Therapy, Autonomy, and the Illusion of Crisis: Rethinking the Purpose of Psychotherapy
By: Maire Daugharty, MD, LPC, LAC, LMFT
In the emotional fluctuations of life, there may come a moment when you perceive yourself as a fragmented mirror—delicate, assembled with care, and uncertain if approaching its fractures is worth the discomfort of reopening what you’ve tried to put to rest. For some individuals, this culminates in a decision: that therapy isn’t for them. Psychotherapy, with its profound explorations of identity, suffering, and evolution, is not a one-size-fits-all remedy. And that’s perfectly acceptable.
Each individual is the most qualified judge of their own requirements; choices regarding therapy, akin to medical decisions, are profoundly intimate. As clinicians, it can be both humbling and frustrating to observe someone opting for a different route than we might recommend—particularly when we feel their journey could be safer or more advantageous with our direction. However, we must understand that what we contribute—our expertise, background, and objectivity—can never replace lived experience. A patient’s autonomy is more than just a legal entitlement; it is a psychological reality. Respecting it is essential, not merely polite.
The Tension Between Expertise and Control
Medical training instills within us a sense of duty—as healthcare providers, we are trained as rescuers, tasked with alleviating suffering and enhancing life quality. Yet, this sometimes transforms into a misguided perception of control. We begin to think that by presenting sufficient evidence or logical advice, we should seamlessly guide the patient’s choices to align with ours. When this does not occur, we may feel frustration, sorrow, or even worse: uncertainty about our own capabilities.
Yet here lies a vital, often overlooked boundary skill. We are not the arbiters of choices; we are custodians of information and compassion. We cannot grasp the intricacies of another’s suffering, nor should we presume to comprehend the fears that influence their decisions. Nurturing this boundary—not taking others’ choices to heart—can foster trust between clinician and patient, and protect our emotional reserves from the depletion that naturally occurs when we overextend ourselves for others.
Unpacking “Crisis-Hopping” and Misconceptions About Therapy
The belief that therapy must be centered around a significant crisis is a cultural myth—one that has regrettably influenced how individuals engage with mental health services. Referred to as “crisis-hopping,” this misconception encourages people to seek assistance only in moments of acute distress. Once the crisis subsides, they prematurely discontinue therapy, believing the task is complete.
This type of disengagement may be fueled by what therapists describe as a “flight to health”—a phenomenon where clients experience momentary relief or initial progress and conclude they are healed, when in reality, the underlying issues prompting their behaviors remain unexamined or unresolved. Sobriety after a few weeks, enhanced communication after one couple’s session, or feeling “less troubled than before” are frequently misinterpreted as true recovery, when they may actually signify a diversion from deeper, challenging work.
Avoiding the shattered mirror once more.
Therapy that concludes too early often leaves constructive change superficial, lacking integration. Like rearranging furnishings without addressing the structural weaknesses of the walls, visible changes do not necessarily guarantee internal resilience. To genuinely solidify new patterns—whether they involve self-esteem, communication techniques, or grief reconciliation—a period of stability, self-reflection, and sustained effort is typically essential.
The Role of the Therapist: Pace, Presence, and Partnership
Occasionally, a client’s choice to end therapy reveals more about their current life demands than their readiness. Life can be overwhelming, intricate, and often draining. Confronting trauma, grief, or pain demands emotional bandwidth that not everyone has consistently. Sometimes, simply surviving is sufficient.
Nevertheless, certain responsibilities do rest with therapists. Misjudging pacing—such as pushing too ambitiously too quickly—can incite fear and result in withdrawal. Effective therapy necessitates a robust working alliance. It requires sensitivity to a client’s vulnerability and capability to handle emotional intensity. A proficient therapist aids in modulating a client’s emotional intensity, providing containment while gently promoting exploration.
Approach or retreat—that is the moment-to-moment decision.
Therapists must support clients through both the painful instances and the times when nothing appears pressing. In those calm moments, profound work still takes place. That is where integration begins.
The Value of “Smooth Sailing” and the Anchoring of Change
In contrast to crisis-focused assumptions, therapy’s effectiveness often resides in what unfolds during the calm intervals. Acknowledging progress, celebrating growth, and engaging with positive emotions are not diversions from healing—they constitute the process itself. These meaningful experiences ground us in new ways of existence.
Experiencing peace—and allowing it to endure—strengthens the understanding that positive change is not fragile. It becomes an integral part of the self, not merely a transient occurrence. Through this, therapy aids in reconstructing those shattered mirrors into new mosaics, emblematic of hard-earned transformation and deeper understanding.