When it's too much: why people leave just as therapy begins

At the seventh session she cried for the first time. She was talking about her father, about the evenings she waited to see whether he would come home sober, and suddenly she could not go on. We stayed in silence until she calmed down. As she was leaving she said: “I’ve never told anyone that.”

The following week she cancelled. The week after that she wrote that she was thinking of stopping — that she felt better now, that she had a lot of work and perhaps didn’t need therapy any more.

This is the second post in a series on ending therapy early. In the first I described five groups of reasons why people leave. This post is devoted to just one — the one people least often recognise in themselves: leaving that comes just as therapy has begun to touch the heart of things. When it becomes too much.

Why just then

It seems illogical. Someone comes to therapy because something hurts. When therapy finally comes close to what hurts, they leave. Why?

The answer is simple, though not easy: because it hurts. Everything a person has kept shut for years, they shut for a reason. When it opens, it is not only a memory that opens, but also the feelings that were too big to feel back then — fear, shame, sadness, anger. And with them wake the old expectations of what happens when you show what you feel. If as a child you learned that tears would be met with rejection, mockery or being left alone, part of you will expect exactly that after your first tears in therapy. Leaving is faster than rejection.

Something easily overlooked matters here: in therapy it is not only a topic that opens, but also the relationship. When you have shown someone your vulnerability for the first time, you have become a little dependent on them. Attachment theory teaches us that closeness itself triggers everything we have learned about closeness. For people who learned it was safer to be independent and need no one, such a moment often switches on a strong need for distance. You will find a short explanation of this pattern in the knowledge base under avoidant attachment.

The window in which growth is possible

The psychiatrist Daniel Siegel described a concept we use in therapy almost every day: the window of tolerance. It is the range of arousal in which we can feel, think and stay in contact all at once. Above it lies overwhelm — panic, anger, a sense that you can’t cope any more. Below it lies numbness — empty, absent, as if there were nothing to feel.

Therapy works at the edge of this window. Not in the middle, where everything is calm and nothing moves, and not outside it, where there is too much for anything to be learned. At the edge it is hard but still bearable. And when a person experiences there often enough that they can feel something hard in another’s presence without falling apart, the window slowly widens.

But when therapy or life pushes someone over the edge, one of two things happens. Either they are overwhelmed — then leaving arrives as an urgent decision that cannot be argued with. Or the feelings switch off — then therapy suddenly seems unnecessary, because “it’s not that bad”. Both are forms of protection. And both are a sign that it is time to slow down, not to stop. More in the knowledge base under window of tolerance.

Flight into health

Psychoanalysts described decades ago a phenomenon therapists know well: flight into health. After a session in which something essential opened up, a person suddenly feels much better. Symptoms ease, mood lifts, it seems the main work is done. And so they leave.

The improvement is often real — the relief after saying something is real. But sometimes it also serves another purpose: it offers a reason not to have to go back to where it hurts. A 1986 study by Kenneth Howard and colleagues showed that about half of people show measurable improvement by the eighth session, but three quarters only by the twenty-sixth. So the first relief comes quickly. Deeper change takes longer — and often runs through exactly the period when leaving is most tempting.

I wrote about why therapy sometimes hurts first in Why therapy sometimes hurts before it helps, and about resistance in the post on resistance in therapy.

The shame of having told

One of the most common experiences after a deep session has an almost comical name in everyday language — some call it a “vulnerability hangover”. When you remember in the evening everything you said, a wave of heat goes through you. Why did I say that? What does she think of me now? How will I look her in the eye?

This feeling is shame, and shame is one of the most powerful emotions we know. Its job is to protect us from being excluded from the group — so it switches on every time we show something we fear will make us unacceptable. For people who grew up with mockery, criticism or coldness, shame after disclosure is especially strong, because in the past disclosure really was followed by punishment.

Shame has one characteristic that is key for therapy: it likes to hide. It doesn’t say “I’m ashamed”, but “I’ve got nothing more to say”, “the therapist doesn’t understand me anyway”, “it costs too much”. That is why it so often happens that someone leaves with a reason that sounds practical, when in fact it was shame that drove them away.

The good news is that shame also heals in relationship. When a person shows something they are ashamed of and the other stays — does not judge, does not change how they see them, does not leave — something begins to shift. One such experience doesn’t erase decades. But it is a beginning. And it can only happen if the person comes back after the shame.

