Ending Therapy and Continued Growth
It may seem strange to kick off a new blog with a post about ending therapy, but it’s one of my favorite topics (and a somewhat neglected topic in the clinical literature.)
I almost called this “The Blog Post that Proves I’m Not Just After Your Money.” I think it’s a misconception that therapists want to keep therapy going as long as possible regardless of client progress. The reality is a lot more complicated.
The end of therapy is formally called “termination.” For the therapist, termination is about a lot of things, not only a loss of income for the therapist. It is obviously about the end of the therapy relationship, but it is also about facing endings in a healthy way. Looking at how we say goodbye to people can teach us a lot about ourselves especially how we conduct ourselves in relationships.
From a therapist’s perspective, termination can present a complex challenge with a long-term client. The termination phase of therapy can last weeks or months, depending on many factors. There is no right or wrong length of time as each therapy dyad is different.
How termination is handled is of critical importance to the therapy process. How a therapist and client plan for the ending and then deal with that planned ending can have lasting consequences. How a therapy dyad ends can lead to positive, negative, or conflictual feelings about the entire therapy. When the termination phase begins, lots of new (and old) feelings may arise that the client already believes she has “worked through.” The resurgence of old feelings in the face of a difficult goodbye can provide an opportunity to gain even more insight into earlier dynamics and ways of being. Endings are part of life. In therapy, the end of this unique relationship can create lots of complicated feelings: relief, sadness, regret, and/or optimism about the future. The process of termination is not always straightforward. Sometimes, clients will taper off to less frequent sessions. Some will want a hard stop and others wish to leave the door open to return in the future. All of this gets negotiated in the termination phase of therapy.
For me, endings with clients are often bittersweet. Jill Salberg, in Good Enough Endings (2010), eloquently speaks to the therapist’s experience: “We also have our own attachments to our patients: the ones we feel we helped, or the ones we feel we still need to help, or even the ones we feel help us to be better versions of ourselves.”
For the client, post-termination growth can include a sense of renewed competence, a feeling of “I can do it myself.” After months or years of having been committed to the therapy process (and to the therapist), some people feel liberated. Ending therapy frees up and time and money, but more importantly, it gives the client a chance to implement new skills and insights into daily life. If therapy has gone well, the client will have internalized the therapist’s voice.
Salberg posits that “termination is not the final phase of an analysis. It hovers over every session.”
Considering this concept of termination as an ever-present factor, it can be useful for the therapist-client dyad to check in with each other about therapy goals. Explicit discussion about the client’s goals can only serve to enhance the work. And just like death, the ultimate of all terminations, thinking about the end of something can bring into sharp focus where one is now and what, if anything, needs to change.
And finally, it should be noted that the conversation with one’s therapist continues even in the absence of actual sessions. No longer being physically present with one another doesn’t mean the relationship or the bond has ended. It can persist into the future and may serve as a source of great comfort if the therapy has been meaningful or reparative.
After ending my own therapy, I found myself continuing the dialogue with my former therapist (in my head) and using those “conversations” to stay focused on larger life goals. I kept a running list of things I’d have to remember to tell him when I returned to therapy in the future. (I always assumed I would, perhaps as a way to deal with the grief of ending.) Even when you don’t learn certain facts about your therapist’s life, you come to know them quite well and can anticipate what they will say and how they will say it. This deep knowledge of your therapist (and her predictability) are some of the benefits of long-term therapy. You can and should grieve the loss of this relationship but try to also connect with the positives and the reasons you decided to end in the first place. Termination is the end of something very meaningful but it is also the beginning of something new.