Tag Archives: Termination

Clinical Interviewing, Cool Counseling, Counseling and Psychotherapy Theory and Practice, Therapy with Adolescents, Tough Kids, Tough Kids Cool Counseling

How to Make a Collaborative Plan for Terminating Counseling without Ever Using the Word Termination

2 Comments

Stone Smirk

Not long ago I noticed some of my excellent and well-intended supervisees talking with their clients about “termination.” They would say things like, “We need to prepare for termination” or “Let’s talk about termination today.” When this happened, I’d get nervous, squirm a bit, and eventually find a way to tell my supervisees that, although we use the word termination all the time when talking with each other ABOUT counseling, we shouldn’t use it when talking with clients DURING counseling.

Instead of saying termination, it’s preferable to talk about final sessions, or the ending of counseling, or to use normal and jargon-free words that speak to the reality that all good things—including counseling—must end. Sometimes the number of counseling sessions possible is dictated in advance by employee assistance program guidelines or insurance companies; other times, clients and counselors have more freedom to work together as long as the work is helpful or productive. Either way, ongoing conversations linking goals to progress is a part of an evidence-based approach to counseling and psychotherapy. Effective counselors connect the “ending” of counseling with the goals that were, in the beginning of counseling, collaboratively identified (and then possibly modified as needed).

Although you should use your own words, statements like some of the following can help you talk with clients or students about termination without using the word termination.

  • “Let’s talk about how our counseling is going and whether we’re making progress toward your goals”
  • “How do you feel about our counseling together?”
  • “I’d love to talk about what I can do differently to keep helping you move forward toward your goals.”

Speaking of termination—and now I’m speaking to you and not my clients—below you’ll find a Termination Checklist that you might find helpful as you talk with your students about preparing for termination. As will everything, this checklist is imperfect, but it’s a good start to help all of us address the ending of counseling, before counseling actually ends.

Termination Checklist

[Adapted from Sommers-Flanagan, J., and Sommers-Flanagan, R., (2007).
Tough Kids, Cool Counseling: User-Friendly Approaches with Challenging Youth.
Alexandria, VA: American Counseling Association]

This is a guide to help you think about termination—even though some of the details will be different for you and your client(s).

_____ 1. At the outset and throughout counseling, identify progress in the movement toward termination (e.g., “Before our meeting today, I noticed we have 4 more sessions left,” or “You are doing so well at home, at school, and with your friends. . . let’s talk about how much longer you’ll want or need to come for counseling”).

_____ 2. Reminisce about early sessions or the first time you and your client met. For example: “I remember something you said when we first met, you said: ‘there’s no way in hell I’m gonna talk with you about anything important.’ Remember that? I have it right here in my notes. You weren’t exactly excited about coming for counseling.”

_____ 3. Identify and describe positive behaviors, attitude, and/or emotional changes. This is part of the process of providing feedback regarding problem resolution and goal attainment: “I’ve noticed something about you that has changed. Do you mind if I share what I’ve noticed?” [Client gives permission]. It used to be that you wouldn’t let adults get close to you. And you wouldn’t accept compliments from adults. Now, from what you and your parents tell me and from how you act in here, it’s obvious that you give adults a chance. You don’t automatically push adults away from you. I think that’s a good thing.”

_____ 4. You should acknowledge, in advance, that the end of counseling is coming up, but there’s a possibility you’ll see each other in the future. “Our next session will be our last session. I guess there’s a chance we might see each other sometime, at the mall or somewhere. If we do see each other, I hope it’s okay for me to say hello. But I want you to know that I’ll wait for you to say hello first. And of course, if we see each other in public, I’ll never say anything about you having been in counseling.”

_____ 5. Identify a positive personal attribute that you noticed during counseling. This should be a personal characteristic separate from your client’s goals: “From the beginning of our time together, I’ve always enjoyed your sense of humor. You’re really creative and really funny, but you can be serious too. Thanks for letting me see both those sides. It took courage for you to get serious and tell me how you’ve been feeling about your mom.”

_____ 6. If there’s unfinished business (and there always will be) provide encouragement for continued work and personal growth: “Of course, your life isn’t perfect, but I have confidence that you’ll keep working on communicating well with your sister and those other things we’ve been talking about.” You may want to say that even though your client doesn’t “need” counseling, choosing to come back for counseling in the future might be helpful: “You know some people come to counseling to work on big problems; other people come because they find counseling helps them be a better person; and other people just like counseling. You might decide you want start up again for any of these reasons.”

_____ 7. Provide opportunities for feedback to you: “I’d like to hear from you. What did you think was most helpful about coming to counseling? What did you think was least helpful?” You can add to this any genuine statements about things you wish you’d done differently. For example, if your client got angry at you for misunderstanding something and this was processed earlier, you might say: “And of course I wish I had heard you correctly and understood you the first time around on that [issue], but I’m glad we were able to talk through it and keep working together.”

_____ 8. If it’s possible, let the client know that he or she may return for counseling in the future: “I hope you know you can come back for a meeting sometime in the future if you want or need to.”

_____ 9. Make a statement about your hope for the client’s positive future: “I’ll be thinking of you and hoping that things work out for the best. Of course, like I said in the beginning, I’m hoping you get what you want out of life, just as long as it’s legal and healthy.”

