As an existential therapist, or one who mostly travels in the world of losses, the question often arises… so when is therapy over? When is someone better? Is that even the goal of good psychotherapy?

It has been a staple of my practice to ask a new patient (I prefer the term patient to client as “patient” is rooted in “one who suffers” and “client” is rooted in “one who relies or depends” – and I believe people come to see therapists in order to end their suffering) on their first visit “When you finish here, in two weeks or ten years, and you’re walking out that door… if you turn to me and say ‘Michael, this has been great for me because THIS IS WHAT’S DIFFERENT ABOUT ME’, what would you want that to be”? That is their homework week one. Let’s be clear, therapy is not about what I want, it is about what the patient wants. But patients don’t always know what they want, other than relief of their symptoms.

That said, I believe every good therapist has an obligation to do their job well, and that is to end to the greatest extent possible their patient’s suffering. Which returns us to an existential viewpoint. Let’s say an individual enters therapy with a very specific request. “I want to reduce my anxiety around my work or giving talks.” And then let’s go further and say we help them resolve that issue. They come in and tell us that they’re now comfortable at work, and comfortable talking to groups. ARE WE FINISHED?

No is the straight up answer to that question. Whether you resolved that issue with interventions from cognitive, behavioral, dialectical, acceptance, or any other of a myriad of therapies, you’re allowing a patient to leave with having only peeled away one later of that onion. The goal for the therapist should always be reaching the core of the onion, stripping away all layers of armor, reaching the authentic and struggling wounded child within, and resolving that child’s conflicts and anxieties.

Every human being who is aware that they are here is also aware that they one day won’t be here. Nothing is as deeply troubling as this core truth. Culture, stories, and myth all help mitigate that anxiety, but without touching upon it (in some fashion) in therapy, is to fail to do our jobs honestly, and to leave our patients exposed to future surface anxieties as that bubbling core issue will always press its way into their lives.