« Terminating counselling with a client. | HomePage | Terminator 2 »
Sunday, 26 August 2007
Terminating counselling with a client.
Kahless recently wrote a post about ending counselling and how she made a contract that when she decided to do so she would have another last session with her counsellor. An interesting contract and raises the whole area of terminating counselling.
See
http://kahlessnoise.blogspot.com/2007/08/maybe.html
I like how Kahless has given some very good insight into the soul searching that can go on for the clinet who ends counselling. It is very easy for therapists to forget or minimize this.
As I have mentioned before when one employs a counsellor it is different to employing a plumber because you have to take the relationship into account as well. Indeed it is unique when compared to others in the ‘helping’ professions. When one goes to a doctor, surgeon, dentist or physiotherapist the relationship is clear. One goes for a specific goal and when that goal is achieved the relationship ends. Both parties know this from the beginning of the contract between them. Counselling is not like this. Firstly because the goals are usually much less concrete and clear and the relationship between the client and counsellor is just as important (if not more important) than any treatment techniques applied.
As I have mentioned many times recently, ending a relationship (attachment) is not an easy task. It does not matter what that relationship is, be it siblings, spouses, friends and of course client/counsellor. It can be quite difficult for both parties no matter what the relationship is.
The ended relationship
Of course I cannot comment at all on the circumstances for Kahless but I find it an interesting contract that the counsellor suggested to her. So I will comment generically and this of course does not relate specifically at all to her situation as I have no idea what her counsellor’s motives were.
I can not recall ever making such a contract unless it was a “No run” contract. So why would a counsellor suggest such a contract to a client:
Before you terminate counselling you make one last appointment with me.
I can come up with three reasons:
1. Financial. A loss of a client equals a loss of income if it is in private practice. Whilst this could be true I would imagine that this would be an infrequent motive.
2. A “No run” contract. I certainly have used this contract in the past, and it is that the client makes at least one more appointment before ending treatment. The motive behind it is that for some reason you want to lock the client in to this relationship. That maybe to close the escape hatch of running from a relationship when you feel reliance or for some other reason. The counsellor is seeking to increase the clients distress by not allowing them to ‘run’. Or indeed it may heighten a sense of security for the client. There could be a whole range of motives for a therapist to suggest such a contract to a client.
3. Personal. This I would see as the most common cause for such a contract. As I have said before ending a relationship can be difficult and that is no different for a counsellor or anyone else on this planet. It is just hoped that the counsellor has some kind of supervision available to them should a difficult termination arise. I have supervised many trainees and the most common difficulties would be as such.
The termination transaction
Transaction 1 is the overt Adult to Adult transaction that the therapist and client make with the contract to make one more appointment.
In conjunction with this the therapist can also have ulterior, covert and (probably) unconscious motives. (ie The therapist may not even be aware of it).
Transaction 2. The covert Parent to Child transaction: “Explain yourself!”, “Don’t you dare get out of my control!”.
Transaction 3. The covert Child to Child transaction: “Please don’t reject me”, “Show me I am a good counsellor”.
In the human psyche, underneath the surface there are always powerful forces at work and sometimes they sneek up on you and bite hard.
These are some of the more common personal feelings counsellors can have when a client ends treatment. Some of them are fairly normal. If a client says they want to stop, it is not all that odd for a counsellor to question themselves and their abilities particularly for the the trainee counsellor. I remember I could do that in my earlier days but as the years roll on one sees clients come and go for all sorts of reasons. So I don’t take it as personally now but I not uncommonly will reflect on what I did and how I did it and hopefully turn it into a learning experience for my self. I certainly will never stop the peer supervision I get nowadays for this precise reason.
If I just do a really good job then that means I am OK and they will never reject me.
My overall view of this is that a client never has an obligation to see a particular counsellor and a counsellor never has an obligation to see a particular client. If a client simply cancels or just does not turn up and does not say why, I would rarely phone them or seek them out to find why. I know many counsellors who do ring the client in such circumstances, so there are definitely differing views on this. They would say they are doing that to check if the client is OK and to get proper closure for the client and self. Valid reasons one could argue. The problem I have with it is the client has no obligation to give me a reason and it could be pressuring them a bit for some ulterior reason as I mentioned in the termination transaction.