How to tell “too much” from “not right”

I am not saying every wish to leave is flight. Sometimes therapy really isn’t right. How do you tell one from the other? There is no simple test, but there are signs that help.

The strongest sign is timing. If the wish to leave comes straight after a session in which something important happened, it is almost certainly connected to that session. If it has accompanied therapy from the start, it is more likely that the relationship or approach really is wrong. The third post in this series, When it is right to leave, is about when leaving is right.

The second sign is certainty. Decisions that come from overwhelm are often unusually clear and free of doubt. “I’ve got nothing more to say.” “I’m better now.” “I haven’t got time.” Decisions that come from reflection usually have more nuance and more “on the one hand … on the other”.

What helps when it’s too much

If you recognise that therapy has become too much, you have more options than it seems. Leaving is only one of them — and usually not the best.

Say it. Even the sentence “after our last session I had a really hard time” is enough. The therapist needs this information, otherwise they won’t know they went too fast. A good therapist won’t get defensive but will thank you.

Slow down. In therapy we have many ways to reduce intensity: more time for stabilisation, for the body, for sources of strength; shorter periods of touching what’s hard and longer ones of settling. With people who have traumatic experiences this is the rule, not the exception — Judith Herman wrote over thirty years ago that safety is always the first phase of the work, and only then comes processing memories.

Agree on a break. If there is too much going on in life right now, a break can be a wise decision. The difference between a break and dropping out is that a break is talked about, you both know why you are taking it, and it is clear how you can come back.

How it sounds in the room

The woman from the opening came to one more session. This is how it began (a composite, not a real person):

“I think it’s better if I stop. I don’t know what else we’d talk about.”
“Thank you for coming to say it in person. Can I ask — how was it for you after our last session?”
A long silence. “Awful. I couldn’t sleep for two days. I felt … exposed.”
“As if you’d shown too much?”
“Yes. And that you’d look at me differently now.”
“How am I looking at you now?”
She looks at me. “The same.”

She stayed. Not because I persuaded her, but because she experienced something she had never had at home: she showed her vulnerability and the relationship did not change. We agreed to go more slowly, to begin each session with how she had been after the last one, and that she always has the right to say “not now”.

Exercise: a traffic light after each session

You can do this exercise after every session, especially if you notice you are tempted to leave. It takes two minutes.

1. An hour after the session ask yourself: green, amber or red? Green: I’m fine, something shifted. Amber: it’s hard, but I can manage. Red: it’s too much, I can’t settle.
2. Write down the colour and one word about what was hardest.
3. Check again the next day. Has the colour changed? Red that turns amber is often a sign you were at the edge of the window, not over it.
4. Bring the colour to your next session. It is enough to say: “Last time was red.” That is valuable to your therapist.
5. Agree on a signal. Some clients agree a word or gesture with their therapist for “it’s too much now” — so they don’t have to explain when it’s hardest.

You will find a similar tool for recognising emotions in the knowledge base under emotion traffic light.

Where the responsibility isn’t yours

Everything I have written might sound as if leaving because it’s too much is always the client’s “fault”. It isn’t.

Pacing is the therapist’s responsibility. If the therapist went too fast, opened topics for which the relationship was not yet safe enough, or didn’t notice you were withdrawing, that is their mistake, not yours. A good therapist follows where you are and doesn’t push on just because “we need to get to the heart of it”.

Sometimes now really is too much. If you are in the middle of a divorce, an illness or a loss and have no one to support you between sessions, deep therapy may genuinely be too risky right now. Then it is wise first to look after stability — with more supportive work, with the people around you, sometimes with the help of a psychiatrist — and to turn to deeper themes later.

Dissociation is a sign to stop. If during or after sessions you lose contact with yourself, feel as if in a dream or can’t remember parts of a session, that is not a sign you must “hold on”. It is a sign the work needs adjusting — and the therapist must take this very seriously.

What to remember

• People often leave just as therapy touches the heart of things — because with it wake old expectations about vulnerability.
• Therapy works at the edge of the window of tolerance; beyond the edge it is time to slow down, not to leave.
• Half of people improve by the eighth session, three quarters only by the twenty-sixth.
• “Too much” comes suddenly and with certainty; “not right” lasts longer and has more nuance.
• Pacing is the therapist’s responsibility — tell them when it’s too much.