​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

3. Meditation: Happier
When I bring up meditation in sessions, I’m met with comments like, “I hate meditation, I get too distracted, and it’s impossible for my thoughts to be quiet.” The mainstream understanding of meditation is that it’s somehow supposed to teach you to be totally devoid of thoughts, but that is simply unrealistic and, in my opinion, not what meditation should be used for. Instead, meditation is a powerful way to process and feel emotions, relax and recenter ourselves when stressed and overwhelmed, and expand our capacity for skillful coping mechanisms. 

Happier, previously known as Ten Percent Happier, is an app that was recommended to me by another therapist. It is now a resource that I use regularly, personally and professionally, primarily because of the quality and variety of meditation practices and tools it provides. The app has free meditations available, but you may choose to purchase their yearly subscription, like I did, for full access. 

The meditations cover many different topics and guide you through many visualization and reflection options. They also do a good job of setting a pace that allows time for reflection and still calls your attention back to the practice in case your thoughts start to wander. Whether you are experienced or new to meditation, this app is one that my clients and I find helpful.
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Other:
Outside of apps, I recommend Self-Compassion Practices by Dr Kristin Neff. The meditations found on that webpage are geared towards compassion, loving-kindness, and grounding. Her website includes helpful exercises as well, which I suggest checking out.

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5. Couples: Paired
Lots of people struggle communicating with their partners, and that is normal, even in a healthy relationship. The Paired app is designed to facilitate conversations that you may not think to have. These conversations revolve around topics like sex, sharing responsibility, finances, quality time, communication, LGBTQ+, and more.

​Each conversation prompt or quiz starts with a bit of psychoeducation about relationship dynamics. The prompts and quizzes have thoughtful questions designed to make you think and reflect so that you share insightful information with your partner via the app. You can not see your partner's answers until you submit your own, which I feel helps with authenticity. After each of you has answered, you can continue to discuss in the app with messages and emoji reactions, or if you prefer, you can continue the conversations in person to build on your understanding of each other’s answers. 

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6. Movement: Bend
Movement is another therapeutic tool! Moving our bodies, in whatever capacity, can have great mental and physical health benefits. Gentle movement, like stretching, is more accessible for some than going on a run or going to the gym, and Bend is a great way to guide yourself through that. The app has stretches categorized by body areas to stretch and by various intentions for stretching. It has guided routines that are as short as four minutes up to thirty minutes. You select a routine based on whether you’re looking for a wake-up stretch, a bedtime stretch, a mid-workday stretch, or you want to stretch your sore lower back, and it presents you with several options varying in length. You can pick according to the amount of time you have or the kinds of stretches it shows in the sequence, if you have a preference. 

Each option has an explanation of its specific focus. Before you start the stretch series, it shows you all the stretches in the order that they will be presented and the length of time intended to hold those stretches. Both before you start or if you need a refresher in the middle of stretching, each movement has a detailed description of how to get into the position (including a video demonstration showing you what it looks like), tips to help you find your footing and prevent injuries, modifications to accommodate movement restrictions, and the areas that benefit from that stretch.
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I personally love the way that the app guides you through the movements and provides ample support for executing each stretch. You can adjust the time that you hold each stretch if it is too long or too short, and you can pause any time if you need a break to adjust, reread the directions, or sip some water. The app will, of course, send you reminders to stretch if you set it up to, and as with most apps, there are more features available if you pay for the subscription. The unpaid version only does a full guided routine with the timer once a day, but it does not restrict your access to stretches or their instructions if you want to use them with your own timer or at your own pace. 

​Conclusion:
While they are not a fix for our mental health, nor a replacement for trained professionals and community support, apps are a great way to reinforce the things you are working on in therapy. The apps I recommend here may not work for you, and that is okay; they are just options to experiment with. If you find that these are not your vibe, that is just more information to help you determine what you do or do not need in terms of support. It’s all about finding what works for you!

