When is a person ready to leave counseling? What do they need to learn or achieve or grow toward? — T.F., Detroit, Michigan
What a great question! I think termination (as it’s called in the trade) is another part of the art form of therapy. The willingness and skillfulness of your therapist in helping you end therapy are a competence people should expect from competent therapists.
Termination — funny moniker, yes? Ever since film director James Cameron gave us the now-iconic Arnold Schwarzenegger character (1984), I’ve had this zany fantasy that someday, during a last session with a patient, I would feign an Austrian accent and say, “You’re terminated.”
I have thus far resisted the temptation.
I’m going to answer your question in two parts. This column is Part One.
In the near 30 years I’ve been plying this craft, there are three basic ways a patient might employ a therapist. The first is as a resource consultant. These people come for one, no more than three, sessions to pick the therapist’s brain about a particular issue. For example, what can I expect as my children adapt to their parents’ divorce? What’s the latest research about the viability of marriages with significant age differences? Premarital counseling falls into this category.
When I’m deployed in the role of consultant, termination is no big deal. I’m appreciated perhaps, but there’s no significant bond. No more than with the knowledgeable, informative landscape architect who walked around your backyard with you for thirty minutes, talking possibilities and prices. Nice person. Knew his/her stuff. But that’s the beginning and the end of it.
The second use of a therapist is in crisis intervention. Triage. Assess and refer. The “intervention model” is most often two to six sessions. It’s intense. No psycho-freudian navel-gazing because there is no time. People need advocacy, protection and support right now! Or else someone is going to burn down a marriage. A family. A career. Go to jail. Or the hospital. Or the morgue.
In competent crisis intervention, a bond tends to be formed that is not dissimilar to the bond you’d form (assuming you were conscious) with the EMT tending you sprawled on a sidewalk. Or a firefighter on your front lawn at 2 a.m. You’re glad, even very emotional about having someone who knew exactly what to do and exactly what to say at a time you were lost, overwhelmed, terrified and feeling crazy.
But again, termination is “built in” to crisis intervention. It often reminds me of watching “The Lone Ranger” on television when I was a boy. He comes in, saves your life, and about the time you’re recognizing that the crisis is past and you’re going to be fine, all you see is the receding dust cloud trailing behind a galloping horse. “Who was that masked man?” the pilgrims would ask as the credits rolled.
Termination gets trickier — much trickier — in more classical therapeutic relationships lasting several months or even a year or more. When therapy works, these sort of therapeutic relationships have lots of energy. Big Medicine. Weighty indeed. Some patients just know when they are done. And they just plop in and announce it, with a typical shrug of the shoulders and a little shy, self-consciousness, as if they fear hurting my feelings.
Slightly more often, however, patients ready to terminate will become inexplicably busy. Suddenly, it becomes much more complicated to schedule them. Or, suddenly, they begin to be late to sessions. Or to forget them. Or to “no-show.”
In still other cases, they will find cause to be angry or disappointed in me. Or they will risk philosophical disagreements, even enjoin spirited arguments with me. Or they will become slightly belligerent, saying things not dissimilar to an adolescent: “I don’t care if you’re mad at me,” etc.
All of these can be signs that a patient is finding difficulty and discomfort in terminating.
Well, of course it’s hard. It’s a necessary loss. The goodbye we say to the therapist who helped us is an important goodbye. And usually a painful one.
My former therapist lives in Phoenix. I’ll never forget her. Intellectually, I’m aware that she is a regular human being with a life and a family and “ups and downs” just like everyone. But, to me, in my psyche, she also will always occupy the office of Mysterious Shaman. Occasionally, I still dream about her.
I wept during my last session. There were tears in her eyes, too.
The ground between us will always be holy.
Steven Kalas is a behavioral health consultant and counselor at Las Vegas Psychiatry and the author of “Human Matters: Wise and Witty Counsel on Relationships, Parenting, Grief and Doing the Right Thing” (Stephens Press). His columns also appear on Sundays in the Las Vegas Review-Journal. Contact him at 702-227-4165 or firstname.lastname@example.org.