Even though you are now feeling great, think twice about skipping your last therapy session.
Typically CBT (cognitive behavioral therapy) takes 12-20 sessions. It starts with weekly therapy. Once anxiety and depression scores drop, therapy moves to consolidation appointments every 2-4 weeks followed by maintenance sessions 2-3 months apart. This means that your last session could be 3 months after the previous. Should you just skip it?
The last session is vital for three reasons.
The first is relapse prevention. The nature of our lives is that we will all have future challenges and adversities. Additionally, depression and anxiety often relapse. The last session, therefore, develops a preventative plan for future crises. It tells you what to look for and how to respond using tools from your CBT tool box.
“Your relationship with your therapist is special: someone who believed in you and who believes in you”
Your therapy notes can be summarized in the last session with the question, what did you learn? The answers to this question have prognostic significance. It’s a good sign if you have learned valuable lessons and grown.
Relapse prevention uses booster sessions if the need arises. Just as our immunity wanes over time, so do our CBT skills. Setting up the framework for an additional 3-6 booster sessions is very helpful.
The second reason not miss your last therapy session is that depression is a risk factor for cardiovascular disease. Depression increases the risk of heart attacks, high blood pressure, diabetes, obesity and stroke. It also increases the risk for smoking, alcohol use and other addictions.
Your last session should reinforce a wellness plan for exercise, weight and a healthy diet. This includes Primary Care checkups for blood pressure, cholesterol and blood glucose testing and preventative immunizations. Research clearly shows that treating depression/anxiety is not enough to promote better physical wellness. Therapists must now also promote healthy living and address cardiovascular risk factors, previously the exclusive domain of Primary Care.
The wellness plan should also address addictions such as nicotine and alcohol as part of promoting overall health. As I say to my patients, how will it help if we cure your depression but you develop lung cancer, diabetes or have a heart attack in 5-10 years’ time?
The third reason not to miss your last session relates to the personal meaning of the therapy and, in that context, the importance of goodbyes and expressing appreciation. Therapy is meaningful because we delve into the depths of who we are. It’s an uncertain journey at the end of which, we have grown and conquered. Your relationship with your therapist is special: someone who believed in you and who believes in you, whose words and thoughts will echo through your memories. It’s worth reflection because it is uncommon in our busy world. A deep relationship sustains us until the end of our journey.
And it’s a two-way street. Your therapist will also be able to express the importance of your relationship to them. Our relationships with our patients take on a profound importance and that is the way it should be.
Goodbyes are important to us all.