When it is right to leave therapy: signs that the therapy or therapist isn't right

“I don’t know if this is normal. I’ve been going for six months and it feels like we’re going round in circles. She mostly listens and nods. When I said I’d like more feedback, she said that was my resistance.”

I received this message from a woman looking for a second opinion (a composite of several similar ones, not a real person). She was wondering whether the problem was her — whether she was simply too impatient, too demanding, too resistant. Perhaps. But perhaps not.

This is the third post in a series on ending therapy early. In the first I described why people leave, in the second how to recognise leaving that comes from overwhelm. This post is about the other side: when leaving is the right decision. Because that exists too — and it matters that you don’t mistake it for resistance just because someone told you so.

The relationship is the medicine

First, something research confirms again and again. In 2018 Christoph Flückiger and colleagues combined 295 studies with more than 30,000 clients and found that the quality of the therapeutic alliance is one of the most reliable predictors of therapy success — regardless of approach, diagnosis or country. In other words: it is not only what the therapist does that matters, but also how you feel with them.

Research also shows that therapists are not equally effective. Differences between them account for a smaller but consistent part of differences in outcomes — some therapists consistently get better results with similar clients than others. And some therapists are good for some people and not for others. That is nobody’s fault. But it is a reason why changing therapist is sometimes the best decision you can make.

Back in 1979 the American psychologist Edward Bordin described what the alliance is made of. His description remains the most useful compass for asking whether a therapy is right for you.

Goals. Do you and your therapist agree on why you are here and what you would like to change? The goal doesn’t have to be precise at the start — it often takes shape along the way. But if after several months you don’t know where you are heading, and your therapist can’t or won’t explore this with you, that is a serious sign.

Tasks. Does what you do in sessions make sense to you? It needn’t always be pleasant, and you needn’t understand everything as it happens. But you should at least feel the work has a direction, and be able to ask why you are doing what you are doing.

Bond. Do you feel safe enough with your therapist to say the hard things too? Do you feel they respect you, take you seriously, care? The bond builds slowly, but after a few sessions you can usually sense whether it has a chance to grow.

Good reasons to leave

Based on this and my own experience, here are some reasons for which leaving — or at least a serious conversation about it — is entirely justified.

After several sessions there is no connection. You don’t have to like your therapist at the first session. But if after four or five sessions you still feel you are talking to a wall, that they don’t care, or if before every session you feel a reluctance connected not with the content but with the person, that is important information.

You don’t feel heard or respected. The therapist interrupts, corrects, lectures you. They interpret your feelings before you have said them. They respond to criticism with defensiveness or by explaining that it is “your problem”. Every therapist sometimes gets it wrong, but if this is a pattern and doesn’t change when you say so, leaving is justified.

The therapist imposes their values. They tell you how you should live, who you should be with, what is right about religion, sexuality or politics. A therapist has their own values, but in therapy they are not the yardstick for your life.

There is no progress and it can’t be discussed. Therapy is not linear and periods of standstill are normal. But if after a long time you feel no change at all — in understanding, in how you feel, in your relationships — and your therapist can’t or won’t look at this with you, it is a reason for a conversation and perhaps for leaving.

The therapist isn’t qualified for your difficulty. Some difficulties — eating disorders, psychosis, severe trauma, addiction — require specific knowledge and sometimes collaboration with a doctor. A good therapist will say so themselves and refer you on. If not, you can ask. I wrote about when a psychiatrist is the first port of call in When you need a psychiatrist first.

The therapist has crossed boundaries. This is a special category, covered in the fourth post of this series, What a therapist must not do. When leaving for this reason you don’t have to clear anything up.

When “that’s your resistance” isn’t the right answer

Let us return to the woman from the opening. When she said she would like more feedback, her therapist replied that this was her resistance. Could she have been right? Yes. Resistance exists and it matters — I wrote about it in the post on resistance in therapy.

But “that’s your resistance” must not be an answer that closes the conversation. If a therapist explains every criticism you make as your problem, you lose the only tool you have to influence your own therapy. A good therapist will take your comment seriously and explore it: “What would it mean to you if I gave you more feedback? And what do you think happens when you don’t get it?” That way resistance, if it is there, shows itself — and your experience remains valid.

