Written by: Jaime Goffin, LCSW
What is termination? Besides clinical jargon we use to describe the last phase of therapy. It is a fancy term and deserves its own topic because it is so important. In fact, for some it’s the most profoundly healing, meaningful and transformative phase of therapy. But many clients split before they are able to reap the benefits of a good termination.
As final sessions start to draw near we may see clients starting to talk about breakups, death and other endings, dreams may reflect abandonment or others suddenly get better or have a financial crisis and sometimes a conflict in the therapeutic relationship may arise…. Coincidence? Likely not…there are many dynamics that start to shift for the client and therapist as we begin to anticipate termination.
For the therapist, there are several reasons we might want to avoid termination. For starters, we simply may not like to talk about termination, our business “brain” is afraid of termination- possible loss of revenue and we become attached to the client and enjoy working with them. The termination phase really is bittersweet for both parties. It’s bitter because the therapeutic relationship is ending and its sweet because the ending marks a new period of independence and application of skills.
We often don’t do a well enough job talking about termination from the very beginning. When we start to engage this conversation early on in the course of treatment it will be more comfortable for the clients to feel empowered to initiate the discussion on their own. This helps to avoid the “cut and run.” In therapy “cut and run” is like skipping the last chapter of a novel; the part where the loose ends are tied up, you learn what the future may hold and get a sense of closure. Good termination helps clients end a relationship on a good note, this is especially important if the client has a history of bad endings.
I’ve started including a discharge handbook for my clients that we discuss at the very beginning. I often get a strange look with remarks that sounds something like this, “you’re already wanting to get rid of me?” This becomes a great opportunity to talk about goals, how we will know when those goals are reached and how to start moving towards wrapping up services. In my handbook for clients here is a sample of questions that I pose for them to consider throughout the treatment phase:
- Review what you’ve learned about yourself
- Discuss which goals (if any) you weren’t able to accomplish in therapy, and what to do about them
- Develop your “aftercare” plan: everything you’ll be doing post-therapy
- Reminisce about the therapeutic relationship – when you felt cared for, what made you mad, when you shared meaningful moments, etc.
- Discuss fears around endings and grieve the end of the therapeutic relationship
Discussing termination early on will help reduce ambiguity around when and how to discuss the relationship coming to an end. Don’t be afraid to talk about it and keep it simple. Good termination means plan for it, prepare for it and process it. Since all therapy must come to an end, shouldn’t a high quality ending be part of each of treatment plan?