The level of social support is the number one predictor of outcomes after trauma. Having support from a loved one came be a critical step in the healing process. Many family members ache when they see their loved one's suffer and are desperate to help them find relief, and to find relief for themselves of the anxiety and distress the helpless creates.

Seeking mental health support from a family member has some pros and cons. In general, seeking out therapy can be helpful, however not everyone is ready to take that step for themself. This can become a point of distress as family members get desperate for change with ongoing worry. 

Here are some things that therapists want you to know when you reach out on their behalf.

1)Reaching out to therapists on behalf of someone else takes away their sense of agency/responsibility for their therapy process and can be a sign of patterns of enabling or codependence.
All too often  well meaning loved ones reach out on someone else's behalf for therapy, but more often than not those individuals have little motivation to participate in the process. When you make the call for them, it takes away their ownership of the issue. Well meaning family members can become enablers by allowing these individuals to not have to take the role of responsible adults. Women often complain that they get cast in the role of mother to their spouses, but they often enable the very problem they are frustrated with by continuing to make the calls for doctors visits and setting up the appointments for them.

2) Lack of motivation to reach out to a therapist is often predictive of one's motivation to participate in the treatment process.
Often therapists find that when someone else makes the arrangement for someone to attend therapy, the person making the call is more distressed and ready for change than the client is. As much as you want them to change, they may not be ready to. Part of the process of reaching otu to a therapist, filling out the intake forms, and coming to the first session is all part of someone's preparation for change. It involves accepting there is a problem, that you need help, and that you are willing to take steps to make change. When people are just "visiting" therapy and not ready to make change, they usually do not attend past the intake sessions, if they bother to show up for the intake at all. Prochaska & Diclemente (1983) developed the stages of change model that highlights the cycle and one's readiness to change, particularly as it applies to addiction, though this pattern is applicable to the overall therapy process.
​
3) Confidentiality is a barrier for us.
While you may want to advocate for them, your advocacy can only go so far when we are dealing with another adult who is their own guardian. Therapists are required to maintain confidentiality with their clients, so once they make contact, we cannot really communicate with you about them without a release. 

What about when your family member is too ill or depressed to advocate for themself or is a poor reporter/historian?

If someone is in a mental health crisis situation there a few options to consider. This situation is different than a situation where someone is enabling, but more occurs when the client is in such a poor state, they lack the capacity to take the steps for themself. For example, someone who is experiencing psychosis and cannot distinguish reality from a delusion, someone that is so depressed they are near catatonic and bed ridden, someone whose OCD has lead to a hazardous hoarding situation, or someone who is experiencing a manic episode and is engaging in high risk behavior, or someone who has been abusing substances or has been having a reaction to medication and they are seemingly not themself. In each of these scenarios, these folks likely need immediate help. Going to an ER or the nearest psychiatric facility may be the best option to immediately manage the crisis. If a person already has a psychiatrist or therapist, reaching out to them to let the know what is going on can be a tremendous help.

Generally, you can send mental health professionals information, but we cannot acknowledge it or send anything back to you without a consent to release information from the client. Exceptions to this rule may apply if there is an imminent threat to the life of the client or someone else.

As much as I encourage clients to take responsibility for their mental health and challenge when folks are enabling, there have been many times over the years that I have encouraged family members to write letters to their loved one's doctor or to call the office and leave a message to inform them if a crisis has developed or if there are significant pieces of information about symptoms necessary for the clinician to make an adequate diagnosis and appropriate treatment plan, and for their doctor to be able to prescribe the appropriate medications. These methods, when necessary can be absolute game changers in the trajectory of a client's mental health outcomes. 

When we have a release and family therapy or coordination of care is part of the treatment
As family therapists, especially when working with children it is very difficult to make changes with the child if the rest of the family is not on board and participating in the treatment. Some of the best results I have ever seen as trauma therapist have come immediately after sessions using Trauma Focused Cognitive Behavioral Therapy (TF-CBT) when parents are brought into the session to help process/witness the trauma of their child. Secrets are eliminated and parents are coached on how to be effective supporters in the present. The shame the child was experiencing dissipates and healing takes place in the family system.

Although interventions with loved one's have long been used in substance abuse recovery, there are mixed reviews of the efficacy of these attempts.


What about if it's a Britney situation and we think we need to become guardians or conservators in order to help our family member?

Sometimes a person is not well enough to take care of themself. They refuse treatment. They struggle with having the capacity to recognize the risk to themselves. In some cases, a person can apply for a conservatorship or guardianship with the courts. The court determines if this is appropriate.

