Speaker A: Welcome to the therapist burnout podcast, episode 58. 58. I’m not re recording that. Okay, we’re episode 58 and today we’re talking about terminations. I was going to talk about when you have to close with clients all of a sudden, so likely discharging your whole caseload.
For example, if you’re closing your practice and also when you have, you need to do some of those unilateral terminations that I talk about.
So maybe you’re burnout and there’s part of your practice that’s not working for you. Maybe you’re working a job and there’s some clients you don’t feel like you should be working with.
And so some of that you might to push back on the system and really look at treatment goals and tell them, ethically, I don’t feel like I am able to provide the service to the client.
So I talk a little, I’m going to talk a little bit about that. But first I was thinking about Yalam this week because I loved his work. I love his work.
Okay. But early in my career I read a lot of Yalm. I think it’s part of the reason why I fell in love with the idea of being a therapist.
And perhaps if I can get back to the way I saw myself practicing when I was in my training, maybe I will be a therapist again. I don’t know. There’s no promises here.
It’s not happening anytime soon.
But I pulled out my group psychotherapy textbook from school written by Irvin Yalam, the great Irvin Yalam. And there’s just not a lot about therapists countertransference or the needs of the therapist in termination.
And so there’s just. I think we have to. I’m creating resources right now for us as we speak.
But he says, keep in mind the therapist.
Keep in mind that the therapist too experiences discomfort of termination.
And he’s talking about in the context of group, the final group stage.
Throughout the final group stage. If I can read today, we must join the discussion. We will facilitate the group work by disclosing our own feelings. Therapists as well as members will miss the group.
We are not impervious to the feelings of loss and bereavement. We have grown close to the group members and we will miss them as they will miss us. To us as well as to the client, termination is a jolting reminder of the built in cruelty of the psychotherapeutic process.
Such openness on the part of the therapist invariably makes it easier for the group members to make their goodbye more complete. For us, too, the group has been a place of anguish, conflict, fear, and also great beauty.
Some of life’s truest and most poignant moments occur in the small and yet limit, limitless microcosm of the therapy group.
And I think we can extrapolate some of that to individual sessions. So if you’re not in group work, you’re doing individual therapy.
I love that quote. And I’m going to extrapolate to therapy. Therapy has been a place of anguish, conflict, fear, and also great beauty. And I think that’s what keeps us in the work, the beauty.
Like we cannot deny the beauty of therapy and the work that we see our clients do, you know, think often about the beautiful relationships that I had in therapy. And it was really hard for me to leave that part, to know that in this work, with all of those emotions that are difficult, that are depleting, that are hard, and also in the heart is this beautiful, intangible thing that’s beautiful.
And so of course we’re going to miss that. Of course we’re going to grieve that. Even if we’re talking about leaving therapy like we’re leaving therapy, we’re leaving the work with a specific client or.
Yeah. So if we’re leaving the field completely. Right. We’re leaving that beautiful part of therapy behind, or we’re doing this with one client, maybe we’ve said, hey, I, I can’t hold you through this part of this work, or I can no longer do this because it’s bumping up against something in me that isn’t working for me as your therapist.
Those conversations are hard. And honestly, I don’t think we get enough training on when we feel like we can’t provide that service to the client anymore. So I wanted to talk with you a little bit about if you, number one, you decided to closure practice, you need to do multiple terminations.
And I’ve had people write to me. How do I even. How do I tell people? What do I tell people?
Do I tell people I’m burnout and I can’t do this anymore?
The short answer is you could say that maybe not in that way, but perhaps for some clients you might provide a window. Maybe there is enough if a relationship where they’re going to want to know from you why you’re leaving and what’s going on with you.
And so we have to think of that relationship and that client. Can I reveal more of myself with this particular client and why am I doing that? So anytime we Are doing any self disclosure we need to think through therapeutically, is that going to be beneficial for them?
And so for some of my clients, when I was closing, it was beneficial to them for me to tell them, you know, yes, I am taking another job. And I’m finding that my work as a therapist doesn’t always work for me, that running a practice doesn’t always work for me.
