Are You Breaking Up with Me?

how to deal with terminations in private practice

I had been working with a client for several months on a weekly basis. They (singular pronoun for a person that doesn’t identify as either female or male) had sought me out because of my specialty in working with the transgender community. Many people need a therapist to work with them for several months before a doctor will consider prescribing Hormone Replacement Therapy or participating in any surgical procedures. This client needs me to write them a letter for “Top” surgery.

Through our sessions is was clear that my client struggles with some anxiety, depression, and family relationship issues. We discussed the standard coping skills and proceeded to recent live events. Then, there was a night that they sent me a text at 2am requesting a session with me as soon as possible. This wasn’t typical for this client, so I knew they were struggling. We met the next day. They were in distress about an incident that had occurred amongst some of their friends and were feeling anxious about it. By the end of the session, they seemed to be feeling a little better. We scheduled an appointment for the following week.

On the day of our next session, my client didn’t arrive. This was unlike them. They would send me a message if they were running late, never just not show up. I became nervous, so I texted my client to remind them that we had an appointment. Maybe they were confused, since we had met only a few days prior. I received no response. The next day I figured I would try another text. Just to make sure they were ok. Maybe they were sick or in the hospital? Maybe they had gotten more depressed or anxious since our last session and needed to admit themselves for a higher level of care. My text read: “Just checking on you. Send me a text to let me know you are ok”. I got nothing in return. The following day I called their cell phone and left a message. I then called the number they had as an emergency contact. Their grandmother answered the phone. She let me know that my client missed their last appointment due to sleeping in too late. Our appointment had been for 1:00. I let her know that I was glad that my client was ok and to let them know that they could contact me for another appointment. That was it, I never heard from them again.

When Clients Terminate Before We Are Ready

Suddenly I felt like I was back in high school and had just been dumped by my boyfriend. I replayed our last session repeatedly in my mind. The same types of questions started running through my mind. “What did I do wrong?” and “Did I say something to offend them? Did I not nod when I was supposed to? Did they find someone else? What about our future plans for me writing that letter so they could get that surgery that could help transform their life?”

I had to stop myself. I had to realize that terminations don’t always look the way we were taught in school. The kind of termination when you have several sessions to discuss possible referrals with a different provider, processing feelings of ending a relationship, and discussing goals that have to be reached as well as what are good goals for them to work on. I would have to say that the majority of my missed appointments are never rescheduled. Phone calls or text messages go unanswered and sessions slowly spread out until time gets away from us and the next appointment isn’t scheduled due to their ‘busy’ schedules.

I recently realized that every one of these clients that I have will end their work with me eventually. We will not grow old together and walk into the sunset hand in hand. Each one of these relationships will eventually end. So, what can we do as therapists to decrease the sting from the end of therapeutic relationships?

Prepare For The End Right From The Start

Set a time limit. Ask the client to commit to five sessions. On the fifth session, review the progress and see if you both feel it’s necessary, or appropriate, to continue. If you feel it’s appropriate to continue, discuss committing to another set number of sessions and review the progress again.

Make Sure You Have Emergency Contact Information

In case your client does what my client did and doesn’t show up for a session and doesn’t respond to your attempts to contact them, it’s important to do a safety check. This is to make sure that they have not harmed themselves or need someone to know that they are acting out of character.

Supervision

Having a group of people to help you process these feelings is important. Most people experience these feeling of being an inadequate therapist at one time or another. It’s good to have a group to process your feelings about being terminated.

It’s Not You, It’s Them

We have heard years of experiences and education on how to express our feelings. We understand that it’s healthy to end things on a good note, with closure, even if it feels ‘yucky’. Most people in our field don’t understand this and will do anything to avoid uncomfortable feelings or conversations.

This is part of what I include in my intro to new clients. Sometimes conversations can feel uncomfortable, but it’s important to talk these feelings out. It’s a part of the therapeutic process.

Don’t Be Afraid To Reach Out

Although your feelings may have been hurt and it’s not easy to just close your case and move on, don’t be afraid to reach out to your client after a few months. They may feel bad about how things ended and are embarrassed to contact you for an appointment. If you send a simple letter or email, it could make them feel comfortable enough to make another appointment with you if they are in need.

Termination can be uncomfortable for you and your clients. It’s a learning process for all of us. It does, however, get easier as time goes on. As most things, do.

 

Melissa DaSilva, LICSW is a licensed therapist in private practice located in Providence, RI. She is the owner/president of her group practice East Coast Mental Wellness (www.eastcoastmentalwellness.com)Melissa has been a therapist for over 10 years, is an advocate for LGBT rights and public speaker. You can also find out more about Melissa on: Facebook and Twitter .

Facebook Link: https://www.facebook.com/eastcoastmentalwellness/

Twitter Link: https://twitter.com/ECMWellness

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