Graduating from Therapy – What to Expect

Learning to Thrive: A How-To Guide for Therapy

by Gavin Hannegan, Cal Poly, San Luis Obispo undergraduate intern, supervised by Dr. Hannah Roberts

Hello Thrivers! Welcome to the final installment of a three-part series called, “Learning to Thrive: A How-To Guide for Therapy.” This series will help you understand what to expect from the beginning and end of your therapy journey. Over the past few months, we’ve explored how therapy can be an effective self-care tool no matter what your needs are. Now, let’s put those discussions into context as we explore graduating from therapy.

Wait, graduating from therapy? Wouldn’t that be counterintuitive coming from therapists? After all, we even have a blog post dedicated to the evidence-based benefits of long-term therapy. But long-term therapy doesn’t mean that you have to see your therapist for the rest of your life. Graduating from therapy is a lot like graduating from college. It’s an achievement that not only captures how hard you’ve been working, but it also signifies that you’re ready to apply your new skills out in your day-to-day life. For today’s post, we will be answering the following questions about graduation in order to best support you in this process:

How Do I Know When it’s Time to Graduate?

Consider if you have met the goals that you and your therapist have developed since your first session. Maybe you’ve been able to properly process a traumatic event you experienced, or perhaps you’ve been able to consistently address new stressors in your life using healthier strategies. You may even feel like you can continue working towards your goals without the direct guidance of a therapist.

If you’re thinking about graduation, give yourself plenty of time to discuss with your therapist. Oftentimes, your therapist might be the one to initiate this conversation and propose the idea of graduation (Olivera et al., 2021). Like you would with any other therapy work, collaborate with your therapist to plan out what graduation from therapy will look like for you. This mutual agreement will both strengthen the therapeutic bond and improve the likelihood of a successful transition out of therapy (Olivera et al., 2021). These conversations may continue throughout a couple of sessions to ensure that both you and your therapist are comfortable and prepared for graduation. 

What Will My Final Therapy Session Look Like?

The focus of this session is to create a sense of closure with your therapeutic relationship. Your therapist will give you the space to reflect on what you have achieved through therapy, be open about your feelings surrounding graduation from therapy, and to explore how you will maintain your mental health gains following therapy termination (Norcross et al., 2017). You can also talk with your therapist about your expectations and their boundaries regarding communication post-treatment. Due to ethical guidelines, this type of communication should be kept to a minimum. But your therapist may be okay with you reaching out if you ever need a brief check-in, you’re ready for another chapter, or if you would like a referral for you or someone else. Additionally, feel free to update your therapist on your progress post graduation; it’s a great feeling for therapists to know that their clients are doing well. And we’re always thinking of you! This session can be a bittersweet moment for you and your therapist, so feel what you need to feel. Although it may be sad to leave your therapist, try to walk away from this session with a sense of pride, because you deserve it.

How Can I Navigate Life Without Therapy?

Evidence-based therapy practices are designed for long-term success. Many of the therapy models that we offer here at Thrive have been found to support clients after their graduation from therapy. Here are some highlights from recent studies:

• A meta-analysis of 69 clinical trials found that cognitive-behavioral therapy (CBT) consistently reduced symptoms of anxiety disorders up to a year after treatment (van Dis et al., 2019).
• Through interviews, clients of dialectical behavior therapy (DBT) revealed that they have been able to navigate conflicts and build social connections more effectively in the years following graduation (Gillespie et al., 2022).
• Compared to standard treatment from a healthcare provider, mindfulness-based cognitive therapy (MBCT) is significantly more successful in reducing the likelihood of relapse for depression symptoms (McCartney et al., 2020).
• Another meta-analysis featuring clinical data from over 34,000 clients with depression reported that varying different therapies, including CBT and interpersonal therapy, all produced healthier outcomes within a year of graduation (Cuijpers et al., 2021).