And mostly my clients handled that well. They were supportive of me, they were supportive of the work that we did together, and they were happy for me, even though I was like, I don’t know what’s happening.
I don’t know why I’m doing this sometimes, but I just felt like I couldn’t do it anymore the way I was doing it. So if you needed some ideas for things to say, you know, I think there’s multiple things that you can do, right?
So you can kind of make it general so you can say, I’m closing. I’ve made the hard decision to take a break from providing therapy for the foreseeable future.
This wasn’t an easy decision, and I know it might feel really hard to hear.
Also, I want to make sure that the care that I’m providing to you is very important to me, and I’m committed to make this transition as smooth as possible. So again, I think there you’re going to make sure that they know and you’ve provided a letter.
I talked a little bit about the kind of logistical things that you’d want to do, like provide that letter, have some referrals, three referrals ready to go.
But then communicate to them, like, I want to help you. If finding a new therapist seems like a good fit for right now, or if you want to work up until the end of our work together, you can do that and then we can talk about maybe what you want to accomplish in this time.
And I think also communicating, like, it’s okay if you’re feeling a lot of things right now. You know, oftentimes when we end therapy, it’s going to bring up for a lot of clients and feeling of uncertainty, other goodbyes they’ve had in their life, feelings of frustration, and like, I have to start with somebody all over again.
So I think allowing there to be room in the relationship for you to talk about that is important for your client. So for therapists that are retired, they’ve decided I’m like, retiring from the work.
I think you can. It’s easier. It’s kind of an easier statement, not really for the client, because you’re still not their therapist, but can communicate like, hey, I am going to retire my work as a therapist.
It’s a difficult decision. I know you’re going to have some reactions to that and I want to figure out ways to support you moving forward. So I think it’s important just to think about the client.
Right. Do you have to reveal everything of why you’re closing, of what’s going on in your life? No, you don’t have to do that.
You can come up with some things to say. You might need to. With some of my consulting clients, I’ve actually had them write this out and think about those difficult situations and clinically who they might need to tailor responses to because it might be more difficult due to the clinical needs of that client, how they can communicate that to them.
So I would just have you think through, like you can do a little self disclosure if that feels okay to you or you don’t have to. You can just be more general.
Again, I think clients are generally inquisitive, so being prepared for them to say, like, well, what’s going on? Are you okay?
So they will ask those questions. And so to think through those answers. You have to answer that question to say when.
Yeah, it’s not going to feel authentic to say, I am okay if you’re not okay. I think saying something like, you know, it’s been really, it has been really hard for me actually in this role and I’ve thought a lot about it.
And so you’re giving them some kind of process statement so that when you get in session and they ask you questions like that that are normal, very normal response to kind of wonder and be inquisitive about you, that you have a processed response to kind of come back and say, yes.
You know, actually it has been a little difficult. And this is what I’m. I’ve done. I’ve worked, you know, to make a plan to close my practice and I’m taking a job, I’m taking a break, I’m retiring.
So that you have something in place that you’re telling clients and then you’re holding space for them. It is a herculean effort to do a lot of terminations at one time.
So I’d have you really think through what my clients in particular they will need as they go through this process. I think more challenging that we don’t talk about enough is terminating unilaterally with a client.
So let’s say you’re going to stay in practice, but your therapy practice isn’t working. Like at all but you want to be a therapist. You know, there’s some clients that are really, really difficult in your week, and you know that maybe potentially discharging some of those clients and for good clinical reasons.
So you’ve looked at the caseload, you looked at their treatment, have come to the conclusion, and you’ve consulted that you can no longer meet the needs of that client either.
They know they are no longer benefiting from the service like you provided. Let’s say you provided, you know, 12 weeks of EMDR therapy, 12 weeks of CBT, whatever your orientation is, you provided that length of service, and then the client seems to be no longer benefiting.
