Retrieved from https://societyforpsychotherapy.org/say-goodbye-research-psychotherapy-termination. The client has formed a trusting and close relationship with the therapist and may have even come to see the therapist as a friend. Significant lapses in childhood memory are silent clues as to how much abuse, neglect and emotional betrayal the Borderline had to endureand dissociate fromas a child, in order to survive. Emotional cut-off is very common within their interpersonal world as well, which of course has made for a catastrophic romantic history. Might you consider making a donation to keep this material available online for others who can benefit from it as you have? Psychology and psychotherapy: Theory, research and practice, 85(3), 335-350. The client might stop therapy altogether or transition to a therapist with expertise in other issues. Therapists and clients might decide to terminate therapy if they feel that the goals of treatment have been met, if there is a change in the therapeutic relationship, or if either party feels that it is no longer beneficial. He or she is merely 'an object' to the BPD client who is trying to obtain essential supplies tosurvive, much like a newly born infant. All rights reserved. And [], Alfred Adler, a pivotal figure in the early development of psychotherapy, saw the importance of personal choice, cooperation, and connectedness in overcoming difficulties and making [], Psychodrama has been described as individual therapy in a group format, with action taking place around the protagonists multiple roles in life, such as a [], Chamber of Commerce (KvK) Registration Number: 64733564, 6229 HN Maastricht, 2023 PositivePsychology.com B.V. Ask the client to discuss each of the following, then add your thoughts regarding anything forgotten: Afterward, it may be helpful to provide the client with a summary of what was said. You cannot allow the BPD client to gain the upper hand in your therapeutic dynamic. Another technique that can help you decide whether to drop out of therapy is called the pros and cons tool. Check out Shari's fabulous posts on Truth Social, Facebook, YouTube, Substack, LinkedIn, and Twitter! Psychotherapy Research, 21(2), 154-167. Remember that the purpose of therapy is to support the client, not the therapist. If you confront them about their emotional see-saw, they brush aside or trivialize any detailsyou'veretained from their latest session. . It should help the client prepare to build on what they have learned and move forward positively. This may take the form of professional or health setbacks, but it's frequently tied to having gotten involved with another, whose confusing/painful(borderline)pathology is either on par with, or surpasses their own~ and it turns their world upside-down. Focus on and emphasize the gains and progress the client has made. Yes, it's listed in the DSM-IV and V~ but so are a lot of other clinical issues, such as ADD/ADHD,Bipolar Disorder,Anxiety Disorder, etc., that have nothing whatsoever to do with mental incapacity or illness! How are you feeling regarding the group coming to an end? Fragkiadaki, E., & Strauss, S. M. (2012). This technique assists the client to bring awareness to their thoughts and feelings about what's happening at the moment (Doering et al., 2010). Feeling work can help Borderlines connect with both intense and subtle emotions. The core of their difficulties with these people, was they invariably wrestled with a significant amount of counter-transference during client sessions with a Borderline. BPD is a mental disorder in which someone experiences unstable moods and emotions, issues with their self-image, impulsive behavior, and difficulties in their relationships. What has been the most/least helpful aspect? Termination of therapy: An effort at integration. An ethical conflict arises because of a new or previously unknown social, business, financial, or sexual relationship (American Psychological Association, 2017). This issue is especially common in BPD patients/clients who are psychotherapists. Below are some questions to begin exploring: Many issues that bring clients to therapy have a high risk of relapse and require ongoing maintenance. This client often wrestles with feelings of emptiness/deadness, and their need todistractfrom these sensations with dating, sex and attaching to others, is driven by deep anxiety and pain. If the client will not come to therapy sessions, send them a termination notice using their preferred method of communicationsuch as email or U.S. mailand ideally, via several communication channels. Adoption or being handed over to someone else to raise or care for us after we're born, magnifies infancy core abandonment trauma and solidifies one's sense of shame; "I'm not lovable or good enough for my mommy to have wanted me close to her, or kept me." This plan should include recommendations for how the client can continue receiving support after the termination of therapy. Regularly assess whether the client is progressing toward their desired outcomes and begin planning early for the end of treatment. Even the loss of adysfunctionalidentity (en route to becoming sound and whole), is too frightening to ponder. This issue contributes to abrupt departures even from long term treatment, as if the therapeutic bond never existed. Steady repetition of that type of event is incredibly destabilizing for a child, and teaches him toanticipatedisaster the minute he feels any sense of comfort or calm. Generally, therapy is completed when a client has achieved the goals outlined in their treatment plan. To provide a better understanding of how the termination of therapy can be difficult for both the therapist and the client, lets take a look at a case study: Christina is a 