It is also helpful to set a rough timeline for treatment. Both parties must understand and accept what abandonment is and isnt to avoid inappropriate behavior and get the best out of sessions. . For some, ending therapy can give a sense of loss. What did you learn about yourself or how others see you? Clients may worry that termination is their fault or may fear leaving therapy means they will no longer have support. Borderline Personality Disorder isnota "mental illness." Terminating therapy with a borderline client can be difficult for both the therapist and the client. Do not abandon a client without warning. Explore the clients reluctance and what can be done to help them feel ready for termination. Any male who persistently gets involved with borderline personality women, has severe attachment fears of his own. Thank the client for the opportunity to work together. These behaviors can be on the therapist's or the client's end, and include arriving late or even missing sessions and a non-collaborative stance in working towards treatment goals. However, there are some general guidelines that therapists can follow. Together, the client and therapist take a step back and look at the personal growth that has slowly unfolded over the course of treatmentgrowth that may have gone unnoticed . In a sense, there exists a permeable membrane between a Borderline's private life, and the relationship he/she shares with any practitioner who is dedicated to doing healing and growth work with them. Read our. Be honest. Their self-bolstering 'affirmations' may briefly override feelings of self-loathing, but these grandiose defensive strategies are still compensatory, which keeps the false-self actively refuting and rejecting the typeof help they really need, in order to discover, accept and finally embrace the whole, authentic Self. This aspect can be extremely challenging for even the most gifted of practitioners. Borderlines may develop a 'crush' on their clinician as this relationship solidifies. Does a therapist ever terminate therapy with a client? When terminating therapy, therapists should always remember to put the clients needs first. 7. This is no easy task of course, because the Borderline's been in his/her head lifelong,mentallyanalyzingall their feelings(like you have)since they were about two years old, and gained vocabulary. Describe some changes made and coping strategies adopted by the client. This plan should include recommendations for how the client can continue receiving support after the termination of therapy. Struggle to provide closure for the therapeutic relationship. When a therapist and client have a long and trusting relationship, the end of therapy is a major milestone. The unique struggle this can present to clinicians is monumental, as their natural priority is to be gentle with the patient/client, but this might entail dangerous disregard of the Self, to where a professional can feel off-center and completely undone, while treating some of these individuals. Talk therapy teaches people vital skills . There's a separation/individuation issue that's stirredbeforethis two year juncture, which activates subtle anxiety involving real dependency and the risk of abandonment~ tragic remnants of developmental struggles with Mother as a toddler. It is important to allow yourself to experience these feelings. Their anger about these tragic outcomes is palpable and quite understandable, as I'm seen as just another person who'll let them down. Joyce, A. S., Piper, W. E., Ogrodniczuk, J. S., & Klein, R. H. (2007). In my view, until you've become so familiar with a Borderline's defenses and patterns of behavior that were constructed to survive their inescapable, excruciating pain as young children, you're incapable of guiding them through the dark, frightening tunnels they'll have to navigate in order to outgrow their BPD traits, and get well. An evangelical Christian pastoral counselor may not be able to help a committed atheist, for example. If the client will not come to therapy sessions, send them a termination notice using their preferred method of communicationsuch as email or U.S. mailand ideally, via several communication channels. A small child is overburdened by these complaints, and doesn't relish this role--but at the same time, all this special attention from Mother imbues him with a sense of value/importance, which forms thecruxof his self-worth. For example, a client who presented with depression might note that their illness worsened after they isolated themselves from friends and family. Thanks very much! UntreatedADD issuescan inhibit solid BPD recovery outcomes as well. Point out that you will miss the regular sessions but are available if needed. Cochran, B. N., & Kehrer, C. A. Psychotherapy termination: Clinical and ethical responsibilities. Vasquez, M. J., Bingham, R. P., & Barnett, J. E. (2008). Discuss positive and negative reactions to ending the relationship and the therapy. Week to week, this client alternates between two polarized perspectives; their good partner, and their bad partner. Describe the problem the client presented at the outset. A professional will should be drawn up to identify who can access client records, perform an assessment, and arrange referral. Talk to the child about strategies for managing painful emotions when they are no longer in therapy. This therapeutictransferenceissue is very natural/normal within context of doing meaningful, growth-oriented work withall clients, whether