Brian Lehrer: Brian Lehrer on WNYC. Now, we will end today's show with your calls on quitting or graduating from therapy. Listeners, have any of you stopped attending your weekly or otherwise regularly scheduled therapy appointments recently? What brought you to that decision? How did you realize you were ready to move on from the therapy couch, or chair, or relationship? 212-433-WNYC.

I ask this because a piece published in The Atlantic earlier this week suggested that, as the title goes, "Plenty of People Could Quit Therapy Right Now." The author will join us in a second. His idea is to counter the fairly common belief that therapy is a lifelong practice and that everyone should be in therapy all the time. Getting into a therapeutic practice, finding the right therapist, dealing with insurance, if you have insurance, tackling long-held negative thought patterns or trauma is quite laborious. Once you have a good therapist for you, that relationship can be so special. At what point do you reach the end of that journey, if any? 212-433-WNYC, 212-433-9692.

For those of you who've ever been in therapy for whatever reason, and then decided to stop, how did you know you'd be okay without it? 212-433-9692. Or are you long-term in therapy and this whole concept is rubbing you the wrong way?

Well, let's hear from the writer of the article, Dr. Richard Friedman, Professor of Clinical Psychiatry, and the Director of the Psychopharmacology Clinic at Weill Cornell Medical College. He wrote that piece in The Atlantic called Plenty of People Could Quit Therapy Right Now. Dr. Friedman, hi. Thanks for joining us. Welcome to WNYC.

Dr. Richard Friedman: Hi, Brian. It's a pleasure to be here.

Brian Lehrer: Why do you think we treat therapy, "like working out or going to the dentist," as you wrote, in modern times, meaning you got to keep doing it?

Dr. Richard Friedman: Well, I think there's several reasons. One is we're very good at starting treatment. Clinicians- I'm a psychiatrist, are very good at prescribing treatment, but we don't always think about how long we should be treating people. When is somebody actually done? Patients who are in treatment and they like their therapists and they're attached to them, even when they've benefited, they may not be thinking, "Well, what am I still getting from this ongoing treatment? Is it really enough? Am I finished?" I think it's not a question that clients or therapists think about that often.

Brian Lehrer: You even share that therapy, when not necessary, can cause harm. Are there common patterns of that?

Dr. Richard Friedman: It's relative, and I don't mean harm in the sense of mortal harm. I mean that, for example, if you don't have serious problems and you are in therapy and you're focused on the things in life that are bothering you, for example, you're not happy at work, you're not happy in relationships, therapy sometimes can take the place of action in life. In place of doing things to rectify what is disturbing you in life, you stay in therapy and complain and talk about it as opposed to taking action in the real world and modifying and changing it. To me, that's a relative harm.

Brian Lehrer: Is that why you framed the article-- I realize the writers don't always write the titles, but it comes off a little bit like a scold, "Plenty of People Could Quit Therapy Right Now." The implication is you may be continuing your therapy when really you shouldn't.

Dr. Richard Friedman: I certainly don't mean to be censure or scold. It's more like if you're better and you've really benefited from treatment, it's reasonable to ask the question, "How long do I need to keep this up in order to stay well?" Is it like being in training with a physical trainer that is if you stop it, you lose the effect, or is it something that's different?

I think it's something that's different, meaning in good therapy, you gain knowledge, you gain skills. When you leave therapy, the great thing about therapy is you bring those things with you, that knowledge. In effect, you become your own trainer. If you want to ascertain or do a check-in to see what have you gained, I actually would call this taking a vacation from therapy just to see what have I actually learned and what am I taking with me? One way to find out is to pause it and you can ask your friends, you can ask your family, people who know you and love you, "How do you think I'm doing?"

Brian Lehrer: Let's hear from somebody who may have done just that. Jasmine in Nassau County, you're on WNYC with Dr. Richard Friedman. Hi, Jasmine.

Jasmine: Hi. Good morning.

Brian Lehrer: You quit therapy, I see?

Jasmine: Yes. I started therapy when I was in crisis, which I would not advise people to do. I would definitely advise people to be proactive about it before you get in crisis. I was doing really well. Then, I kind of dropped off and then went back to it in crisis again. I totally agree, there should be an end goal for yourself. It shouldn't be there for you forever. If you're working with a really good therapist, I think that they can give you lots of skills and advice.

I agree that you should think of it as a vacation. I started to diminish the amount of times I saw my therapist. Instead of weekly, it became monthly check-ins. Then, with the right balance for me, which was medication, once that was working out really well, it felt like I was capable of going on on my own. I saw it as like training wheels that I was able to take off and continue.

However, I will say that you always have the chance to go back. Therapy exists. Now you know. You understand how to manage the whole thing. You can always look back to see what kind of thing that is. It could be a different kind of therapy. It could be group therapy. It could be art therapy. There's other options. It's not once you leave, it's forever.

Brian Lehrer: Great anecdotes and clearly told. She could have written this article.

Dr. Richard Friedman: She sure could.

Brian Lehrer: Anything on there you want to pick up on? Like the vacations from therapy, you always know your therapist is there, assuming it was a good relationship, if you need to go back and you have another crisis, anything there you want to pick up on?

Dr. Richard Friedman: Yes. I think the idea is not that when you leave, you have to say goodbye forever necessarily, but leave open the possibility that if new problems arise or you're facing new stress and you have trouble dealing with it in a way that interferes with your life, that you can return to your therapist and hopefully they'll have time to see you. I like the notion of intermittent treatment. You do it. You achieve goals. You feel better, and then you go on your way. At every point along the way, as you leave therapy, if you're having trouble, you can consider going back, as Jasmine said she did.