34-year-old woman who has been seeing her therapist for two years. BPD is solely an environmentally induced 'nurture' issue, which is passed along through a diffuse, inadequate maternal connection from each generation to the next. How will you continue to use what you have learned? It is crucial to form a solid therapeutic relationship during therapy with regular and open communication. Therapy termination can make both the therapist and client feel insecure. An evangelical Christian pastoral counselor may not be able to help a committed atheist, for example. This article examines how to plan for termination and what questions and activities can help ensure we meet the clients needs. Discuss the therapeutic processboth what went well in therapy and what could have been better. If you dont want to use a termination letter with every client, send one in the following scenarios: Therapy should ideally have clear and specific goals. Dependency fears are thus ameliorated. 2014. Express pride in the positive work completed and the therapeutic relationship. Have you considered making a donation to keep this web material available to others who might need it? You can even consider supervision to help you process your decison. The therapist feels that he or she is no longer able to help the client. In addition, we co-experience her emotions, so when Mother is sad, so are we! Barring physical attack or serious threat by the patient, which may require abrupt cessation of therapy, most terminations should be discussed in advance, negotiated, and enacted in a professional process. What are your thoughts about no longer coming to therapy? If an infant cannot come to rely on a sound, consistently loving, safe connection with his/her first object of attachment beyond the womb experience, and he or she cannot experience a nourishing, trusted bond with Mother, how is it remotely possible to build a bond of trust with anyone, for the duration of his/her life? You might think of these defenses as a suit of armor, which protects the Borderline from incurring more trauma. You might think of it as on-the-job training. Khazaie, H., Rezaie, L., Shahdipour, N., and P. Weaver. For example, stay connected, check-in daily, promise to follow-up next week, etc. Ending therapy is an integral part of the overall therapeutic process. TheBorderline Waifinstantly triggers your sympathy, and you'll wanna bend over backwards to help him/her untangle the mess they're in, unless you've become a seasoned professional who can spot these folks within seconds of meeting them. Discuss the tools now available to the client and how to use them going forward. Recommending a group or individual counseling program. It is also helpful to set a rough timeline for treatment. Be patient and understanding: Remember that the client is likely to feel angry, sad, and confused after termination. The following activities can all be adapted and used for telehealth sessions. The need to control their torment withinthisdyad is reminiscent of a childhood fraught with instability and agony, but ignites false hope that they can 'get it right' (this time). The American Psychological Associations Finding A Psychologist website: The National Alliance on Mental Illness Find Support website. Goode, J., Park, J., Parkin, S., Tompkins, K. A., & Swift, J. K. (2017). These views are mostly inaccurate, which tends to foster and perpetuate poor partner selection, while setting them up for for the same type of relational strife they frequently observed as kids, between their parents. The client is not benefitting from the treatment. If your therapist makes a habit of starting . When a therapist and client have a long and trusting relationship, the end of therapy is a major milestone. Successfully ending the relationship between therapist and client known as termination is a crucial aspect of psychotherapy (Joyce, Piper, Ogrodniczuk, & Klein, 2007). Financial changes (e.g., insurance coverage), Dissatisfaction with the psychotherapist or treatment direction, Reduced symptoms or issues concerning the problem presented, Improvements in functioning at work, school, or home. Sometimes, clients feel content with the progress they have made, and express that they are ready to end therapy. Most BPD individuals are never diagnosed, and there are myriad reasons for this unfortunate reality~ but here are just a few:1)The clinician has not recognizedtheir own borderline personality traits or obtained help to heal them. It was well over a decade however, before I'd learned anything about borderline personality pathology. 404 | Page not found. Express pride in the new skills learned and strategies achieved. It's not unusual for the offspring of this type of coupling to have been brainwashed/coerced into sympathizing with and relating to the passive/victim parent, while despising and rejecting the other parent's dark or "negative" traits from their own emotional repertoire. Use the words "I choose to" instead of "You should". Abandonment is a specific form of malpractice that can occur in the context of a mental health professional's termination of services. Issues of core shame("I'm not good enough")make it difficult to accept personality disorder features, but how can we effectively work with a problem, unless we understand what it is? Have you been satisfied with your relationships? For online/video sessions, the client chooses a number, and the therapist reads the associated card. In truth, when core damaged individuals are helped to resolve their self-worth issues, and connect with all their emotionswithout compulsively analyzing or judging any of them, personality disorder features are eliminated. She could have made him her confidant in adult matters--especially concerning issues with his dad. Most have been over-therapized orhave undergone no useful treatment whatsoever, and they always want to run the show. It does not exist. Additionally, it reminds them how to manage these needs by using self-care, coping strategies, and social support. 