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It's Over Now: Termination and Countertransference

It's Over Now: Termination and Countertransference

by Melissa Groman

A therapist explores the complex feelings that arise when a client terminates abruptly.
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The Dreaded Phone Call

Recently, a client of mine left the following message on my voicemail: “Hi Melissa, I just wanted to let you know I won’t be coming to my appointment tomorrow. I’m feeling fine now. I’m not coming back, but thank you for all your help. I’ll call you again if I need you.”
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Melissa GromanMelissa Groman is a Licensed Clinical Social Worker in private practice in New Jersey. She specializes in treating eating and cutting disorders and mending marriages. Melissa founded the Good Practice Institute in 2007, and provides clinical supervision, consultation and practice building coaching to therapists from across the country via telephone. Melissa writes creatively late at night when her husband and five children are finally and blessedly asleep. She can be reached by phone at 973-667-8777 or through her website www.goodpracticeinstitute.com or email: Melissgro@aol.com.
I found this article to al about therapists's fear of abandonment and motivated more about what a therapist loses. What about the clients unequivocal right to self determination and privacy. Whose life is it anyway? Learning to rid ourselves of codependent behaviour and to 'let go of the need to control' may be appropriate therapy for therapists experiencing abandonment feelings.
Brian
Shelia, your therapist was waaay out of line. You should have reported him. Personally, I wouldn't see a male therapist, I don't think men can relate to women's issues as well as another woman can. YMMV of course... I abruptly left my therapist after two and a half years. I could no longer justify the expense, and I felt she had really dropped the ball when my Mother became ill and later died of cancer. She was not much help with that ish at all, and this event came up long after I had established a relationship with her. I was also having financial problems, but she kept insisting I continue to come in to my appointments, because "You might be on the brink of a breakthrough". I continued for a while, but I began to feel it was never going to end, and that she was just trying to keep me on the hook for *her* wallet, mine be dammed. The 'breakthrough' never came, either :/ I, too, took the chickensh*t route, cancelled an appointment and never called back to reschedule. My therapist wrote a small note on my final bill "What happened?" I found that to be rather unprofessional, "What happened?, and by the way, you still owe me 100 bucks." Feh, the whole thing just left a bad taste in my mouth, and I really wanted the help. I've never tried therapy again, either.
Michele
Melissa, I gained so much from reading your article "It's Over Now.." It is so difficult when anyone just abruptly cuts off a relationship, but especially a therapeutic one. I had a therapist that I was doing very well with simply not respond to my crises voicemail last summer; she would not address it, nor give me any explanation - just cheerily said "Have a nice day". It was weird, and crazy making and reopened my "I am not allowed to need help" wound. I thank the Universe that there are therapists like you who do take a personal, invested interest in their patients. Your article also made me realize that I had not followed up with a hypnotherapist that I stopped seeing a few months ago because of overwhelming endocrine issues. I am going to call him tomorrow to let him know exactly why I could not return to hypnosis and that it was entirely due to my physical exhaustion and was in no way a reflection of my regard for him. Thank you for your well written reminder that therapists are people too, and great ones aren't afraid of their own feelings.
Alex
A client said she wants to terminate, and instead of respecting her decision, you call her to ask for a wrap up session? Then you write a whole novela about your feelings about it? Get over your ego. People aren't broken and you aren't the hero that's going to fix them. That's not your job. I'm a Psychiatrist.
Malia
I would just like to say that this article, providing the therapist perspective, has been so helpful to me, a recent patient, who is grieving the termination process. I always doubted my therapist's love for me, as she was/is bound by law to respect the boundary of the relationship, maintain composure, and meet or exceed expectations of the position in the ways you have described. Your response to dealing with a difficult patient with love? Ow. And thank you for helping support the humanness of therapists, because I never saw my therapist as just someone to talk to, but to talk with. She allowed me to experience what it means to love and be loved, unconditionally. I'm absolutely in dire pain longing for her, and I'm debating about whether or not getting a call from her as a means of "checking in" will hurt me more, or help. I don't miss her because of what she helped me accomplish in my life or because she knows so much about me, no. It's not about me at all. It's about who she is. It's about who WE were together. I ache because I'm making a conscious effort every day to channel her energy, to internalize her lessons, and to carry her with me…but it seems as though nothing beats the logic, the fact, that she is indeed, not here anymore. And I am not there. So reading articles like these help me feel more connected, and that is the greatest gift.
