Breaking up is hard to do.

May 18, 2007 4:33 PM

My therapist has decided to return to grad school for a PhD. I'm happy for her, but this also means she won't be seeing patients anymore. Our final appointment is on Tuesday. How do you achieve closure in this kind of relationship?

I've only been seeing her for about 6 weeks for CBT, but I have been benefitting from the work, and I felt comfortable with her. This is no small thing since I have seen other therapists and never before found someone I had a rapport with. I'm disappointed and a bit scared that she's checking out, and I'm nervous, never before having ended such an intimate-yet-professional relationship.

She has given me names of colleagues, and I'm sure I will find someone else who is good. But this feels like a scary change and I'm not looking forward to it.

I'm not sure how to approach our last session. I want it to be as enlightening as possible while providing a sense of peace. Are there any specific questions I should ask to gain insight on how the therapy went? How should things wind up so that I don't feel left hanging from being interrupted in a course of potentially successful therapy? Why do I get choked up and teary thinking about it? How do I handle this with grace?

posted by loiseau to health & fitness (9 comments total)

My case was a little different, as I'd been seeing my therapist for years. It was strange to not have her to see every two weeks, but I felt more at the end of my work, rather than right at the beginning. She gave quite a bit of advance notice that she was retiring. She asked me a few times early on if I wanted to talk about her retiring, but I waited until closer to the date, and then asked how she thought it was appropriate to conduct our final session.

As I recall, she gave me a letter talking about my progress with her, my achievements, and things that still might need work. She also gave me some names of other therapists, which I had requested. I gave her a card in which I'd written about what I'd appreciated in our relationship and how much she'd helped me. We mostly then chatted, more as friends, and enjoyed the hour until it was time for me to go.
posted by Squeak Attack at 5:17 PM on May 18, 2007

Awhile back, I had a very emotional and meaningful parting with my therapist of 2 years. We had, however, reached a point where we talking frequently about the therapeutic relationship itself -- a shift which felt weird, especially at first, but actually catalyzed a lot of insights.

I would recommend saying to her exactly what you've said here -- even print out a copy and have her read it. Remember, this is about you -- so you really needn't handle it with grace. If she's a good therapist, and it sounds like she is, she's not going to judge you for getting all choked up.
posted by treepour at 5:31 PM on May 18, 2007

I’m trying to picture my therapist and it being our last meeting, and I’m getting a bit choked up myself. It’s not easy finding someone who you can connect with so intimately. I think you have a right to be worried, and you should tell this to your therapist. I’m sure she will understand, and being the good therapist that she is, and has been in the past, will guide you through the formalities of developing a new relationship with your future doctor.
Why don’t you write down all your fears, so that you’ll remember them when the time comes to ask all those last minute questions? I think the one on the top of my list would be: will this new doctor be good enough for me? And I’m sure s/he will be, if your current therapist thinks so. Besides, hasn’t she given you a list? I know it sounds like a frightful proposition, but you have the option of changing doctors if the treatment is not to your liking.

(Is it possible for you to keep in touch with her, just to have someone there? If not, you can always post here, or mail me, or any of the others I’m sure, and we’ll be glad to help)
posted by hadjiboy at 6:23 PM on May 18, 2007

You might use the time to discuss what has been helpful about the therapy and the things which made this woman particularly well-suited to you as a patient. This will not only allow you to put a period on your time together, it will also help you to articulate those things which you might be looking for in your next therapist.
posted by OmieWise at 8:39 PM on May 18, 2007

It's hard to leave a therapist, and I know from personal experience. When I left mine, I asked her if she'd walk me to the front door (from her office) just as a sign of closure.

I don't know what kind of person you are or she is, and it might not be this way for you, but I ended up crying and hugging her, and it was all okay with her too. She hugged back and I thanked her and then managed to walk away under my own power, which I never thought I'd have been able to do.
posted by IndigoRain at 1:23 AM on May 19, 2007

Thanks everyone.

indigoRain, she told me today on the phone that she has a no-hugging policy. I'm glad I knew before I made any faux pas!

I'm definitely going to cry. I almost did just writing this post!
posted by loiseau at 4:54 AM on May 19, 2007

One thing I've found helpful is to spend some time reviewing with your therapist the specific things you've learned, or changes you've made, during the time you've worked together. What are all the things that are different in your life (or in your head) since your first session? And, after clarifying and enumerating those, what are the things you still want to change, and what are the next steps?

This can help one see the ongoing process of life change that is already well in motion and that will continue as you move to a new therapist, and it also helps to reinforce that you're the one in charge of the whole process, you're the one who's made the changes. (It also certainly can help the therapist with her own closure, and give her some assurance she's been able to be of help to you. Trust me, terminations can be as hard for therapists as for clients.)
posted by Kat Allison at 5:58 AM on May 19, 2007

Well, the appointment went better than I expected.

Before we met she called me to review what I wanted to talk about. She said we would not be covering new ground but would be discussing the therapy itself and where I would go from there.

She asked me to consider how endings had gone for me in the past and how I would like this one to go. She also gave me some questions to answer: How I felt about the therapy generally, what the key moments were, how I came to trust in it, and what I feel I should work on with the next therapist. She also answered the same. Writing this down the night before the appointment was the hardest part. I was expecting to be a broken-down mess, but I think I got most of the crying out doing the thinking and writing on those questions.

The next day when we met, first we reviewed the goals I had made for the course of therapy on the first appointment, and I rated how well I think they had been accomplished. It turned out that my ratings were significantly higher than I had rated my expectation they would be, when I first wrote them. So I had done much better than I had expected.

Then we took turns answering the questions. I felt really good about my answers, and hers matched mine a lot, so we were on the same wavelength about things.

The third thing was that she gave me some feedback about her view of me, including some really nice comments that made me cry a bit. She also told me that she really liked working with me and then we both teared up again. (It was nice to see that bit of humanity.) Then I gave her some of my general notes, like that I was a skeptic and that I was surprised to learn that CBT could work for me, that it was surprising that my problems were not so huge that they couldn't be helped.

Then we discussed what I'd be doing to proceed, and I told her I'd decided to meet with a new CBT practitioner in the same family health clinic (who is a doctor, meaning it's covered under medicare). She agreed that was a good choice, and we went to the desk together to make an appointment with her.

Then we said goodbye and she shook my hand. We wished each other luck and she said again that she really liked working with me. I started to cry again but it was time to make my exit. Once I got outside I felt better. I hadn't totally broken down and I felt that we had wrapped up well.

I'm still bummed about it -- in fact I'm crying a bit writing this -- but I feel like it was a good experience so I'm not wholly sad. I meet with the new therapist on the 12th. She was trained by my therapist and her supervisor, so I have faith that it will be an okay transition. She's only had three CBT patients, but at least I'm not the first, and I'm hopeful.

Anyway, I'm just posting in case someone searches for a question like this in the future. It's not easy and it's not ideal but it's the worst thing in the world.
posted by loiseau at 6:40 PM on May 25, 2007

Thanks for the update, loiseau. I'm glad the final meeting went well and that you're holding up okay.
posted by spork at 7:34 PM on May 25, 2007