Harold Robert Meyer – The ADD Resource Center
Reviewed August 23, 2026 · Published August 29, 2026
There is an old line that you never know what is enough until you have had too much. It is a fine description of appetite and a poor description of treatment, and the difference between the two is worth understanding before your next appointment.
You have been going for a while now. A year, maybe three. The sessions are useful in the way that a good conversation is useful. Nothing is worse. Nothing is dramatically better either, at least not lately. And when you ask yourself whether you still need to be there, you find you cannot answer, so you keep the next appointment, because keeping it is easier than deciding.
Your therapist, psychiatrist, psychologist, or coach cannot answer it easily either. That is not a knock on them. It is a documented feature of the work, and it has a shape worth knowing.
Key Takeaway
Waiting until treatment stops producing any benefit at all is the wrong test. “Enough” can be defined at the start, measured along the way, and confirmed by stepping back rather than by overshooting. If nobody set a target and nobody is measuring, the appointment has become a default rather than a decision.
Why This Matters
Professionals are poor judges of their own results, and the research on this is not flattering to anyone.
In one study, therapists were told the deterioration base rate at their own clinic (8%) and asked to rate every client after every session for likelihood of treatment failure. Across 550 clients, they identified three. In another, when mental health professionals were asked to rank their own clinical skill against peers, the average self-rating landed at the 80th percentile, a quarter placed themselves at or above the 90th, and not one placed themselves below average. The same clinicians overestimated how many clients improved and underestimated how many got worse.
That is the honest version of “your provider gets used to you.” It is not complacency, and it is not dishonesty. It is a blind spot that runs in a consistent direction, and it means the person best placed to notice that you are done is unlikely to be the person you are paying.
Key Findings
- Most therapeutic change is front-loaded. The classic dose-effect analysis found roughly 50% of patients measurably improved by 8 sessions and roughly 75% by 26, with the curve flattening as sessions accumulate.
- The obligation already exists. APA Standard 10.10(a) requires psychologists to end therapy once it is reasonably clear the client no longer needs it, is not likely to benefit, or is being harmed by continuing. AAMFT’s code says much the same.
- Economics can move the dial without anyone intending it. After Dutch providers absorbed a sudden 20% drop in patient volume, self-employed providers did not stretch treatment, but budget-constrained institutions extended average duration by about 8% with no corresponding improvement in patient functioning – attributed by the researchers to uncertainty rather than intent.
The call is genuinely hard, and not for the reason you would guess
Two things make it hard even for a careful, honest professional.
First, improvement is not linear. Plateaus routinely precede gains. A bad month may have nothing to do with the treatment. Reading a flat stretch as “finished” is a real error, not a paranoid one.
Second, and more important, the two possible mistakes do not teach equally. End too early and watch someone unravel, and the lesson is vivid and permanent. Continue six months too long and nothing is learned at all, because there is no visible event, no relapse, no phone call. One error announces itself and the other never does. Over a career, that asymmetry pushes steadily in one direction.
Add the ordinary economics of a practice with open slots and fixed costs, and you have a judgment call whose honest answer sometimes costs the person making it money. The Dutch data suggests the effect is structural rather than predatory, and that it works through uncertainty rather than greed. Which is exactly why uncertainty is the thing to reduce, and why the reduction should not rest entirely on the professional’s judgment.
So do you have to wait until there is no benefit left?
No, and that test fails on three counts.
It is a lagging indicator. By the time benefit reaches zero you have already bought months of nothing.
It asks the wrong question. Not whether there is any benefit, but whether the benefit is worth what it costs in money, hours, and the untested possibility that you could hold your gains alone.
And it is close to unfalsifiable. Any week of an interesting life produces something worth discussing. A conversation you enjoy will always generate material. “Something came up” is not evidence of need.
The better question is whether the rate of change is still meaningful, measured against something you named in advance.
How long should it take to know?
Different clocks for different chairs.
Therapy and psychology. The dose-effect curve is front-loaded, which gives you natural review points rather than deadlines. Around session eight, something measurable should have moved. If nothing has, the correct response is not “give it more time” but “change something” – the approach, the target, or the therapist. Somewhere in the twenty to twenty-six session range, a serious review is warranted, including an explicit conversation about what remains.
Psychiatry. The clock is much shorter, because a medication trial has a defined titration window measured in weeks. Once you are stable the question changes character: it is no longer whether to continue but whether anyone is still examining. A prescriber who has reviewed nothing but the refill in twelve months is not treating you, which is a different problem from staying too long.
Coaching. There is no external clock at all, no licensure floor in most places, and no comparable body of randomized evidence, so the endpoint has to be built in at the start. If a coach cannot describe what “done” looks like in the first session, that is not a scheduling detail. That is the finding.
Defining enough before you have had too much
Four things, all of which can be set up in one conversation.
Name three specific things that will be different, in behavior rather than in feeling. “I file my taxes before April” is testable. “I feel more on top of things” is not.
Ask what is being measured and how often. Something administered repeatedly, not only at intake.