​Author: McKayla Kagie Robinson, MS, PLMFT
McKayla is Provisionally licensed Marriage and Family Therapist with Healing Reflections Therapy, currently accepting new clients for individual, couple, or family therapy.

In doing counseling with clients who have substance abuse concerns and disorders, I
often draw from the world of 12-Step recovery. One of the concepts that comes out of
the wisdom of AA is the idea of People, Places, and Things. In order for someone who
abuses substances or things like food or sex to change their behavior and maintain their
progress, it is usually necessary to change the people with whom they associate, the
places they frequent, and items with which they regularly come in contact. The world
that someone in that situation has created is often filled with other people who abuse
substances, places the person goes to use those substances, and items that are
components of their use pattern.

The comedian Bill Hicks once said that the only things a man needs in order to be come
someone who has an alcohol use disorder are, “the right bar, the right girl, and the right
friends.” I have always liked that quote because it acknowledges that anyone can
become someone who abuses something or other given a few circumstances. While I
appreciate the wisdom of the disease model of addiction and also see people who
abuse substances as having a likely chemical imbalance and a genetic predisposition to
addictive behavior, there is also a role that habit, modeling, and circumstances play in
substance abuse and life in general.

I have always felt that in the “nature versus nurture” debate, the answer is both. As
such, people who abuse substances tend to think in such a way as to maintain the
addiction and the circumstances that give rise to it. Changing people may be the
hardest of the three. It may mean cutting off contact with family or close friends
temporarily or indefinitely. Sometimes new ways of interacting with them can be
negotiated, but sometimes not. When I quit smoking cigarettes many years ago, having
a romantic partner who believed I could and should do and did not smoke herself was a
huge factor in the longevity of my ability to cease and desist from using tobacco. If
someone has a problem with methamphetamine and chooses to stay with their partner
who abuses meth also, one can imagine all of the temptation and other challenges that
will continue to bring into their life while they try to pretend that they are quitting in a
vacuum.

I have seen some of the places people should consider avoiding be the route to the
liquor store they normally go to, places that are trauma triggers that may make them
want to use to self-medicate, childhood homes, their drug dealer’s house and so forth.
Sometimes if avoiding those things is not suggested by a peer or professional, it does
not occur to the user. I have seen numerous people with alcohol problems believe they
can/should work in a bar and have encouraged them to consider other options. There
are countless rituals and routines around using that the person will benefit from
breaking or at least interrupting.

“Things,” can be paraphernalia, numbers in ones phone, the actual substance they use.
I have seen people hold onto a stash of tobacco, drugs, or alcohol because they say
they feel more comfortable still having it if they need it. While this may work as a form
of harm-reduction at first, it is likely not sustainable long-term. Initially keeping alcohol
around with hopes to one day drink in moderation also seems premature in my
experience. In short, every person who abuses substances or struggles with other
compulsive behavior has a list of people, places and things that they need to evaluate
and possibly partially or completely liquidate in order to best prevent relapses into old
behavior. These are always unique to each person.
​
Once someone is far enough along the stages of change to take action, they are more
likely to take this recommendation or see that this work needs to be done without
guidance. Sponsorship within AA/NA, counseling, or just some serious conversations
with concerned loved ones can also wake a substance abuser up to a lot of their
patterns of behavior and once they have this solid information, it is up to them to
personalize it and choose to take it from there.

Avoidance can cause prolonged grief, traumatic reactions and the like and, as such,
therapists typically advise clients to face their fears, explore underlying emotional
responses and the like. By contrast, avoiding people, places, and things is an adaptive
tool for people to use in recovery because they have likely already identified the
underlying emotion, have no sound reason to be around their substance of choice given
the corresponding cravings that may ensue, and are or will become aware that trying to
master regularly being tempted just isn’t worth it.

Author: Chris Scarberry, LPC
Chris is Therapist and CO-founder of Healing Reflections Therapy and is available to see clients in recovery.

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