Termination: When Therapy Comes to a Close
The therapeutic relationship is unique in many ways, not the least of which is that the client and therapist enter into it with a mutual, ultimate goal of it ending it. The broad plan is that both parties get to know each other (build rapport), work together collaboratively to process the old and build and implement new, healthier behaviors and, when therapeutic goals are achieved, bring the relationship to a close. This final phase of therapy is called termination (admittedly not the warmest title!). Ideally, termination comes at a natural and mutually agreed upon time, but a number of factors can push the relationship to a conclusion. Let’s explore the scope of these possibilities along with more about the nature of termination.
Healthy termination is a time of acknowledgement – client and therapist recognize that two crucial factors have been satisfied: (1) symptom reduction and therapeutic goals (both those established at the onset of therapy and additional goals identified throughout treatment) have been achieved, and (2) coping skills and behavioral changes have been fully integrated so as to not repeat problematic patterns in the future. This might include internalizing the therapist’s voice during challenging situations and applying relevant techniques. Clients often describe that they feel like their own therapist.”
How do you know if you’ve come to this point? If you identify with the below bullet, you might be ready for termination:
- You find yourself feeling like you don’t have anything to talk about for several consecutive sessions. You’re “reaching” for topics of discussion.
- You naturally apply coping skills and techniques learned in therapy in your everyday life. You identify the positive impact they’ve had.
- You feel confident that you’ve achieved mutually established therapeutic goals. These goals are unique to you!
- You start talking to your therapist as if you are the therapist in your own sessions
If these signals feel true to your experience, it might be time to have a conversation with your therapist. Your therapist too will likely notice these healthy indicators of readiness for termination and might bring up a conversation with you first. There isn’t a right or a wrong in who initiates the dialogue and regardless of who does, it should lead to further exploration and assessment. If you’ve both determined that you should enter into the termination phase, you will collaboratively identify a number of sessions or a timeframe that you’ll remain in therapy. As therapy reaches a close, sessions typically focus on:
- Reviewing what you’ve learned about yourself throughout therapy
- Revisiting therapeutic goals and considering where and how they stand now
- Establishing an aftercare plan, which will likely include consolidating helpful behaviors and skills in a tangible way, so that they serve as an accessible “toolkit”
- Identifying and processing the range of feelings and memories that termination and endings might bring up
- Reflecting on the therapeutic relationship
What happens when termination doesn’t meet the organic, collaborative process described above? The therapeutic relationship can come to a close for a number of reasons, some of them unexpected and unplanned for, including: not feeling connected to a therapist; feeling like you’ve reached a plateau in your work and seeking a different therapist; financial issues; scheduling issues; life changes; and boundary violations. Some of these factors result in a disruptive end to therapy, perhaps one that doesn’t even include one concluding session.
When you enter into therapy, you have the right to stop treatment at any time. It is worth acknowledging, however, that sometimes clients choose to leave for reasons that are indicative of the need for treatment. Driven by resistance or avoidance, the very issues that bring a person to therapy can drive them away. Below are some signs of resistance and avoidance:
- You rationalize that you’ve done “enough” work, but are actually fearful of accessing deeper, more challenging emotions and experiences that feel too overwhelming. Read more on resistance in therapy from my blog last month.
- You still deal with the same struggles that led you to therapy.
- You make small talk in session as to distract from particular topics and/or to avoid the silence that could lead to them. Read more on silence in psychotherapy on this blog by my colleague, Madeline Weinfeld, LMSW.
- Your choice to leave therapy is motivated by a desire to “escape” rather than a celebration of growth. You might be tempted to end the relationship by voicemail or email to avoid any further interaction.
If any of this rings true, see if you can compassionately and honestly connect with your desire to end therapy. It’s helpful to share this information with your therapist. This can be a particularly therapeutic experience, one that can lead to meaningful work and build a stronger rapport. It’s undoubtedly challenging to do this when you’d rather avoid. Remember that your therapist is there to support you during this difficult time. And it is quite common for this to occur in therapy – it’s actually a good sign that you are getting to the core “stuff” that you can begin working through, which can be as freeing as it is hard.
Regardless of when and how a therapeutic relationship ends, it will likely arouse a range of emotions, as endings typically do. Hopefully, there’s an opportunity to work through these feelings with your therapist. Your therapist should also encourage that the door is open should you need support in the future.
When termination is collaboratively navigated, it is a meaningful and bittersweet time. It celebrates your work and growth, lays the groundwork for future success, and explores the complexities of the therapeutic bond – a relationship has impacted both parties. What a significant and commemorative time!
For more FAQs on ending therapy, check out the FAQs here: https://www.psychologytoday.com/us/basics/therapy/ending-therapy