Friday, November 4, 2011

Good Goodbyes

In my last post, I wrote about leaving a job, and the resulting terminations with clients, as a kind of "break up:" awkward, emotional, and often one-sided. Now, after a week of breaking up (with one client or colleague after another), I've decided to write about how I'd like to be able to terminate - what I think makes for a "good" goodbye.

The biggest challenge in my current situation is that it is rushed. Because my new job is at a new program, with a specified opening day, my start-date wasn't flexible, and I could only give two weeks notice. While that is plenty of time in some kind of work, it's not much time at all in outpatient therapy. If I see somebody once a week, that means I can meet with them twice during this time. If I see them every other week...or if they miss an appointment...or if there's a holiday (e.g., Veteran's Day)...that's only one visit to tell them I'm leaving, process the goodbyes,  and plan for what comes next. There have been other situations where terminations have also been rushed - when someone lost their health insurance, or abruptly decided to move. But, ideally, I'd like to have a month, or 4 visits, to make the most of the termination process.

Goodbyes can be emotionally-fraught for many of us. They represent loss, and may bring up unresolved feelings of abandonment, rejection, helplessness and hopelessness. Without time to process these responses, termination can mean a setback. With time to process these responses, termination offers an opportunity for resolution and mastery of old feelings from past losses. That requires sharing the news of an upcoming goodbye; leaving time for feelings and associations to bubble up (sometimes time elapsing during the session, but sometimes requiring the week between sessions, or longer); exploring these reactions, where they come from, and what they mean to the client; and finding ways to make this goodbye different. If it's rushed, old "stuff" may not be adequately processed, or worse, may not even surface until after the client leaves for the last time.

Of course, ideally, the client will be transitioning to a new therapist, who can work with them on any leftover issues raised by termination. However, that brings us to a second task requiring time - identifying any work the client has left to do in therapy, eliciting their preferences (are they willing to continue now, or do they want a break? do they want a male or female therapist, or someone who has a particular skill, like EMDR? do they have preferences for time of day, day of the week, or location?), and making a referral. If the client has difficulty with trust (perhaps due to past trauma, or paranoia), or is particularly attached to you, these barriers have to be worked through before the referral process can proceed.

However, before talking about the work left to do, I like to take stock of the work already accomplished - what progress the client has made during our time together. I think it is so important to honor and recognize this progress. Naming it and encouraging the client to take pride in it help to consolidate gains, increasing the likelihood that they will maintain the progress, and feel more optimistic about the possibility of further change.

So, that's my definition of a "good" goodbye: it's planned, it helps to resolve old issues related to loss, it solidifies gains and suggests next steps forward. How do you think about termination? What do you think makes the "goodbye" therapeutic?

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