Speaker A: Welcome to the Therapist Burnout podcast, episode number 57. Okay, therapist, today I am talking with you a little bit about termination again. And before I do that, I just wanted to give you a few reflections about my burnout recovery and what I’m dealing with in 2025.
That’s where we are.
Is it the Twilight Zone or is it 2025? Because I’m not quite sure. Oh my goodness. I usually don’t love to talk about politics, but I know that you guys are struggling with this.
So there have, there’s just been a flurry of things that are coming out. If you’re in America, you know what I’m talking about. If you are in other places in the world, you probably know what I’m talking about because of our president.
But you know how it’s impacting me here is I work contract for a school and I’m getting letters like the community that I live in currently and the places I’m working for are getting letters about how our school is going to address immigration officers if they come into our school building so that parents who have children in the school can understand what would happen.
While this hasn’t happened yet, it’s created a lot of fear. It’s created a lot of, yeah, I think a lot of kind of uproar in our mental health community about what this is going to mean.
I saw something that we potentially can’t use gendered, like someone’s gender pronouns in a psychological report per an executive order. I haven’t seen that detail yet, but that’s directly goes into what I do.
Just speaking of when I was working as a therapist, I know your ears are probably burning. If you are still working as a therapist.
I hear you and I am sorry that that is what you’re dealing with because I don’t think really people got that. That, yeah, usually in conversation when we talk to somebody, they’ll say, oh my gosh, politics.
Oh, what’s going, or this, you know, he did this, he did that. But in your therapy session, you basically have a free license to just say everything that you wouldn’t say to another human.
And therapists just absorb that ****. Yeah, I’m not, I’m not for absorbing anymore. So if you need someone’s permission to say, my tender hearted therapists who listen to this, you do not have to absorb hate, you don’t have to absorb someone’s venom.
If you cannot stay in a therapeutic relationship and continue to hold the space for the client and you’ve done the consultation, you’ve Talked to a. You phoned a therapist friend and you can’t do it, then it is time for you to let that client go because you don’t have to.
You don’t have to. If you need permission, I grant it. Okay. That is the PSA for today portion of the podcast. I digress. Okay. But I had to some personal reflections before we get into the topic of the day, which is termination.
I’m doing kind of a high level thing on termination today.
Done one in the past, but I’m gonna do it again. I am at 44 years old learning to ski.
It is not pretty. Parts of me really love it that really enjoy that I am outside because I live in a very cold climate in the state of Maine. We are like two to three hours, if you know where that is.
We’re two to three hours away from Canada. So, yeah, it’s up there and so there’s cold and it’s been very cold this winter. But I enjoy. I have these little glimmers of moments when I’m on skis where I’m like, wow, this is fun.
And then a lot of the other times are I am so scared to death.
And I thought it was a really great burnout recovery metaphor. I’m laughing because it makes me so uncomfortable. I have chairlift anxiety. And some part of me thinks that when I actually learn to ski without feeling like I’m gonna die is maybe when I’ll feel recovered from my burnout.
That’s my hope. That is definitely my hope. But I just want to be good enough to ski down the mountain comfortably with my children on like a blue trail. So they go like green, blue and black.
And I don’t, I have no desire to go on a black trail. I don’t need to be good. I just need to be good enough to go comfortably down that chair.
Comfortably down the mountain, rather, and take the chairlift. So the chair is somewhere in there. So I don’t feel like I’m going to die every time off the chairlift. That would be great.
And yeah, that I can go down the mountain with my children. Because usually when we ski, I am off by myself in the slow lane and my kids, like come past me, hey, Mom.
So that is my goal. And I feel like I told my therapist this week, when I can feel like I’m cruising on my skis while I feel like I’m cruising in life, they will still, still gonna be icy patches and rough patches.
But can I navigate them? Yes, I might fall down, but I’m Gonna get back up.
And so I was grateful after I got off the mountain and felt that it feels a little easier.
January has been a rough month for me. I had a little bout of depression that came back.
