Therapeutic Break vs. Discontinuation of Therapy (Recognizing the Difference)

A therapeutic break is a planned interruption of ongoing treatment. The therapist, the child, and the parents discuss it together beforehand. This includes a reason for the break, an approximate time frame, and an agreement on when the sessions will resume. Sometimes this is prompted by the achievement of an interim goal; other times, it’s due to a family life event such as a move, a school trip, or exam stress. The therapy spot generally remains reserved, and the treatment file stays open.

Discontinuation of therapy ends treatment before its scheduled conclusion, without prior discussion and without a plan to resume. This often happens after a difficult session, out of frustration or exhaustion; in some cases, the child simply stops attending appointments. Professionals refer to this as a premature termination when therapy ends without a concluding discussion. About one-fifth of all psychotherapy cases are ended in this way before the planned goal is reached.

The difference is evident less in the calendar than in the agreement. When taking a break, everyone involved is in the know: there’s a conversation in which the goal, duration, and return are established. The child knows what to do next.

Signs of an impending breakdown are more subtle. Watch for:

• frequently canceled or forgotten appointments without a new arrangement
• statements like “This isn’t going to help anyway” after individual, stressful sessions
• sudden rejection, even though there was previously a bond with the therapist
• Withdrawal immediately after a topic that was painful, such as after exposure exercises

Resistance to individual exercises is part of the treatment and does not necessarily mean the therapy is being discontinued. The situation becomes critical when the client stops communicating with the practice and the sessions simply peter out without explanation.

Children rarely seek therapy on their own initiative. Motivation often takes weeks to build, and it fluctuates. This makes these treatments prone to dropouts during difficult phases.

Research has clearly identified several reasons for this. Some children feel overwhelmed by certain methods, such as talking about traumatic experiences or engaging in confrontation exercises. When their distress is minimal, their willingness to stick with uncomfortable sessions decreases. Conditions such as depression, anxiety, or eating disorders make it difficult to stick with therapy due to the symptoms themselves. Added to this are practical hurdles: long commutes, appointments after school, and disappointment when quick results fail to materialize.

For children and adolescents, their social environment also plays a role. Therapy functions as a triangle involving the child, the therapist, and significant others. If parents aren’t fully on board or if arguments about getting to therapy sessions escalate, the pressure to drop out increases.

Stopping treatment without completing it leaves unresolved issues that were being addressed. The child experiences the feeling that something difficult was started and then abandoned. If treatment is stopped in the middle of a difficult phase, symptoms may worsen before any improvement occurs.

An often-overlooked drawback concerns future attempts. An abrupt withdrawal without a discussion deprives the family of the opportunity to learn from the process. What went wrong, what helped, which method didn’t work? These questions remain unanswered and resurface during the next attempt. A proper conclusion or a documented break preserves this knowledge.

Frustration during a single session is often a sign that the therapy is addressing a sensitive issue. Those who stop attending at that point miss precisely the moment when a conversation with the practice would be most helpful.

Address any doubts early on, not only after you’ve missed three appointments. Therapists are required to explain the process, duration, and potential challenges of treatment, even in the middle of the process. Ask specific questions: Is this a difficult but normal phase right now? Would a planned break make more sense than ending therapy?

Helpful steps:

• a joint discussion with the child, parents, and the therapist before making any decision
• If taking a break: document the duration, return date, and conditions in writing
• If there is a persistent lack of fit, consider a structured conclusion rather than an abrupt withdrawal
• Agree on a contingency plan in case the child’s condition worsens during the break

Parents have the right to freely choose and change their specialist. If the rapport remains poor over time, it is possible to switch to another practice, even if this may result in a new waiting period. After treatment is completed, good follow-up care helps reinforce the progress made.

Rückenwind This guide is intended to coach parents through such decisions and does not replace treatment. Whether therapy should be interrupted, switched, or terminated is determined solely by the treating medical or psychotherapeutic professional; for children and adolescents, this decision is made by child and adolescent psychiatry services.