In mental health, termination is the word used to describe the process of ending psychotherapy. Note the word “process”: Termination should not be an anvil falling from the sky. Under ideal circumstances, patient and therapist address termination during their initial meeting.
Think of termination as an exit interview for psychotherapy that spans several appointments. Patient and therapist review what the patient learned about herself, her accomplishments and goals (did she reach them? did they change during the course of therapy? if so, why? etc.), her reactions to and opinions about treatment, and how she might use the experiences in therapy to help her in the future.
In this way, termination facilitates closure, that “often comforting or satisfying sense of finality”.
Termination can be a Big Deal because, for many people, the end of meaningful relationships is difficult. People can experience emotions that are not only distressing, but also compel them to behave in ways that are neither helpful nor effective. Think about a relationship you had that you believe ended poorly: The girlfriend or boyfriend who dumped you. The unexpected death of a parent or sibling whom you both loved and disliked. The dear friend who drifted away, purposely or not.
Sometimes, even for those uncomplicated relationships that end “well”, we feel conflicting emotions about them. Loss is difficult for most, if not all, people. It’s hard to say good-bye.
Thus, ideally, termination is neither abrupt nor unexpected. Both patient and therapist may recognize that the patient has achieved the goals of therapy (determined at the outset of treatment and adjusted accordingly, right?). In this instance, termination makes sense. Nevertheless, patient and therapist may still feel powerful emotions while going through this exit interview.
In reality, termination can be both abrupt and unexpected. Patients move; therapists move; the Stuff of life interferes with and prematurely ends the therapeutic relationship. If the patient feels connected to the therapist, the patient may then activate old habits of dealing with loss and strong emotions. These habits may have been the very things that brought the patient into treatment. Many therapists therefore believe that termination is the most important aspect of psychotherapy.
In the next few posts, I will write more about the reactions people—patients and therapists—may have during termination.
Maria Yang, MD 