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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by messadivoce on July 28, 2005, at 20:38:35
My second question: I've been on this board for about 9 months and I've read a lot of really sad and difficult termination stories. I think that is the hardest part of therapy. I've heard multiple times that termination is not a subject covered well for therapists-in-training. I think your book was groundbreaking in that it gave the client a voice. Do you think there would be a need for a book purely about termination, and people's various stories of how different therapists handled their terminations? There are people here who have had good, skillfull terminations, and then those who've had bad ones (I've had 2, actually). Is this a subject that therapists even think about before it happens?
Posted by Dinah on July 28, 2005, at 20:53:33
In reply to Lott: Sequel Question, posted by messadivoce on July 28, 2005, at 20:38:35
You took my question. :)
I think there's a real need for a book similar to "In Session" but geared toward termination.
Posted by pinkeye on July 28, 2005, at 20:56:22
In reply to Re: Lott: Sequel Question » messadivoce, posted by Dinah on July 28, 2005, at 20:53:33
Yes - it is my question too.. What is the right way to terminate a client who has intense transference?? How can the client cope up with the loss? It would be great to have a book dedicated to termination.
Posted by rockymtnhi on July 28, 2005, at 21:19:12
In reply to Re: Lott: Sequel Question » messadivoce, posted by Dinah on July 28, 2005, at 20:53:33
Yes, indeed! A book, a pill, anything that would help make termination a little easier is welcome by me.
Posted by deborah anne lott on July 29, 2005, at 15:44:29
In reply to Lott: Sequel Question, posted by messadivoce on July 28, 2005, at 20:38:35
It would be an interesting book, for sure. I know that there have been some clinical studies of termination published in the professional literature. If you're curious you could probably ask a librarian to help you find them. Therapists are supposed to think about termination, prepare for it, consider the specifics of each case, but whether they do, and how well they do it, is of course an individual matter. I don't think there's any easy way around termination. And I think a lot of therapies drag on because the therapist doesn't know how to end it. And some therapists get into boundary problems because they try to slip into friendship or romance rather than facing the hard pain and grief of termination. What does everyone think that therapists should do to make termination easier/less painful/more meaningful?
Posted by deborah anne lott on July 29, 2005, at 15:46:50
In reply to Lott: Sequel Question, posted by messadivoce on July 28, 2005, at 20:38:35
The comment about a termination pill made me think of the movie Eternal Sunshine of the Spotless Mind. If anyone's seen it, people try to get all their memories of a romance that's ended badly erased from their minds. Sounds good, right? Doesn't quite work out that way, though. If you haven't seen it, rent it.
Posted by annierose on July 29, 2005, at 16:03:34
In reply to Re: Lott: Sequel Question, posted by deborah anne lott on July 29, 2005, at 15:44:29
I'm not sure I'm able to answer your question re:termination ideas succinctly, but I'll try. First of all, I'm in treatment with a psychodynamic therapist, so time isn't an issue (i.e. she isn't trying to figure it all out in X number of sessions).
But I would hope she would bring up the issue long before she thinks it should happen ... let's say a year. And gradually reduce the frequency of the sessions until I say "enough". Right now, I can't imagine when that time would come (it's only been 18 months this go around) but it will be a bittersweet ending.
Posted by daisym on July 30, 2005, at 13:55:55
In reply to Re: Lott: Sequel Question, posted by deborah anne lott on July 29, 2005, at 15:44:29
I actually said to my therapist on Friday that I was going to try to enter into this discussion about termination that was going on. He asked the same question you did, "what do you imagine it is going to feel like and how do you think it would be easier?" It has been an intense on/off issue for me since I got attached, knowing it *is* going to end at some point and trying to figure out how I'll stand it. My therapist is always straight up about "yes, it will end" but he reminds me that it will be on my schedule and just like therapy doesn't have to go on forever, it doesn't have to end forever either. He leaves an open door for past clients and he said it isn't unusual for folks to call him up and come in to sort through a few things, catch up or just touch base and make sure he is still there. I think knowing that eases the pain of it, because it doesn't feel like a permanent loss. And not being pushed out of the nest too quickly is going to be what I personally need.
We talked about deep attachment feelings, like I have. He said these usually ease off organically, the more secure you get about the attachment, the less angst there is over it. He believes that talking about it promotes the healing. He said he can't imagine ending a therapy relationship without saying, "I know I will think about you and wonder how you are, so I imagine you will too. Are there feelings we should talk about or anything you'd like to share about how you are feeling?" He said if you don't make it OK for people to be sad and upset and grieve something that is often self chosen, they feel like they can't or shouldn't -- exactly because it is self-chosen. We all know that just because something is the right thing, doesn't mean it isn't still a painful thing. Sort of like kids leaving home.
