Ryan Howes has been running an excellent series of posts on his Psych Today blog on termination. We use such an ominous sounding word for what is really the process of ending therapy. All therapy comes to an end eventually. Under ideal conditions, therapist and patient arrive together at the decision to end and they take the time necessary to fully and respectfully end the relationship. It s a ritual of goodbyes -- taking the time to look back at what has happened, what has changed. It's time to look at what has been accomplished and what has not. It is an exit interview and a farewell all in one and ideally takes up a number of sessions. When this happens there are good feelings all the way around, along side the inevitable sadness at saying goodbye.
But not all terminations are ideal. And someone asked me recently what it is like when a patient leaves abruptly. Well, it's hard. Sometimes a patient will call and leave a voicemail saying they won't be back. Or send an email or a note. Or not show up and then not respond to calls. Sometimes this is part of a pattern in the therapy and the patient eventually returns. But more often, they do not and we end up not knowing why. And that is hard because it is in the nature of therapists to wonder and want to know what happened.
There are all kinds of reasons for ending -- money, time, dissatisfaction, discomfort with the process, dislike just to name a few. But it is the abrupt ones, with no chance to really say good by or talk through what has happened and ending that are hard on therapists, and ultimately on patients as well. Ending well is important. It lets us go forward without lingering feelings and resentments.
The termination process is not about trying to keep the patient from leaving. It may come up in the process that the therapist feels some important unresolved issues remain on the table. But we cannot compel anyone to stay so the choice to leave, the power to leave always rests with the patient. What we hope for always is a good ending, but we don't always get what we want.