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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by pinkeye on June 20, 2005, at 19:40:18
I just thoguht I will start writing something which can be built upon by everyone..
Terminating a Therapy Client
Terminating a client is an art and science in itself and it takes a great deal of skill and expertise on the part of the therapist to do it gracefully without hurting the client. Almost always, the client experiences a huge deal of abandonment, confusion, loss, trust issues, and intense pain at the loss of such a significant relationship. Even if the termination is done as part of a regular therapy ending – that is, if the client has grown and evolved and the therapist feels that the client has fully healed, it should be handled still with grace and compassion and a promise of after care if needed. Extra caution should be taken when it is done prematurely, i.e. when the termination is done for any reasons other than natural growth process.
When a therapist decides to terminate a client, all these factors should be considered before taking such an action.
How long the client has been in therapy? This is the most important factor in deciding the termination approach. Short term clients are always easier to terminate and are likely to be the least affected. Long term clients – anyone who has spent more than 6 months in therapy, should be given more weight age and thought about very carefully. The longer the client has spent with the therapist, the slower the termination should be. Since therapeutic relationship in most cases, simulates and substitutes real life relationships for the patient, termination should be treated as such – ending a friendship or romantic relationship or letting the kid grow out of the nest. And the same deal of consideration and grieving allowance should be allowed for the client.
If the client has confessed any transference or feelings towards the therapist, or if the therapist suspects of any feelings on the part of the client, extra caution should be used to let the client know that the termination is not a direct result of the expression of feelings.
Almost always the client feels that the client is being too needy or too attached, that she/he is the worst client the therapist ever had, and blames himself/herself for being the worst client. Care should be taken to make sure that the client does not blame himself/herself for being terminated.
The key to successful termination are the following things. Empathy, Care, Gradualness of termination, affirmation of continual support for a while, and post terminative care and support. The client needs to fully grasp that the therapist has the client’s best interest in mind first, and that the therapist understands the amount of pain and hurt it would cause the client. Also in almost all the cases, it really helps the client to understand that the therapist likes the client. Most of the times, people come to therapy because of repaired or damaged self esteem and struggles to keep relationships and insecurities, so the therapist’s liking towards the client is the most healing thing a client could ever receive from a therapist. When termination is done, it should be made obvious to the client that this liking does not terminate. Also gradually letting the client go out of therapy is more healing than abruptly terminating the client one day and letting the client pick herself/himself up. Abrupt termination almost always creates havoc in the client’s mind, and should be avoided at all possible ways except in the direst circumstances. Abruptly terminating the client is the worst thing a therapist could do to the client, and it destroys the relationship and the learning that the client had in the therapy completely. As much as possible, the client should be given lot of adequate notice, and allowed several months of gradual termination, combined with post terminative care and contact. The client needs to know that the therapy relationship was real, that all the caring was not fake and that the client was not tossed out one day like an object. The client’s feelings are real, and the dependency is real. So the therapist needs to ensure that the care and the warmth that the client received during the therapy were not fake. Many therapists believe that once a client is terminated, it would serve the client well to cut off all contact with the therapist. It is not so. Just as with real relationships and friendship, the client’s interest are best served, if the therapist maintains adequate, though minimal post terminative care.
Posted by LadyBug on June 20, 2005, at 22:28:32
In reply to Trying my hand at writing.. how is it?, posted by pinkeye on June 20, 2005, at 19:40:18
Great job Pinkeye!!!!
I agree that once terminated a patient should have the right to contact their former T. again. You never know about life. If I have spent over 8 years with my T. and we terminate due to my growth, I expect to call her in the future should the need arise. She has agreed with me. Will she keep her word, we shall see won't we, but not anytime soon. I'm not ready to terminate yet!!!
She knows me better than anyone ever has and I would never think about starting at square one with another T. if I had the choice to go see her!
Thank goodness it's my choice when I do!!!
LadyBug
Posted by happyflower on June 21, 2005, at 2:19:18
In reply to Trying my hand at writing.. how is it?, posted by pinkeye on June 20, 2005, at 19:40:18
You know pinkeye, I think you should send THIS to your exT and teach him a thing or two about therapy! I like what you said and agree with it! :)
Posted by Tamar on June 21, 2005, at 8:18:14
In reply to Trying my hand at writing.. how is it?, posted by pinkeye on June 20, 2005, at 19:40:18
Wow, pinkeye, I think your piece on termination is excellent. I think all Ts need to read something like this!
Tamar
Posted by pinkeye on June 21, 2005, at 14:19:40
In reply to Re: Trying my hand at writing.. how is it? » pinkeye, posted by Tamar on June 21, 2005, at 8:18:14
Thanks LadyBug - I remember your T is an extremely good one - she is the one who said you can contact her forever right?
HF - I should really send this to my ex T I think.. One of these days I will write to him and tell him where all he went wrong.. he is a good guy - so I think he might be open to feedback. But not for now.. I am not planning to write again for a long time..
Tamar - thanks for the appreciation.. I am thinking of starting to write a book - not about therapy as such, but general things.. not sure of how to go about it or even if I would be good.. let me see.
Posted by 10derHeart on June 21, 2005, at 22:34:40
In reply to Trying my hand at writing.. how is it?, posted by pinkeye on June 20, 2005, at 19:40:18
Like it A LOT...you put some effort into this one. Way to go!
I just have one complaint/comment...you were too nice. Waaay too easy on them as far as the harm caused by these brutal endings. I just kept wishing you'd let loose and just pour your heart out....
..but then again, that could be too upsetting to you at the wrong point. And I felt from reading that you were trying to mix some emotion with a lot of logic to GET the point across better, and you know, that's a good thing, too. When I write about it, I just can't help but go a little *nuts* because I am so upset about the wonderful people here hurting for NO good reason!
Just rambling. I really did think you expressed it so well. I just wanted to chime in and start screaming at the end, "Yeah...what Pinkeye said, and let me tell you all another thing....!!"
Posted by pinkeye on June 22, 2005, at 14:42:49
In reply to Re: Trying my hand at writing.. how is it? » pinkeye, posted by 10derHeart on June 21, 2005, at 22:34:40
Thanks 10der.
I would have screamed more perhaps if I had confidence that my ex T really cared. Now I don't have that confidence... I think he really didn't bother too much about me and he doesn't. Of what use would screaming be?? :-(
This is the end of the thread.
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