This is a post I wrote almost two years ago. I thought I would repost it because I had some things I wanted to add. I will add them at the end.
comes to an end. The question is what to do when the therapy ends
abruptly or the patient has been wanting to leave for a while. But what
if it is the therapist who wants out of the relationship and does
things unconsciously to get the patient to end the relationship? Like
missing an appointment, double booking or even being hostile to a
patient. It is always unconscious. Therapist’s are people too. They
have their own psychological wounds. Sometimes a therapist will tell a
patient they don’t need therapy anymore. I believe, it is always up to
the patient to decide that. If a patient seems to be coming less and
less I might bring up the idea of working toward an ending.
think a proper termination is always the best way to end. However, it
doesn’t always go that way. When patients leave abruptly and give a
reason it is rarely the reason given. They may blame it on parking,
money or even “ not getting anything” out of therapy any longer. Or
because of schedules the therapy may evaporate. Either way, exploration
for the departure is always best. Maybe the work was getting to deep.
Maybe my patient felt uncared for. Maybe an addiction had resurfaced
and she was too ashamed to bring it into session.
have come to understand that patients leaving abruptly or starting with
a new therapist before our work is completed can be from something
unaddressed between the me and my patient. The decision to leave can
can arise out of their anger that the therapy isn’t bringing them the
happiness they thought it would. The patient will blame me most of the
time. They might say something like “I have been doing this for a few
years and I am not getting any better.” They usually say something to me
like “ you are a nice person or I really like you, but I don’t think
it is working” which translates to it being my fault. It is my fault in
that something I said has made her feel like she can’t talk to me about
her feelings. It is not up to me to “make them better.” It is up to me
gently listen and hopefully we can repair our relationship.
I was neophyte psychotherapist, I would have tried to convince my
patient to stay. Now I know better. If she really wants to leave I will
say OK. I usually will leave the door open for her return.