How Do You Know When to Quit Therapy?

Weeks one to four, I was feeling very pleased with myself. I did it: I completed therapy. I marvelled at my newfound boundary-setting abilities like prize-winning dogs at Crufts, and began to fantasise about all the stuff I could do with the money I'd no longer have to spend talking about teenage angst more than I did when I was an actual teenager. Then week five came around. In no particular mood, I followed my therapist into that small blank room, as I had almost every Tuesday for the last 24 months. Then I sat down, burst out crying, and didn't stop for 50 minutes. Any questions only made matters worse by giving me more things I couldn’t respond to. Any sentence I tried to formulate fractured into hundreds of trains of thought before I could finish it, which fractured into their own trains of thought, on and on like branches growing at rapid speed off some demented tree. Any word that rose to the back of my throat simply lodged itself there.

I have a tendency to cinematise, to re-organise things into meaningful narratives, and what I had decided was: I had come to the end of a road. I was ready to see how well I would manage without having a regular period of reflection imposed on me: whether I would do it voluntarily, or revert back to pushing everything down until I have a panic attack on the bus and run directly into traffic. I always pictured finishing therapy as a walking off into the sunset moment – not a storybook ending with all my problems solved and neatly ribboned, but the closing of a chapter with a feeling of capability and optimism. What I got instead was the overwhelming feeling that I was giving up.

So, I'm still in therapy.

There were 1.4 million referrals for talking therapies through the NHS England's Improving Access to Psychological Therapies (IAPT) programme in 2016/2017. At the same time, there was a 65 percent increase in demand for private counselling services between 2016 and 2018, with mental health trusts receiving less funding in 2016 than they did in 2012. As the UK becomes increasingly inhospitable, with austerity and the political climate at large taking a toll on people’s psychological well-being, the demand for therapy has shot up while funding for services has gone down. Approximately one in four people in the UK will experience a mental health problem in any given year, with generalised depression and anxiety being the most common. But if you’re receiving therapy in 2019, through the NHS or privately, you’re one of the lucky ones.

People attend talking therapies for lots of different reasons. Sometimes they’re clearly defined: grief, work stress, an eating disorder, sexual issues or a specific trauma. Sometimes people go because they generally struggle with life and reach a point where they need support beyond their friends and family. People heal and change at different paces: one person might notice improvements after two months, another may feel worse after several years. A clearly defined reason for going means more clearly defined goals – which doesn’t make them any easier to achieve, but when your reason for going is simply "make me feel less terrible, please", how do you know when or if you’ve achieved anything at all?

I fall into the latter category. I don’t have a diagnosis (the only time I reached out for a medical assessment through the NHS I was told my symptoms of depression, mania, suicidal ideation and history of self-harm, among other things, didn’t sound worrying enough to look into), and antidepressants aren’t a good fit for me. Like many others in my position, I’ve spent my young adult life in a revolving door of coping methods: cutting, anorexia, substance abuse, sex with everyone, etc. When one stopped serving me, I’d move on to the next. I started going to therapy when I ran out of outlets.

The process of therapy itself is incredibly strange. You go into a room custom-designed to be as unremarkable as possible: a side-table with a box of tissues and a clock you’ll only ever see the back of, a quietly rattling air conditioner, possibly some sort of still life painting. You put yourself face-to-face with a total stranger and ask them questions so intimate you wouldn’t even put them on your finsta: why do I think everyone is lying to me constantly? Is it "normal" to project sadness onto clothes you’ve thrown out in case they feel rejected, but consider your own feelings about anything too silly to vocalise? Does everyone bang their head against their bedroom wall from time to time, hoping to knock themselves out as a brief respite from feeling bad, or no?

Over time, your therapist becomes one of the people you speak to the most. They probably know more about you than your partners, your best friends – certainly your parents. You will try to deduce the fullness of their personal lives from scraps of information: the kind of shoes they wear, what cultural references they throw out. You will try to make them laugh and they will point this out in an effort to get you to stop editing your life to make it more amusing, and you will take it as a great personal achievement when you finally get one in.

Done right, therapy breaks you down and rebuilds you from the bottom up. You might go in expecting a saint-like stranger to listen, comfort, sort your life out. But the first thing you learn is that’s absolutely not what’s going to happen. Therapy is very much driven by the person receiving it: what you’re willing to bring to it, and what you’re willing to take on board. A therapist can listen and leave notes, but they can’t dictate. This is useful long-term, but it can also be confusing. If your therapist isn’t a good match or the treatment itself is ineffective, lack of progress can feel like your fault. Relapses can feel like even greater failures. Leaving, too, is very much on you.

If you’re prone to extreme mood swings, which I am, it can be difficult to know what’s really going on with you. You might take a period of positivity as a sign of progression rather than part of a natural ebb and flow. You might get carried away with the idea that everything is better now! only for a bad day at work to knock you back six months. Highs and lows are always going to happen regardless of how much professional help you’re getting. How do you know if you still need therapy, or if you’re just too scared to leave?

I’m not a good judge of this, obviously. I recently quit quitting therapy. In basic terms, therapy is just venting to someone who knows you really well. If the act of slopping out your head on a weekly basis makes you feel better and you have access to it, keep going. If you lapse into a catatonic state whenever your therapist goes on holiday, you’ve probably gone too far. If you’re getting nothing out of it, consider taking a break to reassess. That’s easy to suggest as a broad framework, but of course it never feels that simple when it’s happening to you.

Ultimately, the thing that prompted me to stop therapy was a weird fixation on the "two year" mark (Psychology For Dummies take: two years is also the point at which all my romantic relationships have failed). In retrospect, I was also on a bit of an upswing and convinced myself that, because I’d done a few bits of work that I was proud of, and fallen in love, this was as good as it would get for me. If I couldn’t be happy in those conditions, I was doomed. I then promptly had my mind blown by the suggestion that a living wage and a healthy relationship were not unreasonable expectations from life, and that perhaps my bar for self-worth is set a little low.

My decision to quit quitting had to be unpacked, of course. Everything has to be unpacked. When asked how I felt about my own change of heart, I said "disappointed". As usual, a dictatorial goal that I’d set for myself, tethered to absolutely nothing of value, had caused some distress. As usual, I flattened that distress down like a pie crust out of fear of reprimand. The idealised version of myself wanted to leave, but my actual self did not. Having to reconcile the two in front of another person made me want to be sick, but – as usual – what feels earth shattering to you is completely unremarkable to everyone else.

I think the most valuable thing I get out of therapy is the casualness with which distress is met. I can b2b DJ the worst things that have ever happened to me in my entire life and they will be acknowledged with a calm the nature of personal relationships doesn’t allow for. I spent six weeks exhausting myself over a decision I’d actually already made, and my therapist simply said, "See you next week."

@emmaggarland