Beginnings and premature endings: A therapist reflection on termination in therapy

The process of termination in therapy is often one fraught with intense emotions for both the client and the therapist. I find that this can become increasingly more intense when terminations are premature. As I therapist I feel incredibly guilty when I have to terminate with a client before we have done all the work together that we could have.

In the context in which I work where the majority of clients have experienced horrific losses and often feel unsupported, isolated and alone in their worlds, I always feel like I am playing into this dynamic and their sense of abandonment when the time for termination arises. But the reality is that as a therapist, we cannot be with our clients forever, we cannot assist our clients on their journey to healing to the extent that our minds and hopes desire. Nor do we have that control over things. But as a therapist, it is hard when I feel that I have not done what I could and that I am making their process of healing even more complicated. However, it is also all MY voice that feels that I am at the centre of the termination. As if I am letting the client down or that I am abandoning them. But the truth is that I am not the most important element of this process.

There are times when I have had to prematurely terminate with clients, but despite what I felt in the room, I allowed them to say they are fine and that they understand why this is happening and in doing so I facilitated their avoidance of what this ending may mean. This is particularly important based on how I work as a therapist within the context that I do. Due to all the contextual challenges clients face, we often sit in a space of crisis management and help in the avoidance of the difficult feelings and memories attached to traumatic events and the circumstances that have led them to therapy. Avoiding avoidance, so to say, is necessary to navigate the unfolding of the therapy process, which can lead to beautiful insights.  In doing this there is a relationship and trust that forms.

Furthermore, in the context of the work that I do where it can often be difficult to do pure therapeutic work, the foundation that I have worked from is trying to allow my clients to see that they can trust another human being. In doing that they can try and get the support they need to get through the difficulties and challenges they face. But trying to translate this into practices outside of the therapy room is a long process. So when I terminate before this point I feel like I have not finished what we started together.

And this is the position I find myself currently in. I have endured premature terminations before, but I have found that this time some of them are a lot more intense than previous ones. In reflecting on this, it is clear that it is the depth of where we have gone together in the therapeutic process, the level of trust created in the space together, the things that they have never explored with another before and those are the things I have taken and held but am handing back and leaving them with before they are entirely ready. So, in sitting with my feelings of guilt at having to tell my clients that we were ending and feeling the need to make it a pleasant and easy process for them, my supervisor pointed out something important: That through the process of therapy and in ending we cannot be the all good object but if the process of termination is handled properly I can hope to leave my clients with the ability to integrate good and bad in one object. That through this they will be able to hold onto the good parts after the termination and remember the things they need to when facing challenges. But that if I don’t and we don’t think and talk about the difficult parts then they will either shut that off and may see me as an entirely bad object and in doing so never access me (and the things done in therapy) for support in the future.

So in introducing the terminations this time around I was horribly aware of needing to do this for my clients. It was difficult sitting in the room being told I am ‘breaking a heart’, or that I am ‘loved and in leaving will create an emptiness’. The pain in this at times became almost unbearable and I wanted to run away, but sitting in it and tolerating it was what I needed to do. So for sessions we spoke about the imminent termination date and the difficulties related to it. But through this process we also spoke about the things that helped make sense of it and in speaking about it I could see the shifts in my clients. When my one incredibly emotionally avoidant client could articulate that he was sad about us ending I felt such happiness. Through difficult moments there can be moments of such intense beauty and growth.

I have reflected on this in relation to my own personal spaces, such as therapy and supervision, that have pushed me to spaces I have not wanted to go but places that I have needed to in order to grow. There is a sadness and beauty in ending something that has allowed a sharing of parts of you that are hidden to the rest of the world. What those spaces have shown me is that the hard, difficult and broken parts of me can be shared with and tolerated with another human being without them hurting me, judging me or running away. So a termination is like the end of a movie, there has been a story together and difficult choices made but that in the end the final decision is to leave and say good bye, the ending is inevitable. But in saying good bye, the memory does not leave. Through the difficulty of it there is a growth that occurs and there are parts of both of you that are changed forever.

Written by Jacqui Chowles

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