Sometimes, when a family member is severely chronically ill and it no longer feels like there is another way to get them help to save their life, this step can be helpful.

However, it can also come with a large price. Family members have the burden of assuming medical and financial responsibility for their impaired family member, which is often a thankless, tiring, and exhausting job. The task and the subsequent blowback of resentment and fight for control from the client can result in major conflicts, and sometimes complete dissolution in the relationship between family members. As they say, no good deed goes unpunished. As we all saw with what happened with Britney Spears and her family over the conservatorship and when it was lifted, the process and outcome were complicated in their impact.

So, should you help a family member? Absolutely! But before you take those next steps, carefully consider your role, expectations of them, ask yourself whether it is possible they can do this for themself and how your involvement may help or hurt. Consider the impact that your helping may have on your own mental health.

Remember local resources like the 988 mental health crisis line as well as NAMI, AA, Al-Anon,  SAMHSA, and Psychology Today  are all excellent ways to help for yourself or to send the information to a loved one to encourage them to take steps for their own mental well being. If you think that maybe you are struggling with codependence with a family member, you can look into a CODA group for yourself.

Author
~Megan Garza, MA, LMFT

​A question that I often hear brought up in therapy is when is it appropriate to cut off my family members? This has become a popular topic these days as generational differences, awareness of trauma, and politics divides family.

As systemic marriage and family therapists, we are trained to study family ancestral trees called genograms and look for patterns of connection, attachment, abuse, substance abuse, and cutoffs. Whenever cutoffs show up in a genogram, it tells us something important about the family dynamic and signs of dysfunction.

Generally, we discourage folks from immediately considering cutoffs vs exploring alternate options.

What are the alternatives to cutoffs
Rather than black and white thinking, that things have to be "all this way" or "all that way" or we are a family unit or we have no connection, as family therapists we often encourage people to explore they gray areas. What about decreasing length of visits or frequency of contacts? Instead of going over every holiday, maybe only go to one, and don’t stay with them, limit your time there and stay at a hotel. Maybe instead of taking all their calls, you choose selectively when to respond or you just send them cards.

There are many times as people explore their development and really individuate from their parents and begin to develop their own sense of identity and beliefs, that they suddenly see problems in their relationship with their family members that were not fully realized prior. Or perhaps the parent is struggling with adapting to the new role of having an independent, adult child where they have less control. At that point, as growing awareness blooms into anger and contempt, sometimes prompted by an outsiders’ view of your family such as partner, teacher, friend, or therapist that the drive to cut-off a family member or make big changes in boundaries with family comes about.

When is a cutoff appropriate?
Sometimes folks have decided that the only way they can have some peace is to cut off their family members. This is especially true when family members have displayed long patterns of egregious, toxic, abusive, manipulative, or selfish behavior and are unlikely or unwilling to change, nor take accountability for their actions. 

• The narcissistic parent who keeps the focus on them and their needs and makes their children walk on eggshells and consequently develop ingrained patterns of hypervigilance and people pleasing
• The antisocial family member who physically, emotionally, sexually, and/or verbally abuses with no remorse or empathy, with pattens of lies, manipulation, and law breaking
• The chronically substance abusing parent or family member that ignores all boundaries, behaves erratic and puts your life or the life of those you care about at risk, betrays trust through lies and stealing, only initiates contact when they want something, and is a source of deep pain and shame
• The morally ambiguous, self-righteous family member who touts themself as a religious/ political/faith leader/follower, But fails to follow their teachings/preaching in favor of judgment or condemnation of people who are poor, suffering, are unlike them, immigrants, minorities, of a different faith, sexual orientation, or gender identity. E.g the parent that kicks out their child for being gay, or refuses to attend their gay child’s wedding because they “don’t believe that” or the parent that aligns themselves with white supremecist movements despite having biracial or immigrant family members (note these individuals often fall into the first two aforementioned categories).

These are all examples of family dynamics that are difficult, if not impossible to manage. Sometimes, for one’s own safety or sanity, there is no recourse but to put distance from the harmful family member. Note, a person is not put into these categories simply because you do not approve of them, or they are not who you want them to be or what you believe, they meet these criteria when they are actively inflicting harm on others through their behavior, the pattern is chronic, and there is a demonstrable unwillingness or inability to change.

