safe way (hopefully). In this way, addressing conflict and dissatisfaction with your therapist is both courageous and encouraged, and can be an empowering and healing, and deeply transformative process with breaking patterns in the clients’ life. 

Political Betrayal by Your Therapist
There are times when a therapeutic relationship just isn’t the right fit, for example there is a recent discussion about folks leaving their therapist after learning their therapist voted in a way that went against their rights. Essentially, the therapist has violated the clients' trust with their betrayal and failure to protect their rights. Traditionally, therapists are trained to be neutral and not bring their stuff into the room and not share much about themselves personally- but arguably anyone who works with marginalized populations and sexual or religious trauma survivors needs to NOT be neutral about protecting the folks they serve. They have a fiduciary responsibility to care about their clients not just in the therapy room, but who they are as people. In this way, the political is very personal, so sometimes a political/cultural/gender/racial/religious match may be necessary for building trust and eliminating harmful bias.

When To Pause before a break-up-When Attachment Wounds Run the Show
The "swipe left" method for choosing/leaving a therapist is particularly problematic if the client has concerns with attachment. What do we mean by that? Healthy attachment develops from our early caregivers. When we feel safe and our needs lovingly cared for, we develop a secure attachment, which enables us to have healthy, secure trusting relationships in adulthood. When our needs are not met, or we grow up in unsafe/traumatic, unpredictable, or chaotic environments we may develop anxious, avoidant, disorganized or insecure attachment styles that hinder our brain development and adult relationships. In children, they may be given a diagnosis known as RAD, Reactive Attachment Disorder, commonly seen among foster and adopted kids where there is a disruption to the early attachment relationships. This article talks more in-depth about the disastrous consequences of early attachment wounds and the impact it has on one's ability to attach to future care-givers. 
https://www.theatlantic.com/magazine/archive/2020/07/can-an-unloved-child-learn-to-love/612253/ .  Mary Ainsworth, Margaret Mahler, Harry Harlow, and John Bowlby were among the early pioneers of attachment theory and more modern books by Dr. Bruce Perry have talked about this concept. At the end of this article there are some videos that talk about these foundational attachment studies and why early attachment relationships are so fundamental to development. 

Carl Rogers, famous for developing the Humanistic client-centered psychotherapy treatment method commonly seen as the foundation of most clinical practices wrote about his theory of change in “On Becoming a Person” where he compared the role of the therapist to that of a healthy soil for a tree to grow. In order for someone to grow and flourish, there needs to be a healthy, nurturing soil. Although the home/family environment might not have been provided enough sustenance for early growth, healing/growth in the therapeutic realm can be made through a secure attachment with the therapist by way of empathy, genuineness, and unconditional positive regard.   

So while for some people the task may be to find the “right fit” with the therapist, for others their challenge is deeper- to work through their attachment wound and allow themself to connect/share intimately in a therapeutic relationship, to not run away as the relationship deepens as a form of self-sabotage (i.e., I will leave them before then can leave me, So I won’t be hurt again), and to be able to appropriately address and work through conflict in order to make repairs to be able to have enduring relationships. This process of challenging patterns helps build new neural networks in the brain, to make repairs from earlier setbacks.

Trust and Attachment Takes Time
For some folks, the real work in therapy may not begin for 6 months to a year until they have worked with the therapist long enough to “test them” to ensure the therapist will not reject or abandon them, only then do they start to show their therapist their deeper wounds, pain, insecurities and problematic behaviors. Not surprisingly, this same pattern can emerge in romantic relationships, where the partnership seems like bliss, so they rush to marry or move-in together quickly. Once the partner has them on the hook, suddenly their personality and behavior shift. One begins to see an entirely different side of the person than they did before, and in some cases it may seem like a Dr. Jekyll/Mr. Hyde situation. The other partner often feels confused and betrayed. 

A Note About The Impact of Sexual Trauma on Attachment Wounds
One common scenario where attachment wounds play out with women in romantic relationships is when there is a history of sexual trauma. In the wake of the trauma she may experience distorted beliefs in which she believes it is her fault, is damages, unloveable, unwanted, or not good enough. This leaves her feeling hurt, sad, lonely, and isolated. As a result she may end up hooking up with various people in a serial fashion combo of trauma re-enactment, maladaptive coping, attempts to reclaim power, and self-fulfilling prophecy. Eventually she ends up with a hook-up that turns into a situationship that turns into a relationship. It starts out hot, but once the relationship gets to a point of stability and safety, the sex life turns cold and avoidant. The couple starts fighting more as he is frustrated and hurt from the rejection and she is feeling pressured and coersed into unwanted and painful sexual activity which cause her to further lose interest and avoid any attempts at intimacy, for fear it will lead to demands/pressure for sex. This pressure is a trauma trigger that feeds back into her original negative beliefs about herself that she is damaged/unloveable/only good for sex. The antidote is recognizing those patterns, and encouraging the partner to create a safer space while the she works to challenge her distorted beliefs and anxiety about triggers. If the couple can work through this together, they can have a deeply satisfying, intimate relationship. If they cannot address it together, there is the risk that the pattern will be repeated with the next partner, and the next. The same can be said about the therapist, if conflicts in therapy room are not addressed, there is a risk that pattern will present with the next therapist and so on.

So, before you fire off that email to break-up with your therapist, really sit and be curious. Ask yourself:
Is this about them, or is this about Me? 
Is this similar to a pattern in your life with other providers, family members, friends, or romantic partners?  
Am I leaving to avoid conflict? 
Am I leaving to avoid connection? 
Have I done the work to give them the opportunity to change or demystify their process or apologize?  
Are they safe?
Do they respect my dignity and autonomy?
Is this therapeutic relationship doing more harm than good?
Were they having an off day when something happened that hurt your feelings or do you feel hurt more often than not when meeting with them? 
Am I expecting perfection?
Did they tell me something I did not want to hear, but maybe needed to hear?
If I don’t trust them, do I feel I can trust anyone?
Am I ready to make changes to myself and the patterns I am in?

Barriers to Change, Lack of Readiness and Low Motivation 
While we are talking about reasons people stop therapy, sometimes it's because of the therapist, sometimes it's because of client attachment concerns, but sometimes it's lack of readiness or willingness to change.  When people are at the pre-contemplative or contemplative stages of change, the might throw up all kinds of barriers to attending services, like needing things to be "perfect", requiring just the right time slot, location, proximity or services; or just the right therapist demographics of race, gender, religion, level of experience/certification/degree, or lived experience; minimal cost, and just the right modality. While all these things certainly can help as previously discussed, when folks are creating barriers that sometimes set it up to where no one can fulfill their needs, and they thus get to avoid the therapy process by escaping it but claiming no responsibility. They may also create further barriers to change by not thinking about their therapy after/between sessions, not doing homework, etc. We find that when people are really desperate and motivated for change, most those barriers fall away and all people are really left with is “Can you help me?” And “How Soon can I get in?” Research is clear that the number one predictor of positive outcomes in therapy is not the therapeutic modality, it is the alliance with the therapist. Attachment matters. Readiness to change matters. Attachment to your therapist matters. Take time to see if they are trustworthy. Decide if you are really ready. If they are trustworthy, and you are ready for change, take time to consider before you leave. 

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Author: Megan Garza, MA, LMFT