Termination

Termination can be tricky. While I think both client and clinician understand the relationship can't go on forever (and the clinician is actively aiming to work themselves out of a job with their clients, because that would mean the client has the coping skills to manage their everyday life in such a way that there is no significant impairment), the end to that relationship can be tough to navigate, especially with trauma survivors.

I have only had to terminate with a handful of clients thus far. Last year I went through the termination process with several of my older adult clients. I determined with the Director of the agency that it didn't make sense to officially terminate with some of my dementia clients because their cognitive impairment was so severe the conversation would upset them more than me not coming the next week. They struggled to remember who I was from week to week and so we decided not to have an official termination conversation, rather provide the continuity of care by talking to them about who would be coming to see them next week (the social worker from the agency who they knew from before I began there). What these clients did remember were feelings of loss, however nebulous. Their losses of spouses, memories, and abilities were acute and felt even if they weren't able to vocalize them. You could see it in their eyes when they spoke about the memories that hadn't left them quite yet. They knew there were things missing from their recollection, though they couldn't say what. I did not want to add to that loss unnecessarily. The clients with whom I did get a chance to terminate with were kind, and sorry to see someone whose company they had enjoyed leave their life. I think at a certain age you see so much come and go (people, places) that to see another person come into your life and then leave is both sad, but not unexpected. And so I think I may have been more upset than some of the clients upon leaving the agency. Though I imagine they missed our weekly conversations, our talks were replaced by conversations with someone else. I'm not sure this experience prepared me for what termination will be like with clients like those I am seeing now in a more traditional counseling setting.

This year I am facing termination with several clients in the upcoming weeks. Some are moving and not returning to the area, others have met their goals and no longer need sessions on a regular basis. I've been preparing for how I want to terminate with the one client who is moving. They have some hostility toward others and I'm wondering if it will come out as a coping mechanism toward me next week. While they are moving toward something good (better than their current situation), I can't help but think they will also miss this therapeutic alliance we've built. So a few sessions ago I broached the subject, that our last session together will be before Thanksgiving and I wanted to make sure they were ready to move on. Their reaction told me they hadn't given it much thought until that moment and then they became quiet (though that isn't atypical). So my plan is to go through what they accomplished since I've been seeing them, and ensure they know what supports they have if/when the need comes up again (where to go, what to do if alone and they begin to feel hyper-hypo aroused). I've been using a safety plan with some of my clients, and I thought about doing a modified version for this client: a termination plan, so they have something in writing they can take with them when they go. It may make them feel better (it may make me feel better). I think this client feels warmly toward me and I hope that our termination process will help them transition toward their new future at a new school and will be a positive example of an ending in their lives.