It is also my view that whilst I, as the therapist have no obligation to see a particular client I do have an obligation to offer a current client the opportunity to get my reason should they want it. Over the years this has happened only rarely. I have referred some clients to others over the years in such circumstances. I certainly have come into contact with clients who I personally don’t like. What usually happens I think, is they pick up the ‘lack of connection’ and don’t reschedule with me.
Graffiti
18:51 Permalink | Comments (24) | Email this
Comments
Interesting blog Graffiti, I wonder whether Kahless went to the "plus one" session to officiate her termination?
I have a young client who wishes to terminate therapy. He cannot state his wish to end counselling without smiling. I tend to believe he means it however his mother wishes him to continue with me. Might book in with my supervisor on that one.
k
Posted by: kenoath | Sunday, 26 August 2007
Yes she did Kenoath,
as she states that in her post which is quit interesting to read.
Sounds like an interesting duplex transaction Kenoath - your client wishing to end and smiling at the same time
Graffiti
Posted by: Graffiti | Sunday, 26 August 2007
That's an awful way of putting it "termination". I'm sure there must be a better way of describing the process :-)
Posted by: Madeleine | Sunday, 26 August 2007
Thanks Graffiti, I missed the link you posted. I hope you are feeling better Kahless, I had no idea you were wrestling with your counsellor recently.
kenoath
Posted by: kenoath | Sunday, 26 August 2007
Hi Madeleine,
Aren't computer thesauruses great!!
Here is the answer to your dilemma,
for termination we get
ending, end, closing, close, conclusion, finish, stopping, winding up, discontinuance, discontinuation; cancellation, dissolution; informal windup.
Graffiti
Posted by: Tony | Sunday, 26 August 2007
I would agree that counsellors have "real feelings" and that some counselling methods require more processing of the client-relationship.
I know of a counsellor that insisted I stay with her for another 6 months, It was obvious she had abandonment issues. I just wanted to leave even more and when I did so felt empowered. Arnie the Terminator.
k
Posted by: kenoath | Sunday, 26 August 2007
Hi Tony,
I suppose I've found ending group therapy much more problematic than 1:1 therapy. I think the therapist often has a lot at stake in keeping the group together. I also think group membership can create many strands of attachment, which can make leaving more difficult, especially if the therapist can not( for whatever reason) support a particular person's decision to leave.
Best wishes,
Nick.
Posted by: Nick | Sunday, 26 August 2007
I liked your post Graffiti, thanks.
I hadn’t thought of it as a ‘contract’ specifically, but yes, it was; I think if I had figured that one out before then I wouldn’t have ummed and aahed so much and just gone.
I remember my ex-counsellor said it was something he asked of all his clients and he said it quite early on after I had started seeing him. I also remember him telling me once that I was one of his more consistent clients. I am guessing the contract was for him, but I guess I’ll never be totally sure. He tried to persuade me to stay and got me to think about it and promise that I’d text him. Funny he didn’t want me to email him! I guess he didn’t want me to have the opportunity to write much!
Actually on this occasion I will break that promise and not text him. I saw him like he wanted, paid him for that and it was hard. The text is definitely for his benefit and I don’t owe him anything. In fact I do feel rather empowered about not doing it; I am doing that for me. It is what I want to do. I feel I’m getting the big bit of cake for doing that!
I didn’t feel angry about it all at the time, but I do know – with him - and it is gnawing away at me.
Thank-you again for the post, has given me some food for thought.
Hi Madeleine, I like the word termination; kind of final and clean cut, though I guess it wasn’t clean cut because it is still bothering me much some weeks after.
Hi Kenoath, not really but I start with a new therapist in ten days so I guess I can talk it through then and hopefully then get a complete termination in my mind from the last therapist.
Kahless.
Posted by: Kahless | Sunday, 26 August 2007
Kenoath,
I like that "the terminator". Now there is a guy who would know how to end therapy.
But then he would probably say just as he is leaving,
"I'll be back".
Graffiti
Posted by: Graffiti | Monday, 27 August 2007
I would agree with your comment about group therapy Nick,
Lots of sub attachments can be made if the group stays together for a period of time. I have never had an ongoing therapy group. They have all been time based (ie 6 weeks) so the end of the relationship is established even before it starts.