Paige
Thanks for confirming all the worst-case-scenarios I've had about therapists and their selfishness. I love my therapist. She's very sweet, and we get along, but I don't feel like I've gotten better in 3 years of weekly work. I work, she works. Nothing changes. I don't want to leave her abruptly, but I'm going to have to, because it just goes on and on and on. Reading this article has made my decision a little easier--I now know that it's useless to try to ease out of therapy. It's better to break it off abruptly, like pulling a bandage off quickly. Frankly, I think therapists should be used to this. I'm paying a hefty sum for a service. If I no longer want to pay, why should I care what my therapist thinks or feels? The bottom line is that therapy is a business. If it weren't--if it were free or low-cost or less formal--I'd feel bad about quitting abruptly, but after spending 1000's of dollars on what I consider a waste of time, I'm not going to feel bad about saving $150 a week.
luc
Hi I really enjoyed your article. I am a very frightened client who keeps leaving therapy. I have been scouring the internet to try to understand better why I do this. It is lovely to read your open account of how a therapist feels.
Sue
As an LSW about to change to a new company, I was looking for something about leaving my current clients and the sadness I've been feeling. Thank you for addressing that and more that I had questions about.
As a clinical psychologist - this article was just what I needed to reflect on my own reactions to abrupt termination. And also to challenge myself to deal with all emotions (mine as well) involved in the termination process. Thank you!
Angie Vorster
I too am not a therapist but found this article interesting as I was Googling around. I was sent to therapy when I was young (age 14-17) at a place called Ecker Center. They felt I was making more progress than I felt I was, (probably because I was quickly approaching age 18 where the school/law requirements I attend due to my many absences due to severe anxiety/who-knows-what-else, and I had a decent bond with my first therapist. My appointments got spread out thinner as they felt my progress (age) dictated fewer visits. One day I went in, and found out that my therapist was no longer working there. I attempted to at least get a basic "what happened, where'd she go?" explanation, and the man at the front desk offered up no other explanation other that a "Kristen moved on to other things". Wow. No warning, call, card, or anything? I grew up. I realized the school/counselors/associated doctor weren't in the ballpark. I found out much later in life that I suffer from something much more severe than the symptoms of depression/social anxiety led on. I attempted to get myself help a couple times as an adult, but found myself up a creek with one drive-by diagnosis after another. I have long sense wondered if Kristen was in the right to give no warning/formal goodbye to her clients, especially a vulnerable minor with severe abandonment issues. The man at the front desk seemed like he'd think I'd be in the wrong to act hurt or confused, so I just left with my Dad and that was that. I found it very refreshing to read this that there are therapists out there who don't shelter themselves completely from their patients in the name of objectivity (believe me, i'd understand how difficult it'd be to get attached to so many emotional investments...it's amazing some still can truly bond. I've studied various branches of psychology since 1992 and while I don't work in the field have "played" intensive therapists for many I have encountered along the way, though I couldn't imagine the strength it'd take to make a living and still not be removed. I admire the author for having the courage to admit these things that I'm sure others in the field might sneer at.
William Y
Could not be put any better!
nk
Thank you for such a great article. I have been working with an amazing therapist for the past 18 months and I am very attached (to say the least). Unfortunately, for medical reasons, he has to retire at the end of the year and the devastation I feel would be unbearable if I didn't have a few months to work through it with him. I still can't imagine saying goodbye to him in our last session, and part of me wants to run away and avoid it all together. But I know that he is feeling a significant amount of pain to at having to end his work. Although therapy is 'all about the patient', I think it is still important that we are aware that our therapists have feelings too.
Narelle - Australia
The best therapist I had in my life took time to get to know me as a person, working with me through several goals I had, some which she gave me. I truly felt like she was interested in the progress of her clients and their ultimate healing. The worst therapist I had actually was on the defensive or argumentative with me when I took initiative to meet my goals (without going through her) and insisted I had to meet her during my work hours (thus having to take a day off work and lose pay) rather than transferring me to another therapist. It was an awful experience, so much that I walked out mid-appointment and never looked back.