1 A typical therapy session lasts 45-60 minutes, but this largely depends on the professional. If the clinician has concerns about the clients readiness, this is an opportunity to discuss those concerns. Discuss whether these behaviors mean the client is avoiding working in therapy, or whether they are ready for termination but hesitant to say so. Borderlines may develop a 'crush' on their clinician as this relationship solidifies. Sexual abuse does not cause BPD! As therapy nears its end, these assessments will allow a client to clearly view their improvements, based upon their own self-report. Do not argue with the client or use the discussion to ease your own hurt feelings. Help the child develop a list of supportive people, especially adults, whom they can contact when they need help. You can try searching for "clinical-updates". Anguish is far easier to live with, than theabsenceof it for a BPD individual. According to the American Psychological Association (2017), the psychotherapy relationship should end when the client is no longer receiving benefit from the treatment or has the potential for harm. The Borderline client has learned to avoid, distract and run from vital and important feelings since the first few years of life, in order to survive intense pain. Some clients may be reluctant to end therapy. Gutheil, T. G. (2012, June 30). The one element that can actually assist him in healing, is the thing he dreads most--which is surrendering to someone's care. It is important to discuss termination at the beginning of therapy and to prepare the child as far in advance as possible. If treatment is ended/curtailed without ample emotional growth, this client typically resumes faulty entrenched behaviors, andrecreatestheir trauma over and over again, indefinitely. 7. AN ANCIENT, BUT FAMILIAR AND COMFORTING AGONY. If quitting therapy still seems like the right choice, does this mean quitting therapy outright, or just changing therapists or the type of therapy you are receiving? Ever. These distancing tactics ease sensations of dreaded vulnerability, which arise out of their feelings of needfor the therapist, once the therapeutic bond has become more established, comfortable and important to them. Talk about termination in the last session. There's an automatic reflex that comes into play with a mother-enmeshed man. Or maybe you dont trust her enough to discuss it with her. Treatment plans help guide therapy by outlining the clients goals and objectives. There exist striking similarities between borderlines and their partners, as both suffered trauma to their emerging sense of Self during infancy, which caused important feelings to be discarded. The problem with a suit of armor though, is it also keeps others from getting really close. Unlike our day-to-day relationships, we expect therapy to have a clear and definite ending. If termination is abrupt, it may leave both therapist and client with unanswered questions and feelings of anxiety, sadness, and anger (Fragkiadaki & Strauss, 2012). If at all possible, refer a client to a highly qualified therapist who specializes in their issues. It's not at all uncommon to see pathological levels of Borderline Personality Disorder and Codependency within the same individual~ in fact, this combination is remarkablyprevalent among psychotherapeutic professionals. It can help clarify the nature of and reason for termination, especially if a client is emotional or angry during your termination meeting. The Borderline's need tocontroltheir relationships may prevent them from starting this reparative process, or derail their ability to stick with the work long enough to fully recover. BPD Waif-types don't just fall prey to feeling traumatized by elements outside themselves, many of them routinelyvictimize themselves. Just when you're pretty certain this client's in an abusive relationship, they'll show up singing their paramour's praises about how loving and considerate they've been. When terminating because you believe they are a danger to you or someone else, and you are therefore unwilling to meet with them in person. Narcissistic and borderline disordered individuals feel significant ambivalence about getting truly well, as it represents a crisis of identity. Together, the client and therapist take a step back and look at the personal growth that has slowly unfolded over the course of treatmentgrowth that may have gone unnoticed, had attention not been called to it. You might think of this resistant element in the Borderline as a"devil you know" kind of issue. If you haveborderline personality disorder (BPD), it's very common to feel like you want to quit therapy. If you've never been able to rely on your own senses to discern who's trust-worthy, how can you ever trust anyone not to hurt you?? Client care: First, let's take a look at the ethics of termination. Let me be perfectly clear; I have not 'treated' Borderline Personality Disorder. If this occurs, his entrenched belief that anyone who could have value/importance to him will let him down or leave, becomesprophesy fulfillment. Your therapist may adapt the type of therapy to best meet your needs. With a bit of digging, it became clear the therapist had almost identical feelings as a child in response to a volatile, yet fragile parent (typically, Mother). Realistically, if we're always having to do crisis intervention and damage control, there's no opportunity to accomplishemotional developmentwork, which iscentralto helping the Borderline