“It’s not you, it’s… my insurance.”
Therapy is never meant to be an indefinite situation. Whatever the reason may be, there is always that inevitable moment when a therapist and client must part ways.
And yeah, it can get awkward.
Here are some of the most common “break up” situations I’ve run into, complete with the truth of how they usually go down, as well as my wishes for the best case scenarios.
1. Not-So-Mutual Break Up: Parent Stops Therapy
Scenarios: Insurance isn’t covering therapy, Parents want to try a new clinic, Parents want to try a different program, etc…
Parent Response #1: “Today needs to be our last day.” (AKA: The Bomb Drop)
I respond to the bomb drop in one of two ways, depending on how secretive the parent has been:
1. “Yeah, I had a feeling.” You have to give me some credit. I mean, I can tell if you are not happy with therapy. Sometimes it just isn’t what a parent thought it would be, or they aren’t seeing progress that meets their expectations. Or, of course, they might just hate me. (I’ve learned to not take this as personally as I used to, but yeah, that thought still crosses my mind. I’m human, people!)
2. “Huh?!” Sometimes I’m just blind-sided by a parent informing me that they are going to stop. There are some parents that are so nervous to tell me that they are stopping that they hold it in until the last possible moment.
Parent Response #2: Someone other than the usual parent brings the child to their final appointment so the parent doesn’t have to tell me themselves. (AKA: The Switcheroo)
(This happens way more than you would think! Say Mom always brings the child to therapy, but then one day Dad or Grandma drops off the child with the news.)
Therapist Response: This is the equivalent of breaking up via text message. It hurts- hurts deep. But honestly, it does make me sad that a parent is uncomfortable with the idea of telling me that they need to stop therapy. It could be that they are too emotional to do this in person, or they are just plain afraid of me. Who knows?
The Best “Break Up” Scenario: If you know ahead of time that you need to stop therapy for any reason, just give your therapist a heads up. (Even if you have heard of another awesome therapist across town that you want to try.) Just tell me! First and foremost, I am a professional! I think the personal relationships get mixed up in the business of it all and things can get weird. If I were in their shoes I would have no problem saying, “Hey, thanks for all of your help, but I really want to give _____ a try.” I’ll only judge you a little for leaving me.
2. Not-So-Mutual Break Up: Therapist Stops Therapy
Scenario: Parent just stops showing up, or only shows up periodically.
Parent Response: (Nothing, because they have disappeared.)
Therapist Response: “Really?! I did all that paperwork for nothing?” It takes a lot of work to write up an evaluation and goals. Plus there is the work of simply preparing for a new child on your caseload. To just drop off the face of the Earth is really upsetting and kind of like a smack in the face to a therapist.
Sometimes a parent will come to the first session, no-show for 2 sessions, and then try to show up again for the next appointment. Depending on the policies of the clinic, the therapist might have every right to just take you off of their schedule and fill that spot with someone else.
Scenario: Therapist transfers a client to another therapist.
Oh, this is super awkward. Sometimes a child is transferred to a new therapist because the first therapist simply can’t handle this particular client anymore. Kind of like tapping out in a wrestling match. There are also some clients that are considered “frequent fliers” (people that start and stop therapy quite a bit). In these difficult situations sometimes therapists call out “not it!” when it comes to scheduling the client. (That might sound awful, but remember, I’m being honest here!)
This could also occur when a therapist puts their client on someone else’s schedule for maternity leave, vacation, going part-time, or simply quitting.
Therapist Response: “I’ve actually had a change in my schedule, so you’ll be seeing Ms. Newtherapist from now on. She is great and I’m sure your child will do well with her.”
Parent Response: I’ve heard everything from “Eh, ok,” to “What?! Why? Can’t we stay on your schedule?” It depends on the client and how attached they are to their therapist. This is also a classic moment when a parent might decide to take a break from therapy themselves. It’s kind of a free “out”, and they might say, “Well, if that’s the case then I think we might take a break ourselves…”
Scenario: Therapist must stop therapy due to lack of progress or severe behavior issues.
What I’d like to say- “I really don’t want your child to hurt me anymore, so I think it’s time to stop.”
What I actually say- “Behaviors have really started impacting our ability to make progress in therapy. I think that it might be beneficial to consider behavior therapy to assist with this issue. Once the behaviors are under control, we can try again.”
There are often situations when it is simply not ethical to continue to bill for therapy when you get absolutely nothing done. Not to mention that insurance companies will stop reimbursement or question the clinic’s practices when they review the paperwork.
Parent Response: This is sometimes met with anger and defensiveness. I never want a parent to think that we are giving up on their child; there just comes a point when we are not the best use of their time and resources.
Sometimes a parent is relieved that we have been the ones to call “uncle”. They are aware of their child’s stalled progress, but can’t handle the idea of being the ones to take a break from therapy.
The Best “Break Up” Scenario: Any of these situations are awful for me, because it means things didn’t work out the way they were supposed to. Not to mention the fact that I am terrible at breaking up with people. I suppose I should take my own advice and be honest, but phew, that might be dangerous. I just use finesse and my natural charm to make the transition as painless as possible.
3. Mutual Break Up
Scenario: Goals have been met and the child no longer needs therapy. Hooray!
Parent Response #1:”Ok, bye.”
Therapist Response: Wait, I just worked with your child for the last year! Can I get an “it was fun” or maybe a “thanks”? I guess technically I was just doing my job, so thank you’s shouldn’t be expected. But man, that whole “peace out” move is harsh. An exception to this feeling is when the parent might have been super mean or made me dread the thought of facing them every week. (It’s rare, but it happens.) In that case… see ya!
Parent Response #2: Tears, cards, flowers, and/or gifts.
Therapist Response: Teetering between the following: “This is kind of fantastic and makes me feel like a rock star!” and “Whoa, this is way too much and I don’t deserve this much credit.”
When a parent and I part ways in this scenario, you better believe I am crying like a baby right along with them. These are the relationships you treasure, the moments that make you ridiculously proud yet humbled to be a therapist.
However, in this situation, I usually feel guilty that the parent has gone out of their way to buy me something. I mean, they have already sacrificed so much to get their child to therapy and do the work at home to make progress. They seriously don’t need to get me anything, but I hope they know how much I appreciate the gesture when they do.
The Best “Break Up” Scenario: Honestly, my favorite goodbye is a note from the parent or child. I totally save those and am not against pulling them out on rough days to remind me why I do this job.