Marie
I never wanted to leave my Therapist. After working together for over a year. I felt I could not cope with my strong attachment to her. My way of dealing with it was to run. I will regret this for the rest of my life. I miss her so much. But I felt she didnt care enough for me to let me go. The loss for me is with me everyday. I feel sometimes I must have hurt her. But then again I am just a number. Another Client. I am sure I was replaced very soon afterwards. Therapist`s do great work. but do they relize how much they can mean to us in our lives.
lise
I have a great and talented therapist. I am very thankful that she came into my life to help me. I had one problem though. My therapy was funded by a crime victim's advocate board and when they suddenly stopped funding, I was in no way prepared. The problem was that my therapist made me think that I had 8 more guaranteed sessions; when I was denied, I was in shock. I had no idea that I even could be denied more therapy. She wasn't explicit about the possibility of denial for funds. We had a termination plan outlined but suddenly it was over and I only had one more day. I was very upset and canceled my next appointment because I felt angry and powerless. We should have ended therapy at the previously scheduled date and only resumed if I was granted more funding. This just made everything really awful for me.
Kathryn C.
This post makes me want to cry. I had a therapist for several years who suddenly started screaming at me when I said that a comment he made hurt my feelings. I thought I was doing the right thing--that therapists wanted to know how you felt. But he got out of his chair and yelled at me and told me I was a bully and a manipulator and that I didn't know anything about him and he wasn't sorry that he said something imperfect because I wasn't so perfect either. This man was pacing and leaning over me while I was on the couch and it scared the crap out of me. It's been months since I left him (and I even went back for a wrap-up session--big mistake even though it was cordial), but I am still heartsick over it every single day and probably cry over it four or five days a week. I am just totally mystefied by what happened. Was he trying to get rid of me? Was it countertransference? Why didn't he say he was sorry for yelling? Was he trying to say I deserved to be talked to that way? I really wasn't trying to be a bully--I sincerely was trying to give the feedback that I thought therapists want about your feelings! I have a new therapist now. Luckily, she specializes in PTSD. Because I definitely have it now, thanks to my old therapist.
Sheila
I stumbled on this article randomly as I'm a patient, not a therapist, but it was interesting and helpful to me. I did the AWOL thing when I was in therapy before--just failed to call to schedule the next appointment and never contacted the therapist again. I felt bad about not even saying thank you or good bye but felt the therapy was not helpful and thus justified about the whole thing... reading this article made me realize how the incident actually does speak volumes about me and my issues, not just the situation. One example: I tend to avoid conflict so I ditched rather than talking over a difficult thing (ie feeling disrespected and understood by the therapist). I never examined this aspect of things before now.
Jamie
To my knowledge, less has been written on the termination of the therapist-to-client relationship than on any other aspect of the professional alliance. Using concise format, Melissa gently draws attention to this very important facet. Simultaneously, she highlights the humanity of the therapist by describing just how the loss of a client nudges at the deepest parts of the professional's psyche. I'd like to see Melissa find greater space to elaborate on issues of termination and how it quietly stirs the unconscious of the caregiver. Kevin Quiles, M.Div. Author of "Spiritual Care to Elderly and Dying Loved Ones" www.kevinquiles.com
Kevin Quiles, M.Div.
I have been reading your article on closure with great interest. I was expecting a new client and his partner 20 minutes ago. I am still waiting. Obviously they are not coming. I tried to call them - no reply. I am feeling really quite pleased rather than annoyed as I had the time and opportunity to read your article. I found it so interesting and related so many incidents and experiences with my clients. Oops, the 'phone just rang! No, it wasn't the client apologising, it was my lovely daughter ringing from Calgary. My feelings now are one of absolute joy, so profound I can taste them! There are times when I am so proud of my client's endeavours to sort out the debris in their lives that I feel the same feeling - I don't hesitate to share it with them. A stroke for them and one for me! I loved your article - thank you!
Christine Piff - England
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CE credits: 1
Learning objectives:

1. Identify some of the factors that Groman takes into consideration when dealing with client terminations.
2. Explain how Groman recommends therapists deal with the myriad feelings that come up in them when clients terminate treatment.
3. Describe how Groman might respond to a client who is considering ending treatment.
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