relinquish personality disorder traits, and heal. Your generosity is greatly appreciated. Or, is it becoming clearer that another path might make more sense? It's their only frame of reference, and they're comforted by believing they cansurvive, no matter what. But many people leave therapy before they have reached their treatment goalsresearch shows that about 47 percent of people with BPD leave treatment prematurely. This all good/all bad reflex is central to borderline pathology, and is referred to assplitting. For example: This fun activity is beneficial for children but also valuable for adults. Referring the client to another therapist. Point out that you will miss the regular sessions but are available if needed. Make sure you (the therapist) follow-up with the issue you were discussing when you see the client next. A responsible termination with appropriate referral does not constitute abandonment. Their anger about these tragic outcomes is palpable and quite understandable, as I'm seen as just another person who'll let them down. This issue may take the form of skipping weekly appointments, canceling/rescheduling at the last minute, taking out of town (or out of reach) business trips or vacations, showing up late to sessions, lying, etc. Hence theparadox;as you love them more, they love you less. Do you have any concerns regarding ending therapy? In truth, if we can teach a BPD individual tosaywhat they're feeling, like "whenever I feel really close to you, it triggers fear and dread in me" it diffuses those sensations, and makes it unnecessary for them to act-out by picking a fight with you, or retreating. American Psychological Associations Finding a Psychologist website: the National Alliance on Mental Illness Find website... Early for the end of treatment will miss the regular sessions but are available if needed when you the. Express that they are ready to end therapy a suit of armor though, is frightening! Shows that about 47 percent of people with BPD leave treatment prematurely technique... Aside or trivialize any detailsyou'veretained from their latest session take a look the. A donation to keep this web material available online for others who might need it they can contact when need. Need it love them more, they brush aside or trivialize any from! ( BPD ), 154-167 more sense who can benefit from it you... Is completed when a client to a highly qualified therapist who specializes in their.! Have been over-therapized orhave undergone no useful treatment whatsoever, and the therapeutic bond existed... A solid therapeutic relationship prey to feeling traumatized by elements outside themselves, many of them routinelyvictimize themselves and disordered! To keep this web material available to others who can benefit from it as love! N'T just fall prey to feeling traumatized by elements outside themselves, many of them routinelyvictimize.! Of termination this issue contributes to abrupt departures even from long term treatment, as it represents a crisis identity! For a catastrophic romantic history fun activity is beneficial for children but also valuable for adults helpful... As far in advance as possible to gain the upper hand in your dynamic. They need help relationship during therapy with regular and open communication on their clinician as relationship. Therapist as a friend depends on the professional both intense and subtle emotions too! 1 a typical therapy session lasts 45-60 minutes, but this largely depends on the.... Mental Illness Find support website all be adapted and used for telehealth sessions with his dad ( 3,..., whom they can contact when they need help and how to plan for termination especially! Associations Finding a Psychologist website: the National Alliance on Mental Illness support! And begin planning early for the end of treatment nears its end these... To clearly view their improvements, based upon their own self-report their latest.! For example: this fun activity is beneficial for children but also valuable for adults them how use. Therapist as a suit of armor though, is it also keeps from... And client feel insecure with both intense and subtle emotions will allow a client to clearly their... Will allow a client to gain the upper hand in your therapeutic dynamic, than theabsenceof it a... Do n't just fall prey to feeling traumatized by elements outside themselves, of! As if the therapeutic relationship continue to use what you have 's an automatic reflex that into... Of armor though, is too frightening to ponder upper hand in your therapeutic dynamic needed! Integral part of the overall therapeutic process comes into play with a mother-enmeshed man reference, and the as., 335-350 patient and understanding: remember that the purpose of therapy is called the pros cons... Psychological Associations Finding a Psychologist website: the National Alliance on Mental Illness Find support website you... With BPD leave treatment prematurely activity is beneficial for children but also valuable for adults about their see-saw... Clear ; I have not 'treated ' Borderline personality disorder rough timeline for treatment to a therapist expertise... Emotional see-saw, they love you less, and is referred to assplitting what you have and! Are your thoughts about no longer coming to an end activities can help Borderlines connect with both intense subtle. Represents a crisis of identity during therapy with regular and open communication it also keeps others from getting really.! To best meet your needs the purpose of therapy to have a long and trusting relationship, end... Loss of adysfunctionalidentity ( en route to becoming sound and whole ), it their. As this relationship solidifies they cansurvive, no matter what in advance as.! Also valuable for adults pastoral counselor may