I’m openly saying that because I know I’m not the only one that struggles with depression as a mental health practitioner. And I told people about it this time. Usually I wouldn’t.
I always talk to my partner about it, but I also shared that with other people in my life. I don’t know how they took that. Usually it was like, okay, thanks for letting me know.
I guess part of me saying that to the people in my life was also having some accountability and being more transparent with my internal experience to others. I think is something that’s a learning curve, that I am just exercising that muscle more and more.
So I’m grateful that actually I’m feeling better and I have more energy. And that feels really renewing to me to feel like I’m not jogging through a rose bush. Someone sent me that on LinkedIn.
They were like, I felt like I’m jogging through a rose bush. I’m like, wow. It’s like I’m continuing to move, yet I’m being kind of like stabbed a little bit.
Every single. With every movement.
Really good metaphor for depression. Yeah. Okay. We touched base on a lot of things so far. It’s a lot going on. So on LinkedIn and if you’re on my newsletter, you will have gotten this newsletter by now.
I put a post up about.
Therapy is one of the only relationships we enter knowing that it’s supposed to end.
No other part of our lives works in this way.
We don’t start friendships, jobs, or even casual conversations by mapping out how they’ll conclude.
But yet we’re trained in therapy to begin with the end in mind. And I think for therapists and clients, even though we know the endings are supposed to happen, even though we know they are coming, it is still hard.
It is still hard for them. It is still hard for us. And I think in all of our training we’re taught more about protecting that space for the client and not thinking about the space that we need, the emotions we have about it.
So I’m going to do a little bit of high level stuff on termination. I’m going to talk next week about when you have multiple terminations back to back to back.
Like if you’re closing a practice or leaving a job all at once. And so most of us in our career, if you’ve been in your career a Little bit. We have some experience with that now of leaving either a postdoc or an internship or some kind of training experience.
And generally I feel like when that happened, people were aware of that, like that you would only be there for a year, that you’re in your training, it’s going to end.
So I feel like even on the outset of those relationships, clients did have the perspective of they’re not going to be here. Like they. I have an intern every other, like every year.
So they’re not going to be here either. So I think that in those positions, our clients knew we were leaving. However, if you are in mid career or you have been licensed for a while, you are in a practice where you’re likely there.
Your clients don’t anticipate necessarily you leaving and maybe you don’t either.
So I think it’s just kind of thinking about how do we even think about when therapy comes to an end? Because what I know about being a therapist for a long time in private practice is things get a little rusty.
So I was in my therapy session this week, another therapy moment for you. And I had, I always had the DSM on my desk right now because I write reports and so I’m constantly, you know, making sure that I’m, you know, looking up the diagnostic criteria correctly and all of that.
And I was just putting it down and I was telling my therapist, oh yeah, I’ve always got the DSM here. Um, and then I said, you know, when I was in private practice just doing mostly therapy, I really never used my DSM because either I held on to clients for a while or I’d see similar diagnoses or just like Google stuff really quickly about criteria and make sure.
Oh, okay. Yeah, I’m good. So I sh. I showed my therapist, I was like, you have the new one, right? The 5 TR. She’s like, bought the 5 TR.
That’s new. And I was like, yeah, that’s been out for a little bit now. She’s like, when.
Let me put it. And it was, it’s from. I didn’t realize it was 2022 that the DSM 5TR came out. So she was laughing, I was laughing. We were having a moment in our session.
She’s like, you’re gonna think some type of way about me. I was like, no, I don’t. Because I. I think I really didn’t look at my DSM as much when I was in private practice.
So doing therapy. Anywho, we get rusty.
So likely, if you’ve been in private Practice, you’ve been in agency work, you’ve been in a therapy job for a while. You’re not rethinking about like, oh, yeah, how should we think.
Thinking about termination all the time. So we know that the ending of therapy is very, very important to the client. And oftentimes we either don’t get the ability to have termination sessions with clients.
Sometimes they Dr.
