When to Break Up With a Therapist?

Reader’s Question

I have been seeing my therapist for almost 5 years. I had major depression in my early 20s (I’m 42 now) but kind of snapped out of that without any help after a year and a half or so. My therapist thinks I now suffer from dysthymia, I think it’s atypical depression, but it’s basically a milder form that never goes away.

I really like my therapist and get along with her, but I don’t really feel any better now than I did when I started therapy. I value the relationship we have, so I guess I’ve gained that, but beyond that, I don’t think I’ve made any progress whatsoever. She disagrees, but she’s kind of vague about that, so I don’t know if she’s trying to be nice and not hurt my feelings or if she just thinks that I have $150 per week to spend out of pocket for the rest of my life (my insurance doesn’t cover her, and I spend about 1/4 of my income on these sessions).

Can it be that I’m not really depressed but rather just totally unhappy with my life? I hate myself, and I know what depression feels like, but even when I’m not feeling depressed, when I’m feeling great, my life has no meaning. How could talk therapy cause me to reassess my life if I honestly feel that I’m a failure?

Psychologist’s Reply

If you think that therapy is not helpful, then regardless of what your therapist says, therapy is not helpful. Your subjective experience of feeling helped is an important factor in your treatment, although I want to qualify that statement by reminding you that resistance to treatment can make some clients disregard the impact their therapist is having. However, given that you have remained with your therapist for five years, I’ll give you the benefit of the doubt and posit instead that you’ve reached a plateau in your treatment that your therapist has not been able to overcome with you.

Given that you remain dissatisfied with your life, and are uncertain about whether this is directly related to your depression or is a more global issue, it sounds like you still have work to do to achieve the state of mental health and happiness that you’ve been striving for. However, you’re not getting there with your current therapist. Difficult though it may be, it could be time for you to consider “breaking up” with her.

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Therapy is a very intimate relationship, and this can make it feel awkward, distressing, and painful to end the relationship unilaterally. However, when your therapeutic goals are not being met, or are “vague,” as you describe, then the therapy is not serving its purpose. Additionally, if you are engaged in talk therapy with your therapist, you might not be receiving the type of care that you need. There is much evidence that for people with Major Depression, Cognitive Behavioral therapies are the most effective, often in combination with psychiatric medications. You might want to read up on evidence-based treatments for depression and bring them up in your next therapy session. If your therapist is not able to meet you halfway by setting some therapeutic goals and working in some new techniques to help you achieve them, you will know it is time to move on.