Consequences of cutoffs
Sometimes I encounter clients who, at the advise of younger clinicians, have decided to cut-off their family members with formal letters, over more minor and typical family conflicts. Rather than attempting to work through the issue in family therapy, the family member unceremoniously receives a letter that that have been disowned or a list of their infractions and have been informed they are going no-contact. They problem with formally making these statements in a letter is 1) it gives the other person no opportunity to respond, clarify, ask questions, or make amends. And since many issues come down to problems with communication and understanding, this can only exacerbate the problem. 2) You cannot take back the harm inflicted by a formal pronunciation that you are cutting off a family member, thus creating or exacerbating a rejection wound.

Although many people experience family cut-offs for a time, rarely are they permanent. Most people end up reunifying with their family members within a few years. This is true for even the abusive, toxic family members, or the religiously based cut-offs.

Writing letters to harmful family members are very powerful tools in therapy for clarifying your hurt, exploring boundaries, and finding cathartic release. As a trauma counselor I have been witness to thousands of these letters over the years. However, a therapeutic exercise for the self is not the same thing as sending one of those letters to a family member and should be taken with great care and consideration. Sometimes folks who struggle with assertiveness or have fears/challenges with being communication/being heard by their family member may feel letter writing is the only option necessary, which may be true, but it’s also important to know that what is formally written may be hard to take back or make repairs from as well. There is also no guarantee they will read it.

Cautions of cut offs
If your attempt at a cut off is to get the person comply, to punish, to be more the way you want them to be, then you could be abusing the situation and using the cut-off as a tool for emotional manipulation.

If, by contrast, you are using the cut-off as a tool for safety when all methods of communication, family therapy, consultation with faith leaders, and boundary setting have failed, this is totally appropriate. This is especially true when there are no signs of positive change or willingness to change or willingness to take responsibility for the harm that has been caused, and they are in-fact doubling down on their behavior and blaming you for it. Red flags.

As a family therapist, I have witnessed the devastating impact of trauma and clients struggling to set limits with narcissistic parents who continue to ignore and cross boundaries. I have also seen the tragic result of when clients are unceremoniously cut-off by their family members and the pain, sadness, and confusion that results. Many times the person being cut-off genuinely does not recall the events they are being accused of and are shocked at the variation in perspectives. There is no easy path and the decisions you make today may impact generations to come. It's important to remember that small, consistent shifts in your behavior can change the larger family system functioning over time.

A note for parents:
Sometimes parents feel blamed a lot in the therapy process, and the fear of being blamed or judged can keep them away from participating in family therapy. This is a fair concern as parents do take a brunt of the impact when their is family dysfunction. It's important to remember that there are no perfect parents. And even the best parents are going to say or do something at some point that harms their child directly or indirectly. In family therapy we really stress the idea of a "good enough parent". In order for children to develop well, you just need a good enough parent. Most parents do many more good things than bad things. A bad choice does not automatically equate with a bad person/parent/child. Sometimes the positive contributions and the way the parent shows love is not readily recognized. For example, a child may say they did not feel love because dad did not hug them or say "I love you" or was overly strict or critical or said things that made them feel bad about themselves, but that same dad may have shown love through showing up all their sporting events, making sure to always have a job and steady income to support the family, by fixing things around the house to create a safe environment for them, by making sure they had a car to get to their job or college. How a person receives love may not be the same as how another expresses love.

Parents do however have the responsibility, as the older person with more power and authority in the relational dynamics, of being the one to reach out to their children and initiate contact occasionally. It cannot be left just up to the child/adult child. The child also has a responsibility of returning the calls and checking back in occasionally as well if they both wish to maintain a relationship. Parents do have the burden of being the bigger person, because of child's need for unconditional love from the parent.

If you are considering a cut-off, try these steps first

• Practice reflective listening skills to make sure you understand the problem
• Spend time reflecting on your favorite memories with the other person and what you would miss by not having them in your life
• Practice perspective taking- imagine what the situation might feel like from the other person's perspective
• Consider the Context- rather than judge them for their behavior, consider what events contributed to why they acted that what. Consider the influences of their family, culture, prior trauma(s), and generation with kind eyes toward them.
• Consider how that person has shown love to you in their love language vs how you wanted to receive love
• Imagine what your life might look like 5, 10, 20, 30, 50 years in the future with or without them in it and explore any regrets or guilt you might have
• Convey adequate empathy - really put yourself in their shoes and reflect the appropriate emotion needed
• Seek individual therapy from someone who is not biased toward cut-offs
• Try Family Therapy from a skilled family therapist
• Try seeking a consult with your faith leaders
• Consider attending a support group like Al-anon or co-dependents anonymous or a related group such as one's for adult children of emotionally immature or narcissistic parents
• Be cautious of others that encourage you to cut-off your family or to ignore your boundaries/safety for the sake of the family, ask yourself if/how they might benefit or if they have a bias that keeps them from being an objective resource
• Set clear boundaries and stick to them
• Use clear, assertive communication with "I statements" about what your needs are
• Try a writing exercise for yourself to clarify your concerns
• Be curious about your own role in the problem
• Be willing to take accountability for the part you may have played in any hurt feelings that have impacted the relationship
• Listen to podcasts like The Estrangement Project Podcast, The Mend Project, or We Need to Talk about Estrangement, or this TikTok https://www.tiktok.com/t/ZP8rfppao/
• Check out Resources on Psychology Today on Estrangement or the website Rejected Parents
• Read books on family estrangement

