The termination stage of therapy is something that I equally dread and relish. I have learned in practicum and in life that endings can mean almost as much as the preceding work and effort. And who enjoys saying goodbye anyway?
From what I have been told this is something I should relish because in the “real world” clients tend to come to therapy, feel better and then just stop calling. I think that’s alright, although I personally like closure with most tasks I undertake.
What follows is my experience of terminations with clients who were willing and able to, ‘”go the distance,”’ and have made remarkable progress during our time together – a feat for which my co-therapist and I take little credit. It would be fair to share that goodbyes have always been sad affairs for me. And terminating a therapeutic relationship is no exception, but it felt different. When I say goodbye to my family after a wonderful trip back home I feel a deep tangible sadness. I miss them but know I will see them again. This is always difficult for me but the rawness subsides over time. Termination with clients has similar characteristics but feels less visceral because of the warm feelings of hope and happiness I hold for the client’s future and my personal feeling of pride about how far they have come. Most of all, I feel a tremendous sense of gratitude for the opportunity to be part of their journey and their process, even briefly. It’s the unpredictable mixture of sadness, joy, pride and hope that is something I have sat mulling this past two weeks. The intimacy of counseling and the therapeutic relationship makes the end so difficult for me despite its predictability, necessity and clients readiness to re-establish independence.
Using the brief therapy model of ten sessions, sometime around session eight I began to prepare myself and the clients for termination. As we all hurtled towards the final session, I witness myself and the co therapist become less and less involved as the couple fundamentally worked the session themselves with minimal prompting. When asking the clients directly what they thought about termination, (which one couple decided to rename “the celebration”), they reported feeling sad and anxious about not seeing us anymore but nervously excited that they were ready to try things on their own. One technique that worked particularly well was taking a one week break in between sessions nine and ten. This allowed time to process and reportedly the couple felt better prepared for their celebration. This particular couple’s journey was wondrous to behold, and I intend to remember their risks and successes when I try to help clients who do not make progress and do not reach a, “happy ending.”
As a therapist, I try to frame my emotions about my clients’ journeys like this: I have helped someone else and tried to be there for them, even if their therapy is brief. I have listened, held hope and been present. This has felt good, even if the conclusions seem less than satisfactory. I also want my clients to know that I am human and feel emotions with them and that termination for me is often , the most raw of these times. I allow myself wholeheartedly to be present with the happiness, the hope, the anxiety and the sadness about losing the support and ending our therapeutic relationship at least physically. And if I cry then so be it. This human factor really fits with my counseling philosophy.
The final session usually involves a summary of progress made, future aspirations and anticipated pitfalls alongside the open expression of feelings, concerns and in typical fashion appropriate use of humor - after all this is supposed to be a celebration, not a funeral (and even then humor can be appropriate). In my most recent termination, we asked the clients what they had learned about themselves and about each other. Their responses illustrated that they had grown tremendously as individuals, and had also traveled a long way from the loud, reactive pair that I witnessed in intake into a more serene, openly emotional and supportive couple. It made me feel everything I have shared above, only in a more condensed, revolving fashion. The residual feeling that is left is one of positive regard, warmth and hope compared with the almost wave like visceral sadness of saying goodbye to my family. And yet both feel strangely familiar. Is it really the end? Or is it just the beginning of a new chapter?
In writing this blog I realize what I am trying to do is say ‘thank you’ for the time and experience I have shared with my most recent couples and clients in practicum.
Christian Billington is a counselor in training. He is passionate about end of life issues, grief and loss, trauma and the development of training to better prepare the emergency services for what they experience in the field.