Maybe because it’s summer, and everybody’s thinking about vacations, or maybe it’s just a coincidence, but we’ve been spending a lot of time talking with people these past two weeks about taking a break from treatment or drastically cutting back on treatment, etc.
All of it has us wondering about how to think sensibly about these types of decisions.
After some consideration, we decided that there are three important questions:
1. How serious was the problem that led you into treatment in the first place?
2. How urgent is your feeling that you need to reduce or stop therapy?
3. How long have you been seeing this person?
The warning signs are when somebody who had a potentially life threatening condition suddenly feels an urgent need to cut back on treatment, especially if this treatment has been going on for awhile.
To give an extreme analogy, we probably all recognize that there is something a little strange about the thinking of someone who has just come through an intensive treatment for cancer who, learning that the cancer is in remission, decides to take a break from seeing his or her oncologist or getting any further studies, on the grounds that they are feeling good and thinking about cancer is depressing. It’s not too difficult to see how the case of someone who has only recently come through intensive treatment for suicidal depression, and is feeling good, and now decides to take a break from treatment is potentially similar to the person who has just gone into remission from cancer.It’s not that we think that everyone should be in treatment forever. There aren’t enough good therapist and psychiatrists to treat all the people who need help. It’s just that the process of ending or winding down treatment, needs more attention than many people give it. We’d like to see a couple of things.
1. Some thought about what is an appropriate level of monitoring or self monitoring for a return of symptoms. The fact of the matter is that, the feeling that you want to take a break from treatment can easily end up being reflected in a wish to pay no attention to early symptoms. This can be potentially disastrous. We are always more optimistic about a reduction in treatment frequency if there is a strong commitment to continuing mood charting, for example.
2. A plan about what signs or symptoms might suggest resuming treatment or increasing the frequency. This is better done now when you are feeling good than waiting until you are feeling a little “off” – but at the same time trying not to acknowledge that because it makes you feel even worse to see what is happening.
Talk about it with your therapist or psychiatrist first. Develop that plan. And then try making the change. And try not to set it up so that it is a “failure” if you need to modify the plan for reduction.