borderline disordered or not. A client who originally sought help from an eating disorders specialist may need a different therapist when the eating disorder is in remission, and their new challenges involve work or parenting. Surrendering a long-held 'Victim' Identity feels akin to limb amputation, and is often resisted. Providing closure for the therapeutic relationship. In this blog post, we will explore different reasons behind the termination of therapy, as well as the challenges that therapists may face when terminating therapy with a borderline client. Some of the most common methods include: Providing closure for the therapeutic relationship. If you never challenge those defenses, they can find no way to shed them. Instead, it should be planned and prepared for, working collaboratively toward the end of successful treatment. Point out that the gains are likely to carry over to other areas of life. Their impatience is palpable, and they're always speeding ahead of themselves and the work, due to the daily anguish they have to endure. Behind these judgments are the values in the Ethics Code and clinical experience. Successfully ending the relationship between therapist and client known as termination is a crucial aspect of psychotherapy (Joyce, Piper, Ogrodniczuk, & Klein, 2007). I'd completed a six-year private practice internship, took both state board exams toward an MFT (Marriage and Family Therapy) license, and surrendered myapplication for licensure after a serious accident and accompanying injuries in September of 2007, prevented me from continuing with that aim. We can easily acquire what I've coined, "womb anxiety" if we're born to a woman who often felt worried or unsafe during her pregnancy with us, for this was often the predominant sensation we experienced in-utero. Discuss the therapeutic processboth what went well in therapy and what could have been better. They are bright, engaging and affable. Thriving is completely out of the question! What Is Dialectical Behavior Therapy (DBT)? ), Psychotherapy relationships that work (2nd ed., pp. Kristalyn Salters-Pedneault, PhD, is a clinical psychologist and associate professor of psychology at Eastern Connecticut State University. Dont forget to download our three Positive Psychology Exercises for free. 8. Begin laying the groundwork for successful termination from the very first session by describing therapy as a time-limited process. Agree on the goals and how the therapy will end in earlier sessions. This takes hard core (and hard-core) trauma work, which challenges everything she grew up believing about herself. She can also give you a referral to another therapist if you feel like you're not clicking with her or making enough progress. Recovery from emotional pain can feel intimidating or scary for someone with BPD traits, because the absence of pain brings with it brand-new sensations the client has no familiarity with or frame of reference for, that feel foreign, unnatural and threatening to them. Helping Borderlines heal, means teaching them how to toleratetheir owndifficult feelings, so they can begin to identify with andrelateto another's. Kristalyn Salters-Pedneault, PhD, is a clinical psychologist and associate professor of psychology at Eastern Connecticut State University. Encourage the child to share their feelings. Some weeks, the therapist is "brilliant," and he's ecstatiche has found him or her. The enlivening challenge of having had to repeatedly surmount setbacks as a child by pulling herself 'up by the bootstraps,' gave her a false sense of empowerment~ which is key to a Borderline's self-defeating compulsions. A dual diagnosis must always be considered, as a fair number of Borderlines also struggle with chronic depression orBipolar Disorder, and balancing brain chemistry with medication is often acrucialadjunct to helping them hold the work, and make good use of it. This means that therapy will not go on forever. Displeasure with the therapists services can be a springboard for discussion and growth and does not necessarily warrant termination. Termination can be eased through early and ongoing planning, as summarized by the following six stages (modified from Barnett, 2016). Sometimes a therapist is just not a good fit for a client. Thisreboundissue is typical in their romantic endeavors as well. These views are mostly inaccurate, which tends to foster and perpetuate poor partner selection, while setting them up for for the same type of relational strife they frequently observed as kids, between their parents. Termination is a time to review the clients achievements and reinforce plans for maintaining good mental health. I do not view anger as a 'bad' emotion, and Iencourageit during this work. Recommendations And yet, when the therapeutic relationship and outcome are seen as positive by the client, termination can be a healthy, valuable, and successful process; so much so that practitioners often report pride and a new sense of faith in the therapeutic process (Fragkiadaki & Strauss, 2012). Recommending a group or individual counseling program. Copyright 2004 - 2023, Shari Schreiber, M.A. Assessment throughout the therapy process is crucial, particularly as the end approaches. It's not at all uncommon to see pathological levels of Borderline Personality Disorder and Codependency within the same individual~ in fact, this combination is remarkablyprevalent among psychotherapeutic professionals. 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