Tony
Posted by: Tony | Monday, 27 August 2007
Thanks for your thoughts Kahless,
They are interesting and are what got this post going in the first place.
I am surprised by what you and kenoath say about the counsellor asking (pressuring) you to stay or maintain some form of contact.
In my mind it is very clear that the client has no obligation to the counsellor in terms of attending sessions. They are free to come and go as they like. If they choose to end therapy even when it is obvious they are not in a very good space, then I respect their decision, just like I would expect a counsellor to respect mine in the same circumstances.
I am a big boy who is old enough to make his own decisions thank you very much Mr/Ms counsellor!
thanks again for your thoughts
Tony
Posted by: Tony | Monday, 27 August 2007
Tony,
Wow! Some client/therapist relationships sound intense! Holy smokes!
But then again, it does seem to be a human 'thing' to want to fix things - broken or not. Probably gets even more dodgy because those that are involved in the relationship are both human. I must say... i do like win win situations.
Kahless,
The looking for love thing? Yep, that so fully makes sense, and i'm so glad you said it in your post. Isn't it strange when things look, feel, seem so bad (Bad = yucky with a small 'y') because in the end (regardless of what the outcome looks like) it all works out - one way or another. I'm sorry that things have gotten yucky for a bit. I'm excited for you for when this piece of yuckyness is gone.
Tony,
Our son has moved back home with his girlfriend 3 dogs and a pregnant cat. We were expecting them but while they were away, a huge wolf hound kind of dog adopted them. Oh my goodness, just on the quiet, we're thinking of buying a sulky (horse buggy type thing) to hook up to him so he can pull us around town. Just as much output (all over the yard eww!) just as much input (bottomless pit!!) but so so cute!
He's THE sweetest thing on four legs. A table full of desserts to die for, wouldn't even come close to the sweetness of who we've met in this big guy! He's a little bit frightened of us and when we move quickly he ducks and dodges - moves away. Well, i can relate to that so it's all good. I don't know if he can live here with us or not but that's not for me to decide i guess. I will bleed, heart broken if he can't - but we get that don't we?
You have been a busy bee! Hope you're having fun. Have a happy Monday - no matter how we're feeling, nice stuff still happens around us. Hope we can catch as much 'nice' as we can. Smiling at you...
Roses
Posted by: Roses | Monday, 27 August 2007
I only had one therapist ever call and send letters to try to get me to resume therapy. I don't hold it against him, though. I did leave under very bizarre circumstances and it was very obvious that I was 'not okay'. I guess I probably would have done the same in his shoes. Even so, the problems I was having were so bad that I couldn't even take his (or anyone's) calls. I like the therapist I have now. I never really made any progress with the others. I guess some people (me) are a bit unusual and it's harder for them to find someone they can really click with.
Posted by: Lynn | Monday, 27 August 2007
I guess that was a bit unclear -- I have not recently changed therapists. The one I am with is the same one I have been with for almost two years.
Hi, {{{{{{{{Tony}}}}}}}}.
Posted by: Lynn | Monday, 27 August 2007
Hi Lynn,
Good to hear from you
Glad you have found a therapist you can relate to well and you are getting something out of it. It can take some time to find someone who fits for you as you say.
Cheers
Tony
Posted by: Tony | Monday, 27 August 2007
Hello Roses,
It sounds like ahouse full at the moment. Your son sounds like and animal type person.
years ago I had a good friend who had a great dane dog. It was a huge thing. Because of its sheer physical size in the house it was like almost another person was there. But a very lovable and non threatening dog, just very big and ate lots and lots of food
Tony
Posted by: Tony | Monday, 27 August 2007
Well this guy is so nice. He's been here for a couple of days, and he went missing this morning. I was so very worried Tony! They drove him to another place for the day some where in town, and he found his way home. Ohh my goodness! He was home just a couple of hours later! I have a problem with attachment, I think he knows. I think he'd like this to be his home. I wish he was bad and scary but isn't very "lovable and non threatening", very big and eats lots and lots of food. Another nail on the head.
You seem to be good at that. 2nd career choice - carpenter perhaps? *giggles*
We have a 2 bed room flat just out the back of our place (my son and his lady i mean). They're living there for the moment. We built them a fence for their dogs but it's not quite finished yet so they're sleeping in our yard (the dogs that is).