That is a reason for termination. That is a reason why we can. We can know we don’t have to provide services if we don’t think that that client will benefit.
Also, potentially, the client might be being harmed by continuing to stay in service if they could be discharged to community supports or there’s another service, maybe they need another modality of care, trauma work, EMDR or whatever it is that they may need DBT groups, something like that, to.
To recommend that service so that client can get to where they need to go.
So we’re thinking through that ethically, through that ethical code of, you know, those. Those. I think just asking yourself this question, is the client benefiting from the therapy? It is the question I ask all the time for difficult cases, and that is directly from ethical code.
So I want you to really think through that question and look at your caseload, because that will illuminate your next decisions in needing to terminate with that particular client. So it’d have you do that.
I think what we don’t talk enough about is what care we may need as we’re saying goodbye to the client. When I came to the end of my practice, I.
It really felt like I probably said this on the podcast a number of times. I’ll say it again. It felt like loss. It felt like someone was dying.
And it was my practice. It was losing all these clients. And I think going back to Yalam’s words, it’s losing that beauty that we enjoyed in therapy that sometimes we don’t see very often, but we do see it.
And maybe I was naive in my 20s and my training and thinking a lot of therapy, yes, it would be hard, but it would also be really beautiful. And it is those things, but it’s also a lot of hard.
And so, yeah, I think it’s a lot of grieving, like the expectations we had of our field and what we saw for ourselves in the career. And I think, you know, often I’m on console calls and there’s just a sense of feeling utter, like really rudderless afterwards, like if you don’t know where you’re going or even if you have a job.
Just feeling like I really got it wrong. I really got it wrong going into this field or doing this thing. And I just want to offer you, you made the best decision with who, what you thought the career would be, what you thought the work would be, like how you thought you would thrive in it.
And it wasn’t a wrong choice. Perhaps I can say that now after two years of leaving the field and that comes, that’s a very processed thought. But for a long time I felt like I had failed.
I felt like I really messed up, I got it really wrong. And now I have compassion for my 20 year old self in believing that this would be a good choice for me, that I would like it, that I would thrive in it, and perhaps if some of my training experience would be more like what it looked like when I was in practice, which was a solo practice, where I didn’t see people, where I didn’t have support when I was in my training.
I feel like I was always talking to people about the work. I was always going to lunch with people from my jobs. And so I think we can’t, we, I think we have to remember that a lot of what many of us feel in solo practice especially, but also in other roles as a therapist, because we, we do go into the therapy room alone.
If we’re doing individual therapy, we don’t have anybody witness.
Whereas like I, when I go to my pt, I’ve talked about this before, they’re often co. Treating with each other or they’re in a common space. And though there’s just like maybe little banter about the super bowl, which is up and coming, or you know, what a dumpster fire, our political system is, you know, just this commiserating on things that are happening in our world.
Right. So I’d have you really think through what’s coming up for you, if you’re thinking about this and if you’re considering multiple terminations, that it is likely that your thought process and your emotional process is likely colored by the work and it’s going to be colored by this sense of loss.
Just think about if we lost multiple people and we were grieving multiple people at once in our life. Let’s say, you know, our, you know, our parents passed away or a friend passed away and you had Multiple losses that stacked at the same time.
Would your thought process be colored by that? Would your body be affected by that? There’s so much research on grief in the body and neurochemically how we change, of course it will be.
Of course your body will be affected. Of course your emotions will be affected. Of course your thinking will be affected. So I think we tend to personalize a lot of that on ourselves because therapists, while we know a lot of great techniques and how to manage our thoughts, we often don’t do it very well.
Personal experience speak to you from personal experience and someone who’s been in therapy for a long time. I am trying, learning, you know, trying to be kinder to myself. And does it always work?
No. But I think because we have often been in these situations that are traumatic, that are difficult, that of course our thinking and our interpretations are going to be colored by that.
So I would, I would have you, you know, really think through what is coming up, but in the context of why it’s happening, in the context of how you’re thinking about this for yourself, and I hope if I can be a therapist, big sister to you, is would be to say, please be kinder to yourself.
