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Key points
- Even with experience, saying goodbye is frequently difficult.
- The therapy relationship is an investment for both people.
- Therapists are real human beings.
It’s something we’ve all experienced, and more frequently than you may think: Clients decide to end therapy, sometimes abruptly before the therapist feels either party is ready to terminate, and without talking about it beforehand. There are myriad reasons for these decisions, some healthy, some not-so-healthy. But what doesn’t get any attention is the effect they have on the therapist left behind.
We’re trained to use the termination process as an opportunity to review the work accomplished in therapy as well as making suggestions as to what clients might continue to work on by themselves. Reviewing joys and disappointments felt by the therapist is also a vital part of the termination process.
However, as psychotherapy experiences become shorter or more standardized, providers are keeping that sacred part of the relationship more covert; as a result, clients don’t always know why saying goodbye in therapy is even important, much less recognize its impact on both themselves and the therapist. Let’s face it: They’re often in therapy in the first place because of an inability to confront, so slipping away without “doing termination” is pretty much within their comfort zone. Most people aren’t very good at saying goodbye, don’t know how to prepare for it, and end up doing it sloppily in ways that avoid intimacy and honesty—via email, text, voicemail, or occasionally a surprise announcement at the very end of a therapy session.
The client may feel fine about doing this. The therapist? That’s something else altogether.
I’ll use a client we’ll call Kyle as an example. He’d been seeing me for individual work centering on his relationship. He’d worked hard and had in essence gotten what he needed from our sessions—I’m willing to admit that—but the truth is, I didn’t want to deal with my feelings around him leaving: I was feeling sad. Our sessions were interesting and clearly helpful, and there was a part of me that hoped he’d stay on forever.
Which isn’t to say I was surprised when the day came that Kyle was ready to go. He’d been dropping hints for some time, and after working together for some years, I could intuit it as well: I heard how his voice had become tentative, watched his uncharacteristic hesitation in our sessions, sensed some question lingering unspoken in the air between us.
I’ll be honest: I was wishing I could come up with a few reasons why he should stay, but there weren’t any. Instead, I summarized his accomplishments, reiterated what he could continue working on by himself, made myself available at any future time, and … told him I felt sad. There, I said it! A lot of therapists don’t believe it’s okay to share those feelings with a client, but I felt it to be appropriate and even empowering for him.
Kyle’s was a decent termination. But frequently there are other goodbyes that happen when the course of treatment is going along fine and suddenly we feel—or actually are—blindsided. This happened to me recently with a client we’ll call Peter who’d been seeing me for depression. Together we tried a variety of interventions, but he wasn’t feeling better.
Peter consulted a different provider, with the result that he sent me an email to cancel our next meeting and all future slots as well, noting that he’d found another treatment modality and a new provider with whom to work.
Had he talked to me about his frustrations, I wouldn’t have disagreed—yes, his depression was lingering and its continued presence in his life was frankly still a mystery. But since we hadn’t had that conversation, I was completely taken aback, particularly since he’d repeatedly told me how important these sessions were to his well-being and how helpful I’d been. Fortunately he agreed to meet for one last session so we could do some termination work.
Just as I had with Kyle, I felt sad saying good-bye to Peter, but in addition I was mystified by his now-cool demeanor towards me and the distance he was inserting between us. It felt so different from the usual tone. I had to think that it was difficult for Peter to say goodbye; perhaps he didn’t want to let me down. I agreed with some of his concerns but also questioned his abrupt change of heart and noted that our treatment was producing some results, though they were slower and more tentative than either of us might have liked.
In the forefront of my mind was a desire to not appear defensive or controlling, to keep a professional tone and distance. So I spoke about our work together, highlighted some gains that he had made in my care, noted how our relationship had been positive, and reminded him that I would be available to him in the future should he ever wish to reconnect. Peter and I parted on a friendly note, but I was still left feeling uncertain. What had really happened for him? Why hadn’t he told me whatever his truth was regarding working with me? How had he changed his mind?
The point is, none of this is new or unusual for therapists. Clients leave all the time—it’s intrinsic to the process—and they feel awkward about saying goodbye. And every time a client leaves, we feel the loss. It’s certainly painful for me even after 40 years of doing this. How I cope is to try not to ruminate about it too much, check in with clinician colleagues for validation, and take the time I need to move beyond it.
The reality is that we aren’t just people running a business. We are in the business of caring, and most of us actually do care deeply about the people we work with. Part of the arrangement is certainly a business arrangement (it is, after all, how we make a living!), but beyond the schedule there’s a therapist with a heart who connects, shares, cares, and absolutely has the well-being of each and every client foremost in their mind.
When people leave, we have a reaction, whether they leave like Kyle or like Peter or any of the other myriad ways that they choose to go. Clients become part of our lives as well as our work, because we have a job that entails everything we bring to the session: our whole person, not just one small skill area.
I always feel loss, even when my clients leave when it’s right for them to go. I always feel sadness that they will no longer be a part of my life, nor I of theirs. I wish more clients understood that, understood how important they are to their therapists, and how much, at the end of the day, we miss them when they go.
