Termination in Therapy

May 10, 2018

Written by: Sonia Heidenreich, A.M., LGSW How do I know when I’m ‘done’ with therapy? Lately, I’ve been thinking a lot about how to help my clients know when they are ‘done’ with therapy.

Written by: Sonia Heidenreich, A.M., LGSW

How do I know when I’m ‘done’ with therapy?

Lately, I’ve been thinking a lot about how to help my clients know when they are ‘done’ with therapy. This isn’t because I want to stop working with them, but rather because I want to honor the work that they’ve done and the growth that they’ve experienced. As therapists, we call this process “termination.”

You’ll notice that I referred to it as a process, and that’s because in an ideal world, we would take time to talk together about the idea of ending therapy, review progress you feel you’ve made, talk about future aspirations, and then say goodbye. It’s a lot to accomplish and can feel like a lot to take in, so I always prefer to take some time (at least one or two sessions, minimum) to engage in this work.

As a client, this can be an emotionally complex process. You might wonder how you’ll know when you’re ready to end therapy, you might worry about hurting your therapist’s feelings by talking about terminating, or you might feel sad or worry about missing the relationship that you have with your therapist. Even though it’s a different kind of relationship than you have with other people in your life, it can carry with it emotional closeness, trust, and a real bond.

Let’s address each of these potential questions one by one, with the intention of bringing greater clarity to this process.

Q: How do I know I’m ready to end therapy?

You can know in a variety of ways. The first is by calling on your intuition: What does your inner wisdom tell you? Do you feel steady, resilient, and capable of weathering the inevitable challenges of life? Check in about the reasons that brought you to therapy in the first place—did you come wanting greater clarity about a situation or relationship, or to learn new skills or ways of relating to others? What evidence can you point to that these goals were achieved? What evidence can your therapist remind of you that demonstrates progress towards your goals? When the evidence is plentiful, you might be ready to consider terminating.

Q: Okay, I think I might be ready, but I’m worried that I’ll hurt my therapist’s feelings if I talk to her about it. Maybe I should just ‘ghost’ instead.

You will never, ever hurt a therapist’s feelings by talking about progress you feel like you’ve made and your readiness to move on without her help. That is precisely our job, so when a client is ready to terminate, I consider this barometer of my effectiveness at my job. Of course, we all care about our clients and so will have our own human feelings of sadness about saying goodbye to you, but trust that we can manage our own feelings, and we cherish the opportunity we had to help you to live your fullest, most meaningful life.

On the subject of ‘ghosting’ (or just not showing up to sessions without talking about it): I get that it can be hard for many of us to communicate in a direct way. Sometimes, it’s easier to just stop showing up than it is to confront your desire to end treatment. Also, if you’re ending treatment because you feel like your therapist isn’t helpful anymore or it’s just not a good fit, you might worry even more about hurting her feelings. I urge you to be brave, and to have this conversation directly. Not only will it be helpful to your therapist to learn about what helped and what could have been better, it will also be very good relational and interpersonal practice for you as you learn to be direct and communicate your needs clearly and respectfully. In therapy, we practice relating in a new way to someone else (our therapist) and use this practice to help us in other relationships. This a perfect opportunity to practice! Trust yourself to be able to handle this conversation, and also trust that your therapist is trained to facilitate and manage this challenging part of the therapeutic process.

Q: I’m worried that I’ll really miss my therapist, and the thought of ending therapy makes me really sad.

Okay, first of all, that wasn’t really a question. (Kidding!) My truest answer to this question is--it’s okay to feel sad. As with any other important relationship, feeling like you will miss someone is an indication of the closeness, trust, and depth of the relationship you built together.

I’m reminded of a 6-year-old client I worked with a few years ago. We worked together for a year and spent the last month of our time together talking about termination and preparing to say goodbye. We made a book together to consolidate his sense of progress, planned a special celebration for his last session, and all seemed to be going well. At our last meeting, while we were eating ice cream sundaes, he turned to me and said, “But how will you remember me when you don’t see me anymore?”

I was moved by his question, and struggled to answer at first. Then, I thought about something that Donald Winnicott, one of the first psychoanalysts who focused on parent-child attachment, said about attachment and self-concept. To paraphrase, he talked about the importance of knowing that we are ‘held’ in the mind of another person even when we are not physically present with them. This trust that we continue to exist in the mind of another gives us the sense of security and inner coherence to move bravely into unknown situations, to be fully present in our friendships and relationships, and reminds us of our own continuity and worthiness.

With my young client, we talked about how I would remember him, things that would remind me of him, and took a picture together. I explained how important he was to me, and we talked about other important people in his life who he had lost and how he remembers them. These people continue to be held in his mind, and he would continue to be held in mine.

Termination doesn’t mean goodbye forever, but rather that you are strong and capable of braving the storm with your own inner wisdom to guide you.