_____ 10. As needed, listen to and discuss how your client is feeling about ending counseling. Don’t make this into a big deal, but offer opportunities for the client to say “I can hardly wait for the end of this counseling crap” or “I wish we could keep meeting.” Whatever your client is feeling about termination warrants respectful listening.

_____ 11. Consider a parting gift. Although I don’t routinely recommend this with adults, with young clients you might give a meaningful gift at the end of counseling. It could be anything from a painted rock to a blank notebook for writing or a written card. The point is to give a gift that’s not especially expensive, but that might hold meaning for your client in the future.

For more information on termination with youth, go to: https://www.amazon.com/Tough-Kids-Cool-Counseling-User-Friendly-ebook/dp/B00QYU630Q/ref=sr_1_7?s=books&ie=UTF8&qid=1550512844&sr=1-7&keywords=sommers-flanagan

Counseling and Psychotherapy Theory and Practice, Personal Reflections

Psychoanalytic Endings

4 Comments

JSF Travel

Psychoanalytic therapists have a penchant for drama. They speak of psychotherapy termination as metaphorical death; they see sexual objects everywhere. The rest of us are, rather disappointingly, seeing trees and rocks and designer boots, while the psychoanalysts get to see, well, you know what they get to see.

You say you dreamt of rocks? What sort of rocks? Might they have been egg-shaped? Or perhaps you saw the sandy bottom of a river covered with little fishes? Could it have been a salmon hatch? Perhaps all this represents your unconscious longing for fertility. But what if you don’t really wish for more children; instead you’re pining for the unmitigated proliferation of all your excellent ideas? Like maybe you’re fantasizing an NPR interview where you get to talk on and on about obstruction of justice. Or just a cameo where you get to comment on who’s really the grand-stander.

Or maybe, yesterday, you just gazed a little too much at the Stillwater River, and so you dreamt of rocks and little fish?

Better yet, maybe both are true.

But I digress.

Like all chapters in our theories textbook, the psychoanalytic chapter has to end. But it doesn’t want to. It wants to drone on and on because it has so many important points to make. One of those points involves closing the chapter with a few fascinating historical comments about Freud. But some people contend that having “Concluding Comments” and a “Chapter Summary” is redundant. But other people don’t think so. If you’ve gotten this far and are still with me, you be the judge. Are the following “Concluding Comments” worthwhile?

Concluding Comments

Anyone whose collected works fill 24 volumes is likely to have—as we psychoanalytically informed mental health professionals like to say—“achievement issues.” Dr. Freud might even accept this interpretation. He sort of said it himself, “A man who has been the indisputable favorite of his mother keeps for life the feeling of a conqueror, that confidence of success that often induces real success” (E. E. Jones, 1953, p. 5).

Judging him based on his own theoretical perspective, Freud suffered from some Oedipus conflicts, and these were, in part, manifest in his intense striving for recognition. It may have been his penchant for stature that caused him to invent and then recant his seduction theory.

In 1937, 2 years before Janet’s death, Edouard Pichon, Pierre Janet’s son-in-law, wrote to Freud, asking him to visit with Janet. Freud responded:

No, I will not see Janet. I could not refrain from reproaching him with having behaved unfairly to psychoanalysis and also to me personally and never having corrected it. He was stupid enough to say that the idea of sexual aetiology for the neuroses could only arise in the atmosphere of a town like Vienna. Then when the libel was spread by French writers that I had listened to his lectures and stolen his ideas he could with a word have put an end to such talk, since actually I never saw him or heard his name in the Charcot time: he has never spoken this word. You can get an idea of his scientific level from his utterance that the unconscious is une facon de parler. No I will not see him. I thought at first of sparing him the impoliteness by the excuse that I am not well or that I can no longer talk French and he certainly can’t understand a word of German. But I have decided against that. There is no reason for making any sacrifice for him. Honesty the only possible thing; rudeness quite in order. (Jones, 1961, pp. 633–634)

There was no special reconciliation for Freud. Toward the end of his life he suffered from many medical and psychological problems. His addiction to tobacco led to cancer and jaw surgery and considerable physical pain. In September 1939, he asked a fellow physician and friend, Max Schur, to assist in his suicide. Freud asked, “Schur, you remember our ‘contract’ not to leave me in the lurch when the time had come. Now it is nothing but torture and makes no sense” (Gay, 2006, p. 651). After Schur responded, Freud replied, “I thank you” and followed this with, “Talk it over with Anna, and if she thinks it’s right, then make an end of it” (p. 651). Although Anna was initially against the plan, Schur argued otherwise and on 2 consecutive September days, he administered enough morphine to finally result in Freud’s death on September 23, 1939.

Freud’s legacy is often linked to negativity or pessimism. There are good reasons for this; Freud focused on issues like the death instinct and primitive instinctual impulses, impulses that we have little awareness of or control over. But he was sometimes hopeful. One of his more optimistic statements is carved in a memorial to him in Vienna which reads,

The voice of reason is small, but very persistent.

**************

Let me know your vote. I’m sure, just like the vote for who’s the real grand-stander, it won’t be particularly close.