I've never had a big dog inside before. Our little dog is the first inside dog we've ever had. I hope we can (if he stays that is) transition him from outside to inside. He's big though.
I'm on my own tonight so it's nice to have the dog population around. It's all good, we're in the country and rarely does much happen. Especially during a week night.
Hope you had a good day and are having a good night. Cheers to you...
Roses
Posted by: Roses | Monday, 27 August 2007
Tony, I meant to say -
"I wish he was bad and scary but he isn't. Instead he's just like the great dane you met before - very lovable and non threatening, very big and eats lots and lots of food. Another nail on the head."
My son is gullable. Isn't it amazing how sometimes our greatest strengths are also our greatest weaknesses?
Posted by: Roses | Monday, 27 August 2007
Oh my goodness! Tony!
The dogs were all barking in the back yard this (very, extremely, unbelievably, not thoughtful at all early) morning and so i thought it would be a great idea to let them go for a run. It's kind of ruraly urban here so there's plenty of places to run.
At first i was out side hanging out the clothes and i'd sprinkled dog bikkies all around the yard - it gives them fun looking for a bikkie here and there - and then i took them down the back. Then they just left, and well... kept going. They just went through the creek - and then!!!!! - over the hills and far (oh my goodness FAR) away!!!!! (over kill on the exclaimation marks perhaps?) But it was so far away i couldn't even see them any more! (tempted to add more exclaimation marks but overcame the urge triumphantly)
Then in about 5 mins they were back. No pound man, no nothing, just the dogs. Phew!!
I was so relieved. I'd just cooked them their dinners/brekkies/meal and so that was a big reward for them for coming home so soon. I love them. So so much! This morning was so much fun but i'm glad it's over.
ps... this is not a report. I'm just saying g'day. Gosh this morning was fun! Have a nice one...
Posted by: Roses | Tuesday, 28 August 2007
Interesting post. I was stymied as to how to officially end therapy and was full of uncertainty as to how to do it - on the one hand thinking that if it was time, the therapst would give me some indication that she thought I was ready; on the other hand thinking she was probably waiting for me to decide I was ready to move on, on my own. In the end, I ended (after 3 years) by simply stating I thought I was ready. She agreed, we had one more session and that was that! Went in for a "tune-up" a year later (3 sessions). Still, it was an odd transition to make without any guidance.
My first therapy experience was horrid. Didn't have any rapport with the therapist at all. He called me and wanted all my reasons for not continuing with him. Him calling and questioning my decision was a great indicator he wasn't the one for me. Glad I didn't go back.
Posted by: karen | Tuesday, 28 August 2007
My very first counselling experience was at least 15 years ago with a woman. I had to fill out a psych questionaire whicj took one whole session and the following week she showed me that I was in the league of Winston Churchill and Einstein with the qualification about "later life success's". Little did I know then that Churchill and co were supposed to fit the ADHD profile.
Six sessions later she said goodbye to me. That we had finished our work together. WTF?
I'll be bachk indeed!
k
Posted by: kenoath | Tuesday, 28 August 2007
Sounds like you are enjoying those dogs a great deal Roses.
When they get in a group they can have so much fun as I think you show
Tony
Posted by: Tony | Tuesday, 28 August 2007
Hello Karen,
It does sound like the first therapy experience was not a great one. If a therapist did that to me (called and wanted the reasons I would have my doubts also).
If find your comment about ending therapy interesting:
" it was an odd transition to make without any guidance."
I think I will write about that
Tony
Posted by: Tony | Tuesday, 28 August 2007
Hello Kenoath,
I like that
"I'll be back".
Imagine counselling the terminator.
If I recall correctly my first therapy experience occured when I was 17 after I ended up in a hospital emergency ward after taking some bad LSD.
I was referred to (what I know now as) a psychoanalytic therapy group, with two female therapists. I would go once a week and there were about 6 people in it if I recall correctly. I remember always feeling a great sense of relief afterwards after being able to talk about things. I think it helped me quite well at that time.
Graffiti
Posted by: Graffiti | Tuesday, 28 August 2007
The comments are closed.