So I guess like most things in therapy, termination would be easier if you had a space of time to talk about the feelings, knowing that they aren't pathological but rather a healthy reflection of a relationship that meant (means?) alot to you. And I think disclosure on the part of the therapist about what they are feeling too would help. I think we often wonder if they will miss us...and if they think we are ready or if we are making a mistake, etc. I think this is critical for those terminations that take place with no possibility of return visits or contact. I think that as many questions need to be answered as possible and as honestly as possible. It seems to me that people get stuck when they are left wondering -- did he hate me? Was it real for her too? Would they have done anything different? Do they miss me? I'm not suggesting feeding fantasy but instead providing closure.
Sorry, this got long. I've obviously been thinking about it.
Posted by annierose on July 30, 2005, at 21:00:08
In reply to Terminations, posted by daisym on July 30, 2005, at 13:55:55
Well thought out, nicely said.
Posted by frida on July 31, 2005, at 12:29:43
In reply to Terminations, posted by daisym on July 30, 2005, at 13:55:55
hi,
I won't be able to contribute much to this, because just reading these posts have made me cry. I can't imagine leaving my T forever.
She gave me something /gives me something I had never had in my whole life.
If I were to lose her it would be just unbearable for me. It would be even more painful than the pain of the abuse back then and the isolation. Because she made me feel that it mattered, what happens, and she makes me feel that i can somehow go back and heal that deep hurt- if she were to leave, after the years it took me to build trust in her and the relationship we built the pain would be so deep.
I do love her dearly, and I believe she does love me too. She has told me and shown me in a lot of ways and she has tried so hard to help me and teach me how to trust. We worked so hard at our relationship.
The way I see it, and from what she said, she will always leave the door open for me and we won't lose touch. I feel I would see her at least once in a while, and call her, and share the most important or special moments in my life with her.
I believe she'll always be part of my life.
Why would we have to stop seeing each other when we've come to mean so much to each other and after sharing so much together? years and a lot of deep deep moments?
we still have a lot of work to do- but it soothes my heart to think that she will be in my life no matter what. Maybe I may see her less, once a month, just to check in or share, but I don't want her to be out of my life completely.
And the few times we talked about this, I think she also agrees about leaving a door open always and staying in touch.It makes me cry to read about terminations.
I'd better stop :-)Thank you
Frida> I actually said to my therapist on Friday that I was going to try to enter into this discussion about termination that was going on. He asked the same question you did, "what do you imagine it is going to feel like and how do you think it would be easier?" It has been an intense on/off issue for me since I got attached, knowing it *is* going to end at some point and trying to figure out how I'll stand it. My therapist is always straight up about "yes, it will end" but he reminds me that it will be on my schedule and just like therapy doesn't have to go on forever, it doesn't have to end forever either. He leaves an open door for past clients and he said it isn't unusual for folks to call him up and come in to sort through a few things, catch up or just touch base and make sure he is still there. I think knowing that eases the pain of it, because it doesn't feel like a permanent loss. And not being pushed out of the nest too quickly is going to be what I personally need.
>
> We talked about deep attachment feelings, like I have. He said these usually ease off organically, the more secure you get about the attachment, the less angst there is over it. He believes that talking about it promotes the healing. He said he can't imagine ending a therapy relationship without saying, "I know I will think about you and wonder how you are, so I imagine you will too. Are there feelings we should talk about or anything you'd like to share about how you are feeling?" He said if you don't make it OK for people to be sad and upset and grieve something that is often self chosen, they feel like they can't or shouldn't -- exactly because it is self-chosen. We all know that just because something is the right thing, doesn't mean it isn't still a painful thing. Sort of like kids leaving home.
>
> So I guess like most things in therapy, termination would be easier if you had a space of time to talk about the feelings, knowing that they aren't pathological but rather a healthy reflection of a relationship that meant (means?) alot to you. And I think disclosure on the part of the therapist about what they are feeling too would help. I think we often wonder if they will miss us...and if they think we are ready or if we are making a mistake, etc. I think this is critical for those terminations that take place with no possibility of return visits or contact. I think that as many questions need to be answered as possible and as honestly as possible. It seems to me that people get stuck when they are left wondering -- did he hate me? Was it real for her too? Would they have done anything different? Do they miss me? I'm not suggesting feeding fantasy but instead providing closure.
>
> Sorry, this got long. I've obviously been thinking about it.
Posted by LauraBeane on July 31, 2005, at 16:23:26
In reply to Terminations, posted by frida on July 31, 2005, at 12:29:43
I've not posted before but this issue is so compelling that I cannot help but add my voice. I hope I am posting properly. I've been with the same T for 2 years. It's the longest I've ever been in therapy. I feel like I really connect with him, but I wonder how much is genuine and how much of this connection is contrived on his part. Certainly he knows how to reach out to people and make them feel special. It's so easy for me to believe that I'M the one who is special, but I suspect that the truth is really that all his patients are special.
He reminds me every so often that someday we will terminate therapy. I get upset (don't want him to leave me) and he says we will both know when progress is no longer being made. He also warns me that some people cling to their problems because they don't want to leave therapy. This scares me too (are you talking about ME?). I hope when the time comes I am strong enough to terminate gracefully. I am really very afraid of terminating. Secretly I want him to stay with me always -- no, more than that, to stay with me, help me, save me, love me, take me away... although intellectually I realize this is absurd. Because I am so eager, I think for me it's crucial that he remain strict about boundaries. I am so eager that the smallest transgression on his part would become larger than life in my mind.
