How can I make ending therapy a positive experience for my client?
Ending therapy is a delicate business, and the final session is something that many clients and practitioners feel uncomfortable about.
I see a handful of clients on an ongoing, time unlimited basis. For those clients, I ask them to have at least one session after letting me know they want to end our therapeutic partnership. Because I introduce the idea of termination early on, those who terminate usually choose to do so gradually, over a number of sessions. In general, though, people struggle to see the value in paying for a session when they plan to finish up with their therapist.
One common misconception is that the termination session is for the therapist to understand what went ‘wrong’ and why the client wants to end the arrangement. So, whenever a client informs me that they are finishing our work together, I let them know that in the termination session, just like every other session, I am working as their therapist and on their behalf. I tell them I won’t bring my feelings to the session unless specifically and clinically relevant, although most of my clients want to see my heartfelt feelings. They want to see that I’ve been affected by our relationship and connection, and they especially don’t want to see a stony-faced therapist or cool impartiality at the end.
I assure them I will hold space for their feelings and help them process their emotions so they feel ready to move on from our work and positive about their future. We will reflect on their achievements, and create a ritual or celebration to acknowledge how far they have come – and prepare them for the next phase of their journey.
It takes skill to conduct a termination session, so even if there has been a perceived misattunement or relational rupture, it's usual to be paid for the session. It’s up to the practitioner to explain how scheduling and planning a final session (or series of sessions) can not only provide closure, but help the client move forward in their healing journey.
Preparing for a termination session
Ask your client to reflect upon their reason for wanting to end therapy. Encourage them to bring their reasons to their session to unpack and process. I assure my clients that feedback is important for successful therapy. If they believe I have said something insensitive or misattuned, I actively encourage them to bring their reactions directly into the therapy process.
For your client, bringing their dissatisfaction can be an important part of therapy, even if they ultimately decide not to continue. It can be a very healing experience to bring uncomfortable emotional reactions to a session and be supported to express them in a safe therapeutic environment. It can restore the power balance between yourself and your client. This can be particularly transforming if the client is used to having their hurt dismissed or minimised, accustomed to giving in to others, or familiar with relationships falling apart when there is conflict or disagreement.
For the client, bringing their dissatisfaction can be an important part of therapy, even if they ultimately decide not to continue. It can be a very healing experience to bring uncomfortable emotional reactions to a session and be supported to express them in a safe therapeutic environment. It can restore the power balance in a client’s internal object relations. This can be particularly transforming if the client is used to having their hurt dismissed or minimised, accustomed to giving in to others, or familiar with relationships falling apart when there is conflict or disagreement.
When your client feels like therapy hasn’t worked
If your client wants to terminate because the changes they expected haven’t materialised, you may need to gently remind them that psychotherapy is a gradual process. No one can predict how much time it will take for the subconscious body-mind to feel safe enough to let old habits and beliefs emerge for healing, but that’s the process required for deep change. Both client and therapist have to wait for their nervous systems to become accustomed to each other, to start talking to each other, and to trust each other. If there are historical trust issues, then the process could be slower than expected.
If there is fear of something terrible happening if they let themselves go, then progress could be slower than desired. Often, clients expect change to look a certain way, which is not always realistic. Part of how to heal a dysregulated nervous system actually involves what feels like ‘hanging around doing nothing’, but it is in this space that the nervous system can learn new patterns and how we begin training the nervous system. This is because a level of safety and trust can be achieved and a working alliance forged, and your client’s body-brain-nervous system will automatically decide it is ready. It’s your job as the therapist to create the conditions for nervous system safety, and for empowerment to be felt.
Ways to ensure the termination experience is positive for your clients
It’s never too soon to discuss termination: ask your client how they will know when they are finished, or what would need to happen for them to know they are ‘done’.
Help your clients build their capacity to notice changes, no matter how small and subtle. Help them learn to hold contrasting states at the same time - e.g., pain and not pain; neutrality and intensity; hot and cold; moving and still.
Share with them that they may not leave every session feeling ‘good’, or as they would like to feel. Therapy places demands on the nervous system, and feeling better after every session can’t be guaranteed.
Let your clients know that their feedback is important. Ask them to let you know as soon as possible if they are contemplating terminating therapy, or they don't feel the modality is working.
Give them a short feedback survey [Working Alliance Inventory (WAI) (Horvath & Greenberg, 1986) is perfect] at the end of each session to be filled out before they leave.
Read more about working with clients here.
Become a Relational and Somatic Trauma Therapist
Ending therapy in the best service to your clients is one of the skills taught in our R.E.S.T. Relational Embodiment Somatic Therapy® practitioner training.
We are now accepting applications for the second round of R.E.S.T. Relational Embodiment Somatic Therapy® Practitioner Training – request the prospectus.
Sign up for R.E.S.T.® by July 31st, 2023, you’ll receive a bonus 1:1 session. You’ll also be able to upgrade to VIP and receive additional 1:1 sessions at a subsidised rate so you can start your journey straight away.
These 1:1 sessions are hugely transformational and can lead to significant breakthroughs – we can talk about this more when you book a call with me to discuss your participation in the training.
The call is your opportunity to ‘feel’ me out, ask questions and better understand how this program can open the way into something bigger, deeper, greater in your practitioner journey. There will be no selling from me - just honest conversation and generous sharing to help you on your way.
Or if you’re not quite ready to chat yet, start here to find out more.
Clients want authentically warm responses from therapists