Brian Lehrer: She also mentioned medication. You are a psychiatrist, which means you're an MD. You can prescribe medication. How do you, in your own practice, if you have a private practice, walk that line between using medications to the benefit of the patient and not just using them as a crutch that avoids dealing with issues?

Dr. Richard Friedman: That's a wonderful question, Brian. I use medicines to target a specific syndrome like anxiety or clinical depression. I treat somebody until they're well and feeling better and stable. Then, in the future, in the next year or two, I consider, "Is it really necessary to maintain this benefit? Must I continue the medicine with this patient?" I de-prescribe medicine all the time to discover whether it's still necessary.

In fact, the motive, and one of the reasons I wrote this piece about psychotherapy is that I thought, "If I do this with medication and biological treatment, why not think about this in a similar way with psychotherapy to assess the treatment? Do I still need to continue therapy to maintain my sense of well-being, or have I already reached it?"

Brian Lehrer: Here is Mark in Hell's Kitchen who I think is going to be really honest about something in the therapeutic relationship in his case. Mark, you're on WNYC. Hi, there.

Mark: Hi. Thanks very much. The pandemic, actually, a lot of people went to therapy because of the pandemic, but the pandemic resulted in my being able to break away from therapy. I've been with a wonderful therapist for many years, but I always felt like if I ended, I would be disappointing him. I used to actually talk to him about this. I was well in the middle age. I used to joke, this is going to sound dark, that, "Either I'm going to have to die or you're going to have to die for me to have the guts to leave therapy."

It's interesting because end of life-- I know people that are involved in counseling people at the end of life, a lot of times people will- they'll accept more treatments from their doctors when they're in their 70s, 80s because they don't want to disappoint their doctors. I just wanted your guests to comment on that.

Brian Lehrer: How about that, Dr. Friedman? Staying in therapy not to disappoint the therapist?

Richard Friedman: Mark, that's a wonderful observation. I think that it goes in both directions. Patients feel attached to their therapist. In that bond, they feel perhaps like they can't leave or they can't disagree, because their therapists will be hurt, upset, disappointed, et cetera. That's a natural feeling. Likewise, I think therapists get attached to their patients, and have a hard time letting go. Both because they really liked them, and they're sad to see them leave. Also their financial incentives in holding on to a well, charming, easy-to-treat person. I think that it goes in both directions. It's not just from the standpoint of being a patient, but therapists have feelings like that as well.

Brian Lehrer: Gracie in Brooklyn, a therapist, you're on WNYC. Hi, Gracie.

Gracie: Hi, Brian. First-time caller. I actually became a therapist, in part, because-- I have been a therapist since 2006 because I was really tired of seeing people be in therapy for decades and not getting anywhere. There's a way I and many of my colleagues work, called solution-focused brief therapy, where we-- It's called, beginning with the end in mind. I work with people as long as it's necessary, no longer.

If people have enjoyed working with me, they're always welcome to come back or work with me periodically, as Dr. Friedman said, but I'm very interested when I work with anybody in, what do they want? What will it mean for them to get it? What do they already have in their lives that suggests they can do it? From there, I add a little, what's appropriate to them so they can get there. I start every session asking what's been better, what will be helpful, and the end every session, asking people what came out of it and what they're going to do next.

Beginning with the end in mind, do people get attached to me? Sure, some of them do, partly because they had a good experience. I think it's unethical to keep someone in therapy for decades. I'm dead set against it. Now, I may work with someone for decades, but I have really trained my patients to only come in when they have something to talk about, and that they determine that criteria for success. I know it's for plenty, but-

Brian Lehrer: It sounds so-

Gracie: -it's really really important to know there are other ways of working.

Brian Lehrer: -helpful and practical. I wonder how you would react, Gracie, to this text that we got from a listener who's also a therapist, and says, "Sometimes people stay in therapy beyond what they need because the therapist, in some way, encourages them to stay on." That's different than the person feeling too attached who's the client. Do you think that happens either for financial reasons, or whatever?

Gracie: It happens. I won't infer an intention when I can't know, but I have certainly heard from clients things like they felt like they had to break up with their therapist, and they were really happy when I explained my way of working. Now, look, my way of working is not the only one, but it came from a genuine frustration and a sincere desire to use the scientific method to figure out what works.

Brian Lehrer: Gracie, thank you very much. That, what we've been talking about, I think what your article is about, Dr. Frieden, is different than people who leave therapy because they don't like their therapists. We have some of those calls coming in, and we're not going to take those. "Oh, my therapist is not doing a good job, or not doing a good job for me, or I don't like this person, really," as opposed to leaving to graduate and try to go out on your own. Then there's what the text writer said that may imply that maybe the therapist sometimes has a need for the person to keep needing them.

I'll give you our last 45 seconds here. How can people who think maybe it's going to be good for them to graduate or to take a break take that first step?

Richard Friedman: Well, I think the first thing is just to take stock of where you are. Think of what you felt like and how you were functioning when you entered therapy and ask yourself, am I better now, and what's better? If you feel like you've made progress towards your goal in terms of what you're doing in life, how you're functioning, what your relationships are like, and you're feeling better, let's say less anxious, less depressed, then the next thing is you say to your therapist, "I think that I've made real progress. I'm feeling much better. What do you think about my taking a break or potentially ending treatment?" and seeing what your therapist says.

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Brian Lehrer: That has to be the last word. We thank Dr. Richard Friedman, psychiatrist at Weill Cornell Medical College, and now the author of the article in The Atlantic, Plenty of People Could Quit Therapy Right Now. Thank you so much for coming on with us.

Richard Friedman: My pleasure. Thank you for having me.

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