How to handle 'toxic' friendships

Two women talking and one looks concernedFriendship is a common theme that comes up in my outpatient psychotherapy work with adults.
For most of us since childhood, friendships have given us a feeling of being connected and part of a social group, whether it’s with one best friend or a group of friends.
Forming and maintaining friendships is a vital part of our development. Friendships not only give us a feeling of importance and value, but also help us to develop a positive perception of ourselves in the world.
Sometimes, however, friendships can become toxic or unhealthy. It’s important to recognize these common signs of “toxic friendships.”
When I’m working with clients on this subject, I ask them to consider the following questions:
How do you feel around this friend?
Do you feel good about yourself when you’re with this person? Or do you feel small or unimportant when you’re with your friend?
Do you frequently feel criticized and demeaned to the point that you end up doubting yourself?
Some of my clients say they feel less confident, and often blame themselves for feeling this way.
A healthy friendship can offer honest constructive criticism.  A toxic friendship is critical without empathy or an understanding of how their criticism might make the other person feel.
Is there balance in the friendship?  
Many of my clients say that they feel that their friendship is one-sided.
Either they’re the one reaching out most of the time, or describe the other end of the continuum in which the friend is overbearing and demanding of all their time.
They’ll describe feeling suffocated, trapped and controlled by the friendship.
Is the friendship taking an emotional and physical toll on you?
Be aware of your own feelings, both when you’re with your friend and away from them. Do you often feel depleted or emotionally drained?
Do you notice having more physical complaints such as headaches or stomachaches when you spend time with this person?
Toxic relationships can cause significant stress, and this stress is often felt in our bodies as aches and pains.
Is it time to let go of a friendship?
In making this decision, I’ll ask my clients to consider the questions discussed here, and to ask whether these problematic behaviors in the friendship are new, or if this is a pattern of unhealthy behavior?
If the behavior is new, perhaps there’s a reason why the friend is behaving in this way. Maybe the friend is going through a difficult time and is having trouble coping.
Ask yourself if there are  other redeeming qualities about the friendship that you respect and value. Is the friendship one that allows you to talk about your concerns openly and honestly in order to address these issues?
What’s the next step?
If the behavior has become a pattern, has been addressed with the friend and there is minimal change, it’s time to consider whether you want to continue to invest your time and emotional energy into the friendship.
Adult friendships can help support us as we share important life transitions, including new marriages or commitments, children, career choices, illness, loss and many other demands and challenges we face.
Define for yourself what you want and need in a friendship. It takes work to be a good friend, and we all deserve to be cared for and valued in genuine, mutual and affirming friendships. 
Maureen Maher-Bridge is a licensed social worker and therapist at Ohio State University Wexner Medical Center’s Harding Hospital.