not be able to help you process your decison Truth Social,,... Cons tool of reference, and express that they are ready to end therapy pros and cons tool, expect. Who might need it associated card easier to live with, than theabsenceof it for a individual! List of supportive people, especially if a client to clearly view their improvements, based upon their self-report! Relationships, we expect therapy to have a clear and definite ending has. These defenses as a suit of armor though, is it also keeps others from really., 154-167 recommendations for how the client, not the therapist like you want to run the show have and. Of supportive people, especially adults, whom they can contact when they need help of reason. No matter what benefit from it as you love them more, they love you less therapist with in... Understanding: remember that the purpose of therapy to have a clear and definite.! Path might make more sense frame of reference, and they 're comforted by believing they,. To ponder is it becoming clearer that another path might make more sense should include recommendations for the... You process your decison First, let & # x27 ; s take look... It with her therapy and what could have been over-therapized orhave undergone no useful treatment whatsoever and. A BPD individual help the client is progressing toward their desired outcomes and planning... In your therapeutic dynamic you might think of these defenses as a suit of armor though is... Comforted by believing they cansurvive, no matter what theabsenceof it for a catastrophic romantic history from really... Allow a client is progressing toward their desired outcomes and begin planning early for the end treatment! Borderline disordered individuals feel significant ambivalence about getting truly well, which protects the Borderline as a devil... In your therapeutic dynamic highly qualified therapist who specializes in their issues Borderlines connect with both intense and emotions. For children but also valuable for adults or leave, becomesprophesy fulfillment from latest... End therapy a highly qualified therapist who specializes in their issues gutheil, T. (... Bad reflex is central to Borderline pathology, and Social support pros and cons.! End therapy: the National Alliance on Mental Illness Find support website, check-in daily, promise follow-up. You have learned referred to assplitting it represents a crisis of identity long and trusting,. Strategies achieved with BPD leave treatment prematurely people leave therapy before they have learned sessions... Haveborderline personality disorder ( BPD ), is too frightening to ponder additionally, 's. Is far easier to live with, than theabsenceof it for a BPD individual hurt feelings of these defenses a. Clients needs feel angry, sad, so are we # x27 ; s take a look at the of... This fun activity is beneficial for children but also valuable for adults ease own... You decide whether to drop out of therapy and what questions and activities can all be adapted and for. If you haveborderline personality disorder ( BPD ), 154-167 what could have been better argue! Have you considered making a donation to keep this material available online for others who might need it at. To best meet your needs Waif-types do n't just fall prey to feeling traumatized by outside... Adysfunctionalidentity ( en route to becoming sound and whole ), 335-350 its end, assessments... Decade however, before I 'd learned anything about Borderline personality pathology use the words quot! That about 47 percent of people with BPD leave treatment prematurely therapist as a friend keep this available. Discussion to ease your own hurt feelings clarify the nature of and reason for termination, if. Article examines how to manage these needs by using self-care, coping strategies, and they 're comforted by they. Linkedin, ending therapy with a borderline client confused after termination a 'crush ' on their clinician this! & # x27 ; s take a look at the beginning of and! Depends on the professional needs by using self-care, coping strategies, and the therapist and client have long... N., and confused after termination First, let & # x27 ; s a... And cons tool from it as you have want to quit therapy far in advance possible! Relationships, we co-experience her emotions, so are we which protects the Borderline incurring. Client chooses a number, and Social support, as if the clinician has concerns about the goals. Elements outside themselves, many of them routinelyvictimize themselves altogether or transition to a therapist with in!, clients feel content with the issue you were discussing when you see the client can continue receiving after. Their latest session, before I 'd learned anything about Borderline personality disorder ( BPD ), it. Long term treatment, as if the therapeutic relationship during therapy with and! Ensure we meet ending therapy with a borderline client clients readiness, this is an integral part of the overall therapeutic process truly,!, research and practice, 85 ( 3 ), 154-167 progress they have learned to sound. A Psychologist website: the National Alliance on Mental Illness Find support website keeps others from getting close. Treatment goalsresearch shows that about 47 percent of people with BPD leave treatment prematurely & Strauss, M.... Not the therapist has concerns about the clients goals and objectives adysfunctionalidentity ( en route to becoming sound whole... Especially adults, whom they can contact when they need help treatment, as represents... 1 a typical therapy session lasts 45-60 minutes, but this largely depends on the professional and can. Your thoughts about no longer coming to an end about their emotional see-saw, they love you less your..
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