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Originally Posted by BudFox
Agree about how termination is handled being critical. For me it was termination and its aftermath that was most significant part of it all, and most damaging.
But even if termination IS done for valid reasons, IS handled with utmost care, and referrals ARE given, that still leaves the client potentially in a terrible bind if they are destabilized by the rupture.
What if the client ends up in a state of near suicidal despair despite a reasonably well handled termination? Is the T ethically obligated, whether according to ethical codes or not, to reconsider termination or to offer some level of help? Or are they absolved of responsibility? My T seemed to feel that once the termination had been carried out, I was on my own.
Maybe she was not best equipped but is that ALWAYS better than abrupt termination? Maybe continuing in some fashion to a safe point IS better in some cases?
And I think Ts get let off the hook rather easily, by just saying they can't help. Even good intentions and well handled termination can become a smokescreen behind which the T can hide from the fundamental failure of the process, and then just slip away.
Also, what seems to be rarely acknowledged is that if a client is traumatized by therapy or by a painful termination rupture -- even if it is handled with some measure of care -- they might well find it difficult if not impossible to trust the process again and so their ability to get support is now hindered. In my case the whole basis of termination was that I would quickly and easily be rescued by one of ex T's referrals. But the inherent danger and flaws that led to such distress with my previous T were there waiting with other Ts. I have given up for now, and am left to pick up the pieces on my own, though I will likely make another attempt to find someone to talk to.
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Your concern is valid and understandable. I've grappled with the same painful questions you've just raised. I myself have been terminated by some of my therapists not in the best way possible and it was painful. At the same time, some other therapists caused me greater damage by not terminating our work when they really should have.
I think, in order to avoid the traumatic effect of termination, the therapist should actively assist the client in finding a suitable replacement instead of just handing them some names without checking if those people can be a good match for the client. Some communication with the therapist should continue until the client gets settled with the new therapist, but it can't continue forever. At some point, the therapist should be able to say "I did what I could" and to be off the hook.
When termination becomes traumatic and client cannot accept it, that tells me that something was wrong with the work itself, and so to me the problem is mainly how therapist conducts the work as opposed to how they terminate it. You said it yourself: "Even good intentions and well handled termination can become a smokescreen behind which the T can hide from the fundamental FAILURE OF THE PROCESS, and then just slip away." It's exactly that, it's the FAILURE OF THE PROCESS rather than the termination that is the problem.
When client is not confused about the nature of the professional relationship and what therapy is and isn't about, termination doesn't become traumatic. In fact, in this case, it's usually the client who calls it quits and leaves. When the therapist projects a clear image of themselves as a professional, not a intimate "friend", not a mother, not a guru, not a teacher/mentor, the client has no problem ending therapy when they feel they no longer get what they need. They quit themselves and they often don't even feel obligated to give the therapist an explanation and they don't have to.
I've never terminated a client. Whoever found me unhelpful left on their own and I had no problem with that.