Therapy provides you with the tools to navigate life, but you’ve always been in charge of using these tools. If you’ve been practicing these strategies in your everyday life already, then the transition out of therapy may not feel as jarring as you would think. Remember that your last few sessions will help you gain the confidence to make this transition. You and your therapist wouldn’t have discussed graduation if you both didn’t feel it was the right choice to make.

Is It Okay to Eventually Go Back to Therapy?

Yes, the door is always open! While you may not need a weekly session anymore, you can always schedule a check-in with your therapist when you need it. These sessions would be especially helpful for putting your therapy strategies into a new context, such as an unexpected crisis. You may also have a new development on a previous area of concern that you may want to discuss with your therapist. Keep in mind that at this phase in your therapy journey, your sessions will be more about the maintenance and fine-tuning of your mental health. The growth you experience may seem less pronounced compared to the first six weeks you started therapy, but you will continue to see improvements as you take care of yourself. (Wojnarowski et al., 2019). Your graduation might be the end of this particular therapy chapter, but continue to prioritize your own needs. Help is available whenever you need it.

For those of you who are graduating from therapy, congratulations on this accomplishment! Therapy can be intensive work, and your graduation from therapy is a testament to your perseverance and determination to show up for yourself. You may continue to face challenges in your everyday life, but your experience in therapy will leave you equipped to overcome those challenges. We hope this series played even just a small role in your self-care journey. Best of luck as you enter this new chapter, and we can’t wait to see you THRIVE!

Have more questions or feel ready to start therapy in California today? Schedule a session with one of our therapists! You can schedule online here!

We hope you enjoyed this blog post! Have more topics you’d like us to blog about? Contact us and we’ll be sure to include your topic in a future post.

References

Cuijpers, P., Quero, S., Noma, H., Ciharova, M., Miguel, C., Karyotaki, E., Cipriani, A., Cristea, I. A., & Furukawa, T. A. (2021). Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types. World Psychiatry, 20(2), 283-293. https://doi.org/10.1002/wps.20860

Gillespie, C., Murphy, M., Kells, M., & Flynn, D. (2022). Individuals who report having benefitted from dialectical behaviour therapy (DBT): a qualitative exploration of process and experiences at long-term follow-up. Borderline Personality Disorder and Emotion Dysregulation, 9(8), 1-14. https://doi.org/10.1186/s40479-022-00179-9

McCartney, M., Nevitt, S., Lloyd, A., Hill, R., White, R., & Duarte, R. (2020). Mindfulness-based cognitive therapy for prevention and time to depressive relapse: Systematic review and network meta-analysis. Acta Psychiatrica Scandinavica, 143(1), 6-21. https://doi.org/10.1111/acps.13242

Norcross, J. C., Zimmerman, B. E., Greenberg, R. P., & Swift, J. K. (2017). Do all therapists do that when saying goodbye? A study of commonalities in termination behaviors. Psychotherapy, 54(1), 66-75. http://dx.doi.org/10.1037/pst0000097

Olivera, J., Challú, L., Gómez Penedo, J. M., & Roussos, A. (2017). Client-therapist agreement in the termination process and its association with therapeutic relationship. Psychotherapy, 54(1), 88-101. http://dx.doi.org/10.1037/pst0000099

van Dis, E. A. M., van Veen, S. C., Hagenaars, M. A., Batelaan, N. M., Bockting, C. L. H., van den Heuvel, R. M., Cuijpers, P., & Engelhard, I. M. (2020). Long-term outcomes of cognitive behavioral therapy for anxiety-related disorders: A systematic review and meta-analysis. JAMA Psychiatry, 77(3), 265-273. http://dx.doi.org/10.1001/jamapsychiatry.2019.3986

Wojnarowski, C., Firth, N., Finegan, M., & Delgadillo, J. (2019). Predictors of depression relapse and recurrence after cognitive behavioural therapy: A systematic review and meta-analysis. Behavioural and Cognitive Psychotherapy, 47(5), 514-529. https://doi.org/10.1017/S1352465819000080