Termination?

What an awful sounding word! I'm just reading posts on here, going back pages and pages, and a few times termination has come up. Aside from a T going to a different practice or something like that, why would they terminate? Do some T's just have a certain number of visits, then consider it done? I see some people with the same T's for years. Does the patient, to an extent, have a say in when sessions stop?

I would think hearing the words "I can't help you anymore" would be very hurtful. But if that's the case, I would hope a good T would take the patient's thoughts into account also. Perhaps the patient feels like going to the T is helpful, but the T doesn't necessarily see that.

I got SO tired of residents and doctors moving on at the clinic I used to go to so I switched clinics, did my research with the doc I have now, and we hit it off. But I will say, during my first appt with her, I flat out asked her if she had any plans to go somewhere else.....if I would get familiar with her, just to have her leave, and she assured me she did not. So when she became pregnant, and knew she'd be taking time off after the baby was born, she told me so at an appt, reminding me of that question I asked her. I laughed that she remembered, and that she took it seriously.

Well, this is a topic that really depends on the T and on their theoretical orientation.

Moving to a new clinic, or quitting are two common ways that therapy ends. Outside of that, some T's are willing to stick with their clients for years and years, and wait for slow improvement patiently. Others are more "quick fix" oriented and want their clients to improve more quickly. There's also the consideration of insurance and how many sessions the insurance will pay for. And sometimes, a T just doesn't feel qualified to help a client or they're just not a good personality match together. These would all be what we call "ethical" termination. In an ethical termination, the T would help hand a client off to a new T who is more suited to the client.

Unethical termination is reasons or methods of getting rid of clients because of problems with the T. There are about a 100 different ways this could go wrong, so I will give a few examples. A client who is triggering a T into breaking boundaries and over-extending themselves would lead to burnout and a dislike for the client, which could lead to sudden termination if the client feels needy or demanding. Often, there is little to no closure given in these cases. A T might also suddenly terminate a client for family reasons, but it becomes unethical if they don't give the client a few closure sessions and hand the case off to someone else who can continue the work. There are other unethical terminations such as demanding a client do something they are uncomfortable with, and threatening termination if they don't agree, or dropping a client in order to pursue a sexual relationship with them. Most, if not all, of these problems can be avoided if the T has good supervision.

Any other questions?

Oh, and there are good ways of terminating, too. Google can tell you more about the ideal termination of a therapist and client and what might be involved in that.

And of course, a client can fire a T whenever they want.

I have asked my T to call our termination Resolution. So much kinder

I asked my T to call ours "graduation". Assuming, of course, we ever actually get there.

Here is a short list of books on the topic:
Termination in Psychotherapy - Joyce, Piper, Klein
Positive Endings in Psychotherapy- Steven Kramer
Terminating Therapy- Davis
Good enough Endings – Salberg
Endings in Clinical Practice -Walsh