Please give yourself a break, because this is hard. So I will leave you with that. That is your shorty episode here on termination. I am going to be doing a little bit of a series on clinician mental health, and I was just inspired by something I saw on LinkedIn that had this comparison to burnout and depression, because I deal with both, I struggle with both.
But also I feel like for clinic to really think through, am I depressed or am I burnout? And maybe you’re both. But I feel like there, there is a great deal of overlap.
And what do I need in my burnout recovery versus depression? Care for my depression if that’s happening for you? Because I feel like there is a lot of overlap. The more I’m in these burnout streets, y’all, the more it reminds me of my work with people who had a traumatic brain injury.
And so many times when I would have a client who had a traumatic brain injury, they would come to me after years of seeing other professionals, they had been told, you just have anxiety.
Yes, you had a brain injury, but now it’s just anxiety. Like, you’re good, you’re fine, you had a clear imaging scan, you had pt, you had ot, you had speech therapy, so now you just have anxiety.
And they would be freaking hot as a hornet coming in here thinking, I’m going to Tell them you just have anxiety.
And I never did that. I never did that. And I, I. What I did was sit with the weight of it. We often in the brain injury will talk about like a mild TBI is like having mild cancer.
Like you have cancer, you don’t have cancer, you have a brain injury or you don’t have a brain injury. And for a lot of people, a mild TBI or otherwise known as concussion means that that individual may no longer work, may no, may no longer have a family relationship with the people they are in their lives with.
So there’s a high level, high rates of divorce, rather.
So a lot of times when people came to me, they were in chronic nervous system depletion.
They, yes, they had anxiety, but for good reason.
For good reason, they had some anxiety and a lot of that wasn’t treated. So they had some traumatic reactions after their initial injury. Perhaps they went to a grocery store and then had a panic attack because their brain injury symptoms made them have a panic attack.
Essentially they were overstimulated and they had a, like a dorsal vagal shutdown. I say all that to say that burnout is more complex than needing a mindfulness technique, than needing a simple intervention or simple self care.
I feel like if you listen to this, you know, this what you need as a therapist if you’re in burnout is going to be beyond a simple solution. It’s going to be beyond finding a, a new job, finding a different career, figuring out how to work differently.
I am still now to this day, two years after closing my practice, still figuring out how can I work without burning myself out.
Still my job, that is still my job, not to burn out of my burnout podcast.
It is my mantra.
So I will leave with you, you with that. Friends, if I could say anything, be kind to yourself.
The world is crazy.
If you want to hear more from me, join my pen pal list. So I have a therapist pen palace. I have to say it like that because I don’t know, that’s just me.
And I write back. So if you write me an email, it’s me. I don’t have staff, I don’t have a million people. Maybe that will change because thank you to all your listeners.
I have like over a thousand therapists that listen to this every month. And so right now I can still write you back. So if you listen to this like five years from now and I’m some big stuff and I’m, I’m just kidding.
But if you’re listening to this like way later, maybe the podcast grew. Maybe I blew up.
I don’t know. But right now I haven’t. I’m still. I’m doing great work. I have some. I have therapist clients, and things are going well. And I’m very, very happy with where things are.
I don’t need it to blow up because I still want to be here for you. And I will continue to do that.
That is all I have. Bye. Bye. Did I tell you to join that. Wait, did I tell you to join the Pen Palace? Click the link in the show notes because you hear from me, you get all the updates.
And I want to launch a group. I’m putting it out there. The burnout groups are happening. I don’t know when, I don’t know where. And I want you guys to come to Maine.
I want to have a retreat.
I want to pack a. One of these sailboats that I have been on in Casco Bay where we’re dry. We’re. We’re sailing past lighthouses with our glass of wine and our charcuterie, living our best lives with the wind in our hair.
You guys are coming to Maine? I don’t know when it’s happening. It’s happening. That’s all.
This may not be included on the final cut.
