Nobody likes goodbyes, but they’re an unavoidable part of life, and shape our sense of ourselves in relation to others. It should be no surprise, then, that the clinical version – termination – is simultaneously one of the most challenging, and richest aspects of this work. In an ideal world, termination occurs at a natural stopping point, when clients have met their goals and feel ready to move on. However, we don’t live in an ideal world, so termination often happens before this natural stopping point, either because the client leaves, or because the clinician leaves. When clinicians leave, it means terminating prematurely with all of their clients – a daunting prospect for even seasoned clinicians!
Because of the nature of field placements, all of our students are about to find themselves in this unenviable position. While the impact – on clients and students – varies by setting and modality, it’s likely to present some degree of challenge across the board. After all, ending a placement involves not only premature client terminations, but also termination with the supervisor and agency, sometimes the advisor, and for graduating students, the school, classmates and faculty. It may be tempting for field instructors to delay and/or gloss over discussion of termination in supervision – after all, we probably have some of our own lingering discomfort with goodbyes, and feelings about terminating with our students. However, this kind of avoidance is a disservice to the students, and their clients. Since skillful termination has such potential to transform clients’ issues related to attachment, loss, and abandonment, while unskillful termination can exacerbate these issues, we should make it a priority to discuss termination early and often.
There are several things field instructors can do to prepare students for skillful terminations. The process will provoke a lot less anxiety for both clients and students if they know what to expect regarding transfer or follow-up care, so arranging a smooth transition should be a priority. We should also prepare students well ahead of time for the full range of possible responses they might get from clients, both emotional (anger, sadness, anxiety), and behavioral (denial, regression, missed sessions). Clients’ responses to earlier interruptions (e.g., Winter and Spring Breaks) can help students predict each client’s possible response. At the same time, it’s important to prepare students for their own possible responses – again, both emotional (guilt, sadness, anxiety), and behavioral (avoidance, minimization, or even promises to “stay in touch”). Since students can be tempted to offer some form of post-termination contact, but may not bring it up with us, it’s important to bring it up with them – to explore what that impulse is about, along with clinical and ethical implications, and review the placement’s policies/expectations. With this preparation under their belts, we can help students implement what they’ve learned by planning when and how to introduce termination, by recognizing and managing their own reactions and by responding empathically and effectively to clients’ responses. This is our opportunity to help students recognize the potentially positive aspects of the termination process: added urgency, focus and momentum, the opportunity to consolidate gains and work on issues of attachment, loss and abandonment.
Perhaps our best tool for teaching termination is how we model it in the parallel process of supervision. It is not a complete parallel – students will eventually become colleagues in the field, so it may be a change rather than end in the relationship. However, it is still an end of the supervisory relationship, and therefore an opportunity to review the work, consolidate gains, process feelings about ending, and negotiate post-placement contact (I follow some good advice I received and tell students that they can contact me, but I won’t initiate contact, so that they are free to decide whether and how to stay in touch). Through this parallel process, as well as through the teaching, coaching, and processing described above, I hope students experience smooth transitions for themselves and their clients, end placement feeling good about what they’ve learned and become a little more comfortable with – and skilled at – goodbyes.