Psychotherapy Termination

therapy1I will be leaving my practicum training placement 4 months from now in the summer, and this is the first time I’ve worked with people more than 12 sessions.  Some of my clients have been coming in for more than 6 months.  How much time do clients need to end therapy?

Starting at a practical level, it is usually helpful to let clients know about your departure 4-6 weeks before the end of your work if the treatment has lasted between 4 months and a year.  Less time is generally needed if the treatment is shorter and more time if it has been longer. Anyone that begins treatment with you now should know from the beginning how long you will be able to work with them. A related question that is often unacknowledged by clinicians in training is how much time you need to end therapy with your clients.  I find that the ending process is much smoother when the clinician has spent at least a month, preferably longer, reflecting on her/his feelings about leaving clients and the placement before beginning to have conversations with clients.  Supervision, sharing with fellow clinicians and personal therapy are all places to talk about this.

All of us have personal experiences with loss and we bring those feelings and reactions to professional experiences of loss.  Even though moving to a new training placement is a move toward professional growth, you are also ending relationships that have been important in your intellectual and emotional learning.  Using self-awareness about how you approach this move will tell you a lot about the ways you are accustomed to managing grief and loss.  You may minimize the importance of this step, find fault with your current placement, become preoccupied with the welfare of your clients, focus on the logistics and required documentation, or remind yourself of the exciting opportunities ahead of you.  I encourage you instead to take time to acknowledge you are saying goodbye to people who have touched your life in unique ways.

Once you have spent some time acknowledging your own emotions about the loss of your clients, supervisor and peers, you can begin to plan your conversations with clients about ending the treatment.  The main goal of termination is to create an ending that is less traumatic than the client’s prior experiences of separation and loss and that honors the client’s way of managing loss.  Your supervisor can help you review what you know about the client’s past experiences of separation and loss and how s/he manages feelings of grief and sadness in the present.  Based on this knowledge, you will be equipped to identify what can be different in your ending with the client.  You can also develop hypotheses about how the client is likely to respond.  You can expect that some of your clients will avoid coming to the final session, and saying goodbye by telephone, email or letter may be the best possible ending for some of these clients.

I hope you have found some food for thought as you anticipate saying goodbye.  The next blog will continue on this theme with some more specific ideas about what to include in your ending process with clients.  Please email me with comments, questions or suggestions for future blog topics.

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