Therapeutic Terminations– How to Know When It’s Time, How to Do It Successfully

“How lucky I am to have something that makes saying goodbye so hard.”  – A.A. Milne

The therapeutic relationship is often bittersweet. The success of the treatment depends largely on the strength of the connection, but the stronger the bond, the harder it is to say goodbye. Patients and therapists may experience a mix of emotions around termination, including grief, anxiety, gratitude, and a sense of accomplishment.

In an ideal world, therapy would come to a close when patients reach their treatment goals. However, situations like geographical location, insurance changes, and retirement often necessitate that patient and therapist part ways before these objectives are met. In addition, therapists must consider termination if a patient stops making progress or they can no longer meet a patient’s treatment needs. How do you know when it is time to terminate, and what is the best way to navigate this delicate process? Here are some tips and guidelines for a successful goodbye.

“Should I stay or should I go?” When it’s time to terminate

There are several situations in which therapists may be ethically bound to initiate termination. These include treatment plateaus, areas of focus that are beyond the therapist’s scope of practice, and the development or revelation of a dual relationship.

While these might sound straightforward enough, the decision to terminate is often complicated. Both therapists and patients may be hesitant to broach the subject of termination due to the strength of the attachment, a desire to protect one another’s feelings, or a reluctance to admit a treatment failure.

In all of the above cases, it is helpful to have an objective means of assessing treatment progress and identifying when patients’ needs are no longer being met. This could be in the form of a treatment plan that is reevaluated at regular intervals, patient questionnaires, or symptom checklists.

7 Steps for a Successful Separation

Discuss termination from the outset

Consider discussing termination as part of your informed consent procedure. Clarify how and when you will review treatment progress, and under what circumstances you will consider termination appropriate. Explain that your goal as a therapist is for your patient to gain the skills to function independently. Discuss with your patient how you will know when this goal has been met.

Establish a timeline

Once you have determined that it is time to terminate, you’ll want to clarify a specific end date with your patient. The timeline for termination will vary depending on the situation and the amount of time the patient has been in treatment with you. For example, in the case of a dual relationship, it is generally advised that termination occur as soon as possible. If the patient is in crisis, the end date might depend in part on the availability of an appropriate treatment provider.

Normalize feelings around termination

Saying goodbye can trigger feelings of sadness, grief, and loneliness. In addition, patients might struggle with the uncertainty of the transition from one relationship, routine, or environment to another. Finally, termination can trigger memories of past losses. Patients might exhibit avoidance behaviors (canceling appointments, changing the subject when you mention that you’ll be ending) and/or anger. All of these reactions are normal and represent an opportunity to empower your patient by reinforcing coping strategies learned in treatment.

Get support for your feelings

Just as patients can experience grief and loss around termination, so can therapists. Find a forum to discuss these feelings, whether that be in supervision, informally with colleagues, or in your own therapy.

Reflect on growth

You can help your patient to consolidate progress by reflecting on treatment successes. Review the goals that you established at the start of treatment, and talk about progress towards each. Make a list of accomplishments, insights, and other important changes that occurred. Talk about how your patient’s life is different now than it was at the start of treatment, and what aspects of the therapeutic relationship they will take with them.

Plan a goodbye session

A “goodbye session” commemorates the end of treatment and creates a sense of closure. Some therapists incorporate rituals like goodbye letters, creating a collage to symbolize therapeutic gains, or recording a guided visualization exercise focused on moving forward. Others use the time to review progress, make a plan for the future, and express gratitude. The specific structure and content of a goodbye session will vary depending on your therapeutic style and the needs and desires of the patient.

Conclusion

Saying goodbye is difficult, but it is also a necessary part of life. A successful therapeutic termination allows for closure, the consolidation of patient growth, and empowerment. By providing patients with the opportunity to recognize and process the emotions associated with the end of treatment, you help them process past goodbyes and navigate future transitions with openness and insight.