It is important to distinguish: does the therapist explore your comment together with you, or use it to tell you that you are wrong? The first is therapy. The second is a misuse of power, even if unintended.

Before you decide

If you are thinking of leaving, I suggest a simple process. It isn’t binding — it is meant to help you leave with clarity rather than from a passing feeling.

The fourth step seems to me especially important, because it requires honesty with yourself. If you notice you have left several therapists, each time at a similar point — when it got personal, when you had to show yourself, when the therapist said something that hurt —, it may be worth exploring. Not to blame yourself, but because that very pattern may be why you went into therapy in the first place.

How it sounds when the conversation works

This is how a conversation might sound when a client says they are thinking of changing therapist (a composite, not a real person):

“I don’t know how to say this. I don’t feel I’m making progress. Maybe I should try someone else.”
“Thank you for saying it straight. That isn’t easy. Can you tell me when you started feeling this way?”
“For a while now. I think I need someone who would give me more concrete tools.”
“That’s an entirely legitimate need. We can try a different way — or I can give you the names of colleagues who work more with techniques. Which would you prefer?”

Whatever the outcome, this conversation ended the relationship respectfully. The client didn’t leave with guilt, the therapist not with resentment. And if he ever comes back, he will know he can.

What if your therapist disagrees with your leaving

You may say you are leaving and your therapist may think it isn’t a good decision. Perhaps they see you are on the verge of something important. Perhaps they recognise the pattern I wrote about above. They have the right to tell you — once, clearly and respectfully. A good therapist will say something like: “I’m worried that you’re leaving just now, because I think we’re close to something important. But the decision is yours, and if you decide to go, I’ll respect it.”

What a therapist must not do is pressure you. They must not make you feel guilty (“after everything I’ve done for you”), threaten consequences (“without therapy you’ll get worse”), take offence or punish you with silence. Nor may they charge you for sessions you didn’t agree to, or withhold your records. Your right to end therapy at any time is one of the basic rights in any therapy — and no therapeutic interpretation takes it away.

If you notice that at the thought of leaving you feel trapped, guilty or obliged to stay for the therapist’s sake, that in itself is important information. It may be a role you know from elsewhere — or the therapist may really have crossed a line. Either way, it is good to talk about it with a third person.

Exercise: a review after six sessions

After about six sessions, take time for a short review. Answer each question with yes, no or don’t know.

1. I know why I’m going — and my therapist knows too.
2. I understand how we work — or I know I can ask.
3. I dare to say even what is hard or awkward.
4. When I said something bothered me, I was heard. (If you haven’t said it yet, that is the first step.)
5. I notice at least a small change — in understanding, how I feel or my relationships.

If most answers are “yes”, therapy is probably working, even if it isn’t always easy. If most are “no”, that is a good reason to bring your answers to the next session. You will find more questions for choosing a therapist in the knowledge base under questions for choosing a therapist and in How to choose the right therapist for you.

Where this reflection falls short

There is no perfect fit. No therapist will always understand you, never get it wrong and always know what you need. If you look for perfection, you will be disappointed by everyone. Good therapy is not a relationship without mistakes, but one in which mistakes can be repaired.

Discomfort is not the same as wrongness. Therapy can be uncomfortable and right at the same time. The very therapist who challenges you a little may be the one who helps you most — pleasant and helpful are not the same thing.

Changing therapist is not failure. If after all this you decide it is time for another therapist, that is not a defeat — not yours, not your therapist’s. It is a sign that you take your path seriously. Many people find their right therapist at the second or third attempt.

What to remember

• The quality of the alliance is one of the most reliable predictors of therapy success — a meta-analysis of 295 studies.
• The alliance is made of goals, tasks and bond; if one is missing for long, it is a topic for conversation.
• Justified reasons to leave: no connection, no respect, imposed values, no progress, therapist not qualified, crossed boundaries.
• “That’s your resistance” must not be an answer that closes the conversation.
• Changing therapist is not failure — but it is worth noticing if you always leave at the same point.