A few months ago, as I was leaving a job, I wrote about the termination process in individual therapy. Now, as I prepare to transition from the program where I've been filling in to my permanent program (set to open in a few weeks!), I'm reflecting on how termination seems different at a different level of care.
The therapeutic relationship is (obviously) different in individual therapy than it is in a setting where treatment is provided by a multidisciplinary team in groups on a milieu (as it is in all higher levels of care). Specifically, the relationship is more intimate and therefore more intense in individual therapy, making termination feel more like a loss. In contrast, relationships are more diffuse in a group setting, so termination is less significant (at least termination between client and clinician; I think clients feel more sadness about terminating with "the program," because the whole is more than the sum of its parts).
At the last partial program where I worked, staff held mini "graduation" ceremonies for clients as they left the program - diplomas and all. At the program where I work now, staff help clients lead their own ritual of saying goodbye with each of their peers sharing something positive about who they are and/or how they've changed/grown. While we introduce the process, this ritual happens without staff present. In both programs, clients have tended to feel more sad at saying goodbye to peers, and anxious about leaving the safety the program symbolizes, than anything they may feel terminating with staff.
Perhaps as a result, my own feelings about terminating from the program are almost opposite to the feelings I had leaving my last job (which involved all individual therapy). At my last job, I was sad to say goodbye to clients, but didn't have a lot of feelings about leaving colleagues or the clinic. This time, I don't have a lot of feelings about leaving clients, but am sad to leave the team.
My theory is that my feelings about terminating with clients are countertransferential (reflective of the client's degree of attachment to me), while feelings toward colleagues perhaps reflect the degree to which the team, versus individual clinicians, is the central therapeutic relationship. Of course, my feelings could simply reflect the amount of time I've spent with a client, and how collegial my relationships with colleagues are.
How do you feel about termination? Have you noticed different feelings in different settings? If so, what do you make of it?