Creating a Therapeutic Termination Process

Chris Panzica LCSW

Approaching Termination With Care 

Termination can be a difficult process for both therapist and client. A client's reasons for choosing to end treatment are an important aspect of the process that needs to be considered. When a therapist is the one initiating the termination, perhaps due to relocating or leaving a mental health facility, other significant considerations emerge. The therapist's decision to stop seeing a client may harken back to previous unwanted disruptions in relationships with important others when they lacked agency and sufficient support. There is the possibility of the client feeling abandoned as may have been the case at another time in their life. While the therapist could be seen as another unreliable person who failed the client, there is also a powerful opportunity for the client to have a healing experience and to build resilience regarding a reality of life, inevitable loss. 

“The therapist’s decision to stop seeing a client may harken back to previous unwanted disruptions in relationships with important others when they lacked agency and sufficient support. ”

How I Prepared Myself 

When I needed to stop working with a group of clients due to a transition in my practice, I found a way to approach the termination process with care and to address some unexpected and difficult reactions from clients. The support of a trusted supervisor and my own personal therapy were vital to how and when I approached terminating. While I had felt ready to leave an agency where I had been working for several years, I noticed myself avoiding initiating the termination process. When I began speaking to my supervisor about it, I realized I needed to first face my own feelings about loss and endings that had led me to dread the process. Although I recognized that I had been a thoughtful and dedicated clinician, I still experienced significant guilt and sadness that I had been wanting to avoid. Letting myself grieve the loss of these relationships and to acknowledge how important they were to me was necessary for me to prepare to support my clients through what emerged for them. 

Approaching Termination with Clients 

Feeling more prepared and confident in my decision, I let my clients know that I would be leaving with 2 months notice. I had been working with many of them for at least a few years and with some for nearly 5 years. Two months seemed to be an appropriate and ample amount of time because clients were able to digest the news while allowing us to be together through different stages of the process of ending our important work together. After the initial shock of learning that the treatment would be ending, I found that clients were relieved to hear that we were not ending immediately. Still, letting clients know that it was happening brought up reactions of various intensity that included sadness and anger. For some, this information became background to our sessions and we continued our work knowing that we had limited time remaining. As we moved closer to our final session, I invited more reflection about our work together and our relationship. This provided clients with an opportunity to see the progress they made, how they still wanted to grow, and perhaps most importantly, I was available to them as they experienced grief about ending. 

Addressing Anger 

For clients who experienced more anger toward me, I was open to them authentically expressing what they were feeling. I was careful to not become defensive, while also not embracing a false narrative that turned me into a victimizer, due to my own feelings of guilt that I had been experiencing. With care, I believe I was largely successful at this task. I listened and responded, sometimes helping clients differentiate our experience from past unwanted endings. I also acknowledged and supported their anger and sadness about no longer being able to continue our work together. Fortunately, it seemed like most clients were able to ultimately understand and accept that I had a separate need that prevented us from continuing our relationship. 

Conclusion 

In the end, I found the process challenging and to varying degrees it was clearly difficult or painful for some clients, but I could also see how it was therapeutic. Clients experienced another ending and loss, but in this case with support and with an opportunity to process their feelings with another, which in some cases had not previously been possible. As a clinician who may need to begin a termination process, you may find it helpful to also consider, what feelings are arising in you, and how can you best prepare yourself for this unique process?