In episode 35, I talk about navigating unilateral therapy terminations. And that was unilaterally from the client side of things and also unilaterally from the therapist side of things. And so oftentimes we don’t get to have this beautiful bookend experience where we have the beginning of therapy.
We know that client’s story. We’re able to kind of work through them, work on some, you know, I was an EMDR therapist when I was in practice, so work on their targets or work on whatever was going on and then, you know, wrap the therapy up, have a nice bookended experience with them and they go forth.
And it is beautiful. Doesn’t always happen. And I think what therapists worry about often when they’re closing practices or leaving or significantly cutting back on therapy clients is abandonment.
So abandonment is when we’re ending therapy without fully addressing their needs or without making arrangements for other treatment. And I’m referencing an APA article which I will also include in the show notes, which is when therapy comes to an end and how clinicians can bolster growth at the end, at the conclusion of the therapeutic relationship.
I think this is important ethically. Psychologists, this is. It’s APA psychologists. You can extrapolate for your own licensure, must terminate treatment if they can’t address the patient’s needs, if the patient isn’t benefiting from the treatment over time, or in the event of an inappropriate, inappropriate multiple relationship that may impair objectivity or judgment or harm the patient.
So that three pronged thing is what I think about in termination.
If you’re staying in practice, are they benefiting from the service?
If you just ask yourself that, is the client benefiting from the service you’re providing right now? What does their life look like? Is it better? Are they benefiting? Can you really address their needs?
Is this the service they need right now? Oftentimes we’re not asking ourselves that. We need to think about that referral. And also this rarely happens. But if someone threatens to assault you or, yeah, you can terminate treatment immediately without the termination phase.
So in my next episode, I’m going to kind of talk about those two situations. So how to manage when termination sessions need to happen all together and how to manage it when therapy’s really stagnant and how to know when to do that.
So interestingly enough, when I started with that thing from LinkedIn, in my little post, we’re taught to discuss termination early on to prepare them for termination, even if you don’t anticipate it’s going to happen soon.
And I think I did that early on, but I’m not sure if I really kind of got into bad habits of not talking about it at a regular cadence of therapy ending because I tended to hang on to my clients for years, right?
So when I left therapy, I still had a number of long term clients that I held on for multiple years.
And some of that was great work that I was doing with that client. They had goals that they were continuously working on and at other times it was not a great situation.
I don’t think that they were meeting their treatment goals or I did not address it at a regular cadence. So from this article, along with introducing the process of ending treatment, discuss how you’ll review progress on treatment goals.
Again, I think when we’re out of our training experiences, we are taught to do this. Do we always do that? I think we get into bad habits there too, right?
So I think it’s really thinking about this, about this cadence of talking about the end. What does this look like?
Of course we need to avoid abrupt termination. So when I talked about my guide, I recommended a 90 day practice closure. If you are closing your practice, there’s no hard and fast rules, right?
No one says that if you see a client, you have to give them 90 days. If you have to, you know, like move across the country if you get orders or say you’re in the military or something like that, you, you have to go, you have to go.
You have to do the best with the time that you have. And so we’re ethically thinking through that for ourselves and our clients of how to do that. One research article said that psychotherapists tend to spend about 12% of their total treatment length dealing with termination issues.
So that’s a good rule of thumb to think about.
You know, that could be roughly like a month if you see them for a year, you know, or four sessions or five sessions, something like that for clients you’ve seen for a long time.
I mean, I, I think it can, right? If we’ve seen them very many years, then projecting that, like not projecting, protracting anyway, can’t Think of the word I want could be too much, right?
But think about if I’ve seen this client long term, I want to spend more time with them. The termination phase, a protracted amount of time, Right? All right. You know, the things I, I often loved termination sessions.
And I wish, I wish I had more bandwidth in those last, I think, months when I closed my practice, because I had some really beautiful sessions. And I can now see that, that I did some really, really great work with folks.
And I really highlighted the work they did. It was their work that they did. And my job was really to gather, I think of like gathering the flowers that they, that bloomed for them, right?