Put a review date on the calendar at the start, at which continuing becomes an active decision rather than the default.
Then use the taper. Move from weekly to monthly and find out whether the gains hold without the appointment holding them up. This is the real answer to the old proverb: you can locate the edge by stepping back a little instead of walking a long way past it and looking behind you.
“The best endings in this work are scheduled, not stumbled into. If nobody said at the beginning what finished would look like, nobody is going to notice when you get there.” – Harold Robert Meyer
The next step
Before your next appointment, write down what would have to be true for you to stop. Bring it in and ask the professional to react to it. A good one will engage with the list and may sharpen it. Reluctance to have the conversation at all is itself information.
Bibliography
American Psychological Association. (2017). Ethical principles of psychologists and code of conduct (Standard 10.10, Terminating Therapy). https://www.apa.org/ethics/code
Douven, R., Remmerswaal, M., & Vervliet, T. (2021). Payment schemes and treatment responses after a demand shock in mental health care. Health Economics, 30(12), 2956–2973. https://doi.org/10.1002/hec.4417 · Free full text (PMC)
Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316–340. https://doi.org/10.1037/pst0000172
Hannan, C., Lambert, M. J., Harmon, C., Nielsen, S. L., Smart, D. W., Shimokawa, K., & Sutton, S. W. (2005). A lab test and algorithms for identifying clients at risk for treatment failure. Journal of Clinical Psychology, 61(2), 155–163. https://doi.org/10.1002/jclp.20108
Howard, K. I., Kopta, S. M., Krause, M. S., & Orlinsky, D. E. (1986). The dose-effect relationship in psychotherapy. American Psychologist, 41(2), 159–164. https://doi.org/10.1037/0003-066X.41.2.159
Walfish, S., McAlister, B., O’Donnell, P., & Lambert, M. J. (2012). An investigation of self-assessment bias in mental health providers. Psychological Reports, 110(2), 639–644. https://doi.org/10.2466/02.07.17.PR0.110.2.639-644
Resources
From The ADD Resource Center
- Three providers, three opinions: who coordinates, who weighs in, and who decides
- ADHD Treatment Options: CBT Therapy vs. ADHD Coaching
- Peer-Reviewed Alternatives to Medication for ADHD
- Understanding the ADHD Diagnostic Process: What to Expect from Evaluation to Treatment
External
- APA Ethical Principles of Psychologists and Code of Conduct – Standard 10.10 sets out the professional obligation to end treatment that is no longer helping
About the Author
Harold Robert Meyer is the founder and Managing Director of The ADD Resource Center, established in 1993, and a Senior Certified ADHD Coach, author, and international speaker with more than thirty years in ADHD advocacy and education. He co-founded CHADD of New York in 1989 and served on CHADD National’s board and executive committee, including as VP Finance. He was elected to lead the Institute for the Advancement of ADHD Coaching. [email protected]
📚 Come back often — we add new evidence-based ADHD resources daily.
The ADD Resource Center [email protected] · +1 (646) 205-8080 · 127 West 83rd St., Unit 133, New York, NY 10024-0840 USA
X · LinkedIn · Facebook · Substack · Newsletter
Please consider the environment before printing.
Our content is educational and informational only – not medical, legal, financial, or other professional advice, nor a substitute for it, and should not be relied on as such. We strive for accuracy, but errors or omissions occur and information becomes outdated. Some content and images may be created with AI assistance and, though reviewed before publication, may contain inaccuracies. Our screening tools are not diagnostic instruments. Verify independently and consult a qualified professional before acting on anything here.
In the USA and Canada, call or text 988 anytime for free mental health and suicide prevention support, or call 911 if someone is in immediate danger. The ADD Resource Center is independent from these services and is not liable for any actions taken by you or by these services.
Under GDPR and CCPA, you may request access to, correction of, or deletion of your personal data at [email protected].
© 2026 Harold Robert Meyer · The ADD Resource Center. All rights reserved.
Synopsis
The Session That Should Have Been Your Last: Deciding When Treatment Has Finished Its Work Harold Robert Meyer · https://www.addrc.org/
Topic: Therapy & Psychological Treatment (primary); Coaching & Case Management, Medication & Medical Management (secondary) Audience: Adults with ADHD; clinicians & prescribers
The proverb that you never know what is enough until you have had too much describes appetite well and treatment badly, because treatment permits enough to be defined in advance. This article examines why deciding that a client or patient is finished is genuinely difficult for a therapist, psychologist, psychiatrist, or coach, drawing on evidence that clinical judgment rarely detects non-response, that professionals systematically overestimate their own results, and that the two possible errors teach unequally, since ending too early produces a visible relapse while continuing too long produces no visible event at all. It notes that practice economics can lengthen treatment without anyone intending it, and that research suggests the mechanism is uncertainty rather than intent. It argues against waiting for benefit to reach zero, gives review points appropriate to each professional relationship, and offers a four-part method for defining the endpoint at the outset and confirming it by tapering rather than by overshooting.
Keywords: termination, dose-effect, outcome monitoring, plateau, taper