Thanks to all who share their thoughts and experiences on this very tough issue, and thanks to Deborah Lott for sharing with us what you have learned both through your own difficult experiences and through your years of research. I think that many people are being helped by reading this board. thanks too for listening to me now.
LB
Posted by Tamar on July 31, 2005, at 17:26:39
In reply to Re: Terminations, posted by LauraBeane on July 31, 2005, at 16:23:26
Hello LB, and welcome to Babble!
It’s true: termination is a compelling issue.
I’m sure that even if all your therapist’s patients are special, you’re still a particularly special person to him. I think it’s a bit like having kids (I have three). They’re all special in their own particular ways. They’re all different but all infinitely special to me. I like to think that good therapists feel much the same way about their clients.
I’m curious about your therapist’s comment that you will both know when progress is no longer being made. To me that seems an odd way to put it. I finished therapy four months ago because so much progress had been made that I was no longer horribly depressed, and I didn’t need my therapist the way I used to. But maybe I didn’t quite understand the point you were making.
I really think that in an ideal world you will feel ready for it when the time comes. It’s terribly difficult to imagine when you’re in the middle of therapy. Sometimes I think it’s better not to worry about it too much at this stage. Of course you want him to stay with you always. And for now he *is* with you, and presumably you’re doing the work you need to do together. I would say: don’t be too frightened. If you’re not ready yet, then you’re just not ready. When you eventually are ready, it won’t be so frightening.
Tamar
Posted by LauraBeane on July 31, 2005, at 18:00:22
In reply to Re: Terminations » LauraBeane, posted by Tamar on July 31, 2005, at 17:26:39
Thanks, Tamar. Your analogy works well for me (I have two kids) and makes me feel much, much better.
Regarding his comment, if I remember correctly (ack, it was only a few weeks ago), I think he was replying to my fearful question -- how will I know, how will you know, how can one tell when it's time to terminate? At the time we were in the midst of what he has since called an impasse, where I was complaining bitterly every session about my current situation and avoiding all talk about the issues that brought me here. This lasted for six months or more. So maybe he was trying to light a fire under me. I dunno, does that make sense?
It helps a great deal to hear about termination from someone who's been there. Thanks a lot for telling me about your experience. It's so good to hear about the positive, proactive ones.
LB
Posted by gardenergirl on July 31, 2005, at 19:34:07
In reply to Re: Terminations » Tamar, posted by LauraBeane on July 31, 2005, at 18:00:22
I'm struck by how what I was taught in school about termination, that it should be given as much importance as the presenting problem and should have enough time to work out..versus what I've read and experienced with terminations. It so often doesn't work out the way it's "supposed to." I've been bringing it up with my clients for a few weeks now, since my placement will be up at some point. As an aside, it's interesting to me which clients seem to "forget" about how this is coming up...I think they will need a bit extra care.
There's all kinds of reasons I've noticed why it doesn't work out ideally...people moving, insurance issues, failure on the part of the T to honor the client's feelings or to allow enough time to process, a bad match between T and client...so many others.
I feel confident that my T, who is psychoanalytically oriented, will allow enough time and process to our eventual termination. (Hmm, I didn't cry when I thought that word in connection with him....). But I also know I am very fortunate in the arrangement I have.
Sigh.
I wish everyone could have as much therapy as they need with the best T for them at any given time.
No wonder my supervisor calls me too ideal. Of course I think he's too rigid. :)
gg
Posted by LauraBeane on August 1, 2005, at 14:07:10
In reply to Re: Terminations, posted by gardenergirl on July 31, 2005, at 19:34:07
> I'm struck by how what I was taught in school about termination, that it should be given as much importance as the presenting problem and should have enough time to work out.
Interesting. Actually, that makes me wonder if my T and I are on the same page. He has told me that he feels I am not as troubled as I think I am. Perhaps that's why he is bringing up termination. Unsettling, but good to know about the possibility.
> I feel confident that my T, who is psychoanalytically oriented, will allow enough time and process to our eventual termination.
I've had the (really great) benefit of reading a variety of babblers' prior posts, and so it is with confidence that I can say I am sure you are right.
thanks
LB
Posted by Dinah on August 7, 2005, at 13:49:48
In reply to Terminations, posted by frida on July 31, 2005, at 12:29:43
My therapist says different people use therapy for different things. And that it's ok for me to use his as one leg of my support stool for as long as I like, unless he's forced to retire or moves. Even if he gets a full time job, or whatever short of poor health or leaving town, he'll still see me in a part time practice. As long as I find it useful.
Which doesn't mean he doesn't encourage me to find other legs for my support stool as well. But it's ok with him if I lean on him as much as I need at any given time.
This is the end of the thread.
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