All these flowers bloomed, and we gathered the flowers and made this beautiful bouquet and then sent them home with that. And I like that imagery for clients because really they did this beautiful work.
And so one of my favorite ways to do that was by doing resource development in emdr.
So in the EMDR model, we start with, well, history taking first, and then our second phase of EMDR is resource development. And so you installed basically all these resources, a lot of the things that most therapists have been trained in.
So some of that is like regulation skills, grounding skills, deep breathing. The EMDR model often uses two specific ones, which is a calm place or comfortable place exercise, where we install that with the client, and also the container exercise.
But also we often would install a nurturing figure, wise figure, older self, an older, wiser self figure. And then throughout the therapy. So let’s say they had driving anxiety just because I have that and it’s easy for me or used to any think about all their targets and all the positive cognitions they had.
Like I got through that or it’s over now. And so I would, I would highlight all those positive cognitions and then install that usually bilateral stimulation in their last session.
So if they had a favorite regulation skill, maybe it was a nurturing figure. And their nurturing figure was a character from the help. I had one client that had. That was their nurturing figure was a character from the help.
And we installed that. And so maybe we brought that character in. Maybe we used some of those positive cognitions from our resourcing sessions. Potentially we used other things that were really meaningful in the work and we installed them as an actual resource.
So all those positive cognitions, then we gather all those roses together and do bilateral stimulation, tapping, eye movements, whatever you want. Running around the room, walking could be a walking meditation, right, that you’re doing with clients.
Some people do walking EMDR Therapy. That’s how franchise Francine Shabiro founded the model.
Think about how we’re going to end that. How are we going to help them gather that bouquet of wonderfulness that they can take with them? Oftentimes, I would write a letter to a client, so I would write them a letter about their gains, about what I noticed about them, and then wrote them, like, a wish, you know, going forward in their life, and then gave that to them, actually read it to them in session, and then I gave it to them before they left.
So that’s another way. I think we are definitely planning that goodbye, right? We’re planning ways that would be meaningful for the client and the work that you did together to have a meaningful goodbye.
So I think for some of my clients had been particular to them. Like, I had one client where we listened to music a lot together because that was really regulating to them.
So they would often share a song on their phone with me. And so I thought of let’s share some songs together. That made us think about our therapy sessions. And so that was a way that we ended our work together.
So it can be specific to the client, specific potentially to any cultural factors that might be important to the work that you did together. I think the key is we want to plan it right?
We want to plan what would feel good. I often would talk about the card that I didn’t expect them to write me a card or to read my card, but that I wanted to provide that for them if they were okay with that.
And most of the time they said everyone said yes and say they would want the card and they would be okay with me reading it. This last part, I think, is also coping with your own emotions.
So multiple terminations and I’ll talk about this next week. It is a lot to go through at once to have your whole caseload to say goodbye to all of them.
They are connections we have with humans. And emotionally, it feels very heavy. It feels like a lot of loss. And so I really think about this process as attending to grief that you’re feeling through that.
So as you’re doing these terminations, I think honoring the relationship, doing some kind of ritual or practice to help you through that. So I work with that often with my therapist, coaching clients on how are you going to attend to the grief that’s coming up about not having this client in your life anymore that has been really special to you.
You’ve done really great work together, and you can’t see them anymore, you can’t contact them anymore. And it’s. It’s such a weird part of our role that we have this emotional intimacy with people, yet we can’t have them in our lives and vice versa.
Right. For a lot of good reasons. We know why, but it’s still hard and we still have an emotional response to it. So I think caring for yourself is often what I do is that’s what I hold space in My consultation is just what’s coming up for you around all these losses and your burnout and your depletion.
And it’s just one more thing often that I think we have to think about. But if we’re doing this, you know, maybe we’re cutting down our caseload also thinking about that, how are we attending to our own emotions through this?
That is all I have for you today, therapist. I hope you enjoyed this episode. I still have my practice closure guide, so if want to grab that in the show notes, please grab it.
It helps you kind of understand those steps on what you need to do to close your practice. I hope you have a good one. Bye.