Author: Megan Garza, MA, LMFT is a licensed Marriage and Family Therapist and Supervisor at Healing Reflections Therapy

Over the holiday season people often come together with families, sometimes to celebrate, sometimes to grieve losses that tend to congregate around these times of year. As is often the case when families get together, sometimes things are said or done that are hurtful. Sometimes painful truths of the past are unmasked. People are often forced to reconcile with these new harsh truths and realities and to cope with their hurt feelings or the way they have hurt others, sometimes intentionally, but more often than not inadvertently or unintentionally, yet the hurt remains.

Dealing with the aftermath, once problems surface, means that healing and reconciliation may be needed. Some may find that their friends or family members are distant, if not not cut off from them until they attempt to acknowledge the hurt or make amends. One of the biggest challenges relationships face is when the offending party refuses really to acknowledge the harm done. A good apology is more than just saying “sorry.” Effective apologies help repair relationships, build trust, and promote healing.

Here are the key elements that make an apology meaningful and effective.

1. Acknowledge the Harm
What it means: Recognize the specific behavior that caused harm or hurt.

•  Instead of: “I’m sorry if I upset you.”
• Say: “I’m sorry for saying something hurtful during our conversation.”

Why it matters: People want to feel understood. Acknowledging what went wrong helps
validate the other person’s feelings.

2. Take Responsibility
What it means: Own up to your role in the situation without excuses or shifting blame.

• Instead of: “I’m sorry, but you shouldn’t have…”
•  Say: “I take full responsibility for my actions.” Or “I understand the harm I caused when

I _____”
Why it matters: Shifting blame undermines trust. Apologies are meaningful when they come
with accountability.

3. Express Regret and Empathy
What it means: Show genuine remorse for the impact your behavior had on the other
person.

•  Instead of: “Sorry you’re so upset.”
•  Say: “I regret that I hurt you with my words when I said ________.”

Why it matters: Research shows empathy deepens connection and helps heal emotional
wounds.

4. Offer a Plan to Make Amends
What it means: Outline steps to fix the mistake or prevent it from happening again.

•  Instead of: “It won’t happen again.”
•  Say: “Moving forward, I will communicate more respectfully, and I’d like to know how I

can make it right now.”
Why it matters: Offering amends signals that you’re committed to change, not just offering
empty words.

5. Be Sincere and Timely
What it means: Deliver your apology with sincerity, and don’t wait too long to do so.

•  Instead of delaying, take the time to reflect but apologize promptly once you realize the

harm.
Why it matters: A well-timed apology keeps emotions from festering and shows the other
person you care about their feelings.

6. Avoid Repeating the Same Mistake
What it means: After an apology, work on personal growth to avoid the same behavior in
the future.

•  Apologies lose their meaning if the same behavior continues.

Why it matters: True apologies are not just about words—they require action.
A good apology does not ask for forgiveness of the one that has been harmed. That only
further burdens the victim with guilt and responsibility.

Quick Recap:

• Acknowledge the harm.
• Take Responsibility without excuses.
• Express Regret and empathy.
• Offer Amends or solutions.
• Be Sincere and timely.
• Learn from Mistakes and grow.

While apologizing may be hard and requires the strength of being vulnerable and swallowing your pride, when done well, the reward is worth it. Keep in mind though, if you are only apologizing as a tactic to get more of YOUR OWN needs met, the other person may see this as a manipulation tactic and may not be willing to accept it. True apologies and amends come from your own desire to heal the person you hurt, sometimes out of a commitment to faith or justice to do right, and they acknowledge that when you attempt to heal others you also heal yourself.

If you are still struggling and need help, our counselors at Healing Reflections Therapy are also available to help mend the broken divides. Check out our Meet Our Therapists page to find a clinician that best fits for you.

​Author: Megan Garza, MA, LMFT

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. 

​

Author: Megan Garza, MA, LMFT