Terminating Therapy, Part I: What, Why, How?
Why we fear the end of therapy
Posted Sep 30, 2008
"Termination" is clinical jargon for the last phase of therapy. It has its own fancy term and deserves four posts because it's that important. In fact, for some it's the most profoundly healing, meaningful and transformative phase of therapy. But many clients split before they're able to reap the benefits of a good termination.
One hat I wear is supervisor for graduate students who rotate each academic year at a community counseling center. Most have clients who stay with them all year. In the Spring, students remind their clients that the rotation ends in the Summer and they will terminate or transfer to an incoming therapist. Most clients respond to this news with nonchalance, saying they knew this was the case and it's no big deal. But as the final session draws near, interesting material begins to emerge. My students notice their clients start talking about breakups, death and other endings. Their dreams reflect themes of abandonment and loss. Other clients suddenly "get better" or have a financial crisis and terminate via voice mail. In some cases a conflict arises and the clients leave angry. While some of this may be coincidence, the yearly repetition of these patterns seems to support the idea that termination pushes buttons on a deep, perhaps unconscious level.
We don't like to talk about termination; it brings up uncomfortable feelings for clients and therapists alike. Many of life's endings - breakups, divorce, graduation, getting fired, moving, death of a loved one, etc. - provoke feelings of sadness, anger, grief, rejection and/or abandonment. If successful therapy requires a meaningful connection between client and therapist (as my fellow bloggers and I claim), then we should expect these painful emotions when therapy ends. When we avoid termination, these thoughts and feelings may go unexplored, preventing a healthy closure. I've even heard of clients who go to therapy to grieve their previous therapy.
There are other reasons we avoid termination. Clients may fear they'll be told they aren't ready to stop, or are concerned their leaving will hurt the therapist's feelings. They worry that saying goodbye will be awkward, sappy or painful. Some avoid the sting associated with endings from their past - pain they felt before and don't care to revisit. As a result, they terminate via LMB or a voice mail message: "Hi, it's Jane. I won't be able to make it this week, I'll call you for my next appointment." And that's it, we never hear from Jane again.
Therapists may equate ending with a loss of revenue and shrinking caseload. Their business brain is afraid to mention termination out of fear they're planting a seed. Many attach their success as a therapist with their appointment book, so losing a client means they've failed. Some might avoid the topic because it's an uncomfortable conversation, and we don't want our clients to feel uncomfortable. Or maybe they're too emotionally attached to their clients and don't want to let them go. Either way, their silence colludes with their clients, resulting in a denial that termination will ever happen. By avoiding the topic their clients might not even know there is such a thing as a termination phase, and that it holds great value. In these cases, the "see ya!" voice mail is really no great surprise.
Clients (and therapists) who avoid the termination process are missing out on some of the best material therapy has to offer. For example, many issues clients raise in therapy include an element of loss. During termination, therapy becomes a laboratory for experiencing, processing and coping with those feelings first hand. What kind of model is therapy if we preach dealing with and accepting loss, but practice denial? Can we rationalize spending a year working through grieving a loved one, yet end our relationship via voicemail? Since all therapy must come to an end, shouldn't a high quality ending be part of each treatment plan?
Termination is a time to evaluate the work you've accomplished, celebrate the progress, talk about which goals weren't reached and explore any disappointments with the process. It's reminiscing, an exit interview and saying goodbye wrapped up in one. Sometimes this overview helps it all come together, as seeing the work in the rearview mirror lends perspective. Insights like "Ah, I'm glad you didn't tell me what to do," or, "That explains why I felt frustrated sometimes" are common to a good termination. Yes, sometimes this discussion opens a new can of worms, potentially resulting in more therapy. But it may be a can worth exploring.
We don't have enough good endings in life. The nature of therapy and strength of the relationship should provide clients with this one final gift: a corrective emotional experience regarding endings. Clients and therapists who avoid it are depriving themselves of the insight and healing the termination phase provides.
Coming next: Part II - The Ideal Termination