Wednesday, November 9, 2011

On Their Own Terms (Or, It Takes Two to Terminate)

A few days ago, in my post on Good Goodbyes, I wrote about my ideal termination process from a clinical perspective. However, as I sit here waiting for my clients to come in for scheduled termination sessions (after notifying them last week that this would be our last session together), I am reminded that what I consider a "good" goodbye clinically may NOT be what my clients want. And while they may not have much say over whether or not I leave, they do have some say in how they take their leave from me: it takes two to terminate.

Some clients will come in for a final visit. They may studiously avoid speaking of endings, and instead try to divert conversation onto other, less sensitive subjects. However, some will talk about goodbyes, this one and others, and express their feelings about it. They may be able to review the work they've done, and the progress they've made. They may express anxiety about whomever the next provider will be - sometimes I get the sense that it is change rather than endings or goodbyes that causes the most discomfort during termination. They may try to drag the session out as long as it will go, to delay the inevitable. But, eventually the end comes, and we bid each other farewell - some over their shoulders as they rush out the door, others with a handshake or hug or wave.

I like the closure of saying goodbye. But, a lot of people really HATE goodbyes. Confronting their feelings about the loss, sitting with those feelings, isn't something that they want to do. So, when it comes to a planned termination, clients who hate goodbyes may just not come. They prefer to say goodbye on their own terms, by not saying it at all. Avoidance at its finest. I find this kind of non-goodbye deeply dissatisfying because it lacks closure...but I understand the impulse, because I'd just as soon not make a fuss of saying goodbye to my colleagues.

Another possible response to planned termination is regression - the client may revert to symptoms or behaviors they experienced earlier in treatment. When this happens, it can leave you feeling discouraged about the work...but it helps to know that it's normal, and time limited: the progress is still there, and will reemerge after this ending has passed.

It's been suggested to me that therapists can predict and plan for how each client is likely to respond to termination by seeing how they respond to other separations during treatment, such as the therapist's vacations or sick leave. However, not enough of my clients have been with me through this kind of break, so I can't tell whether a pattern would appear. Are there other things you've learned or noticed about how clients handle termination on their own terms?

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