Laying the Groundwork for Termination describes the role that termination plays throughout therapy. He is unwilling to see me for more than that. These clients often begin therapy with heightened expectations; they express commitment to the work and idealize their new therapist. Thriving is completely out of the question! You might think of it as on-the-job training. Chaos in their outer world mimics the chaos they experience internally, so it's much easier to tolerate. In addition, we co-experience her emotions, so when Mother is sad, so are we! Many core injured people presume there was some sort of "major trauma" that occurred during childhood that left them impaired, but what's far more accurate is that there were dozens, maybe hundreds of little emotional betrayals and disappointments that cumulatively derailed this child's capacity to trust someone with their care. 4) Too many psychotherapists/psychologists have accepted the layman's very narrow and stereotypical notion of how BPD presents in impaired individuals, and what Borderline Personality Disorder actually looks like or entails! When successful, termination is an opportunity for closure. Clients' perspectives on therapy termination. American Psychological Association. Focus on and emphasize the gains and progress the client has made. Discuss the future and the potential for returning to therapy if required. Consider and discuss the following in the lead-up to therapy termination (Goode, Park, Parkin, Tompkins, & Swift, 2017): Use the following worksheets to assist you with the termination process. Wow! Talk to the child about strategies for managing painful emotions when they are no longer in therapy. This type of client seldom stays in treatment long enough to achieve their wellness goal, and typically blames this failure on even the most gifted practitioner. 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. It's after we leave her womb that our trouble often begins, if she is not emotionally sound and whole. If he/she did not require sound, reliableadultguidance and sensible, concrete direction, they would not be struggling with this disorder! "We explore how they are already employing those strategies, so they are fully aware of how far theyve come and feel empowered to move forward independently. Anyone who grew up with a BPD mother cannot help but acquire survival defenses during infancy and early childhood, which leave them with abandonment fears and attachment difficulties. Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. There are several challenges that therapists may face when terminating therapy, including, the therapist may feel: These challenges can make terminating therapy with a borderline client difficult for both the therapist and the client. Even after decades of focused, psychodynamic treatment, childhood issues of unworthiness and shame can remain entrenched and implacable. The therapist should make a reasonable attempt to help address any ongoing treatment needs, even if only to connect the client with replacement treatment resources. Like Houdini, both male and female BPD clients are compelled to keep creating and surviving perilous conditions, just toproveto themselves they can~ but even the greatHoudinieventually succumbed to one of his death-defying performances! Sadly, this reflex keepsreallove at bay--and he'll continue to dabble with Borderlines (and clinicians), who have no real capacity to meet his intrinsic needs. Passivity in thework-placebut volatility and depression at home, is usually how this story goes. Effective treatment of clients with BPD might be very similar to doing child psychology, and requires just as much mindfulness and patience. Save my name, email, and website in this browser for the next time I comment. The upshot? Why won't he resume with the last one who helped? Background Mentalization-based therapy (MBT) is an evidence-supported psychotherapy approach for borderline personality disorder (BPD) that has been implemented in mental health services worldwide. Consider the following points when writing the letter: A client can also develop a healthy sense of closure from creating a letter for the therapist. By filling out your name and email address below. This technique assists the client to bring awareness to their thoughts and feelings about what's happening at the moment (Doering et al., 2010). During this time, I would like to accomplish: During my time in therapy, I have achieved: The therapist does not have the skills or competencies to meet the clients needs. Steady repetition of that type of event is incredibly destabilizing for a child, and teaches him toanticipatedisaster the minute he feels any sense of comfort or calm. It is important to be patient and understanding during this time. She could have made him her confidant in adult matters--especially concerning issues with his dad. Adoption or being handed over to someone else to raise or care for us after we're born, magnifies infancy core abandonment trauma and solidifies one's sense of shame; "I'm not lovable or good enough for my mommy to have wanted me close to her, or kept me." Retrieved from https://www.scottdmiller.com/wp-content/uploads/2017/11/Termination-Checklist.pdf. Be sure to keep your counter-transferencein check while working with a BPD client, for he/she can easily triggeryour ownunresolvedcore trauma issues. I've coined this,The Life Raftsegment of treatment: If you've stayed afloat on a huge chunk of driftwood in the middle of the ocean your entire life, and it's kept you from drowning every time a large wave hits, you're not gonna easily surrender that life raft~ even though it's steadily taking on more and more water each week! After 6.5 years my t unexpectedly terminated me. Ideally, when treatment ends, the therapeutic process will have met all treatment goals. Identify strategies for helping the child adjust, and develop criteria for returning to therapy. Trust issues have serious ramifications within a potentially solid and meaningful therapeutic endeavor. For example, if the therapist has been threatened or feels endangered. The BPD Waif inspires these assurances frequently from you, but they'll test you at every turn, and keep acting-out their ambivalence surrounding thisattachment, just as they do with their lovers. Below are some questions to begin exploring: Many issues that bring clients to therapy have a high risk of relapse and require ongoing maintenance. Terminating therapy: A professional guide to ending on a positive note. I've worked with some who've gotten very close to joy and wellness, but they've left treatment just short of it--or done something to undermine their progress either professionally or personally. "Knowing that can ease the discomfort clients may feel in ending their treatment.". Throughout various phases of treatment, the Borderline client both longs for and resents their practitioner. You cannot allow the BPD client to gain the upper hand in your therapeutic dynamic. Remember that the client is likely to recover with time. For instance, if you want to quit because of money or because of your schedule, your therapist could perhaps work out a payment plan or agree to meet you after her main office hours. Emotional cut-off is very common within their interpersonal world as well, which of course has made for a catastrophic romantic history. For example, a therapist counseling a new parent with postpartum depression might mutually agree with the client to terminate therapy when depression symptoms go into remission. Their resistance to surrendering a malfunctioning sense of Self is palpable to the trained clinician. Recommending a group or individual counseling program. We might begin to comprehend why under these conditions a borderline personality experiences profound difficulty in terms of trusting others, or even being willing to depend on and embrace the emotion of love itself (beyond a few fleeting moments, that is). I wish there were further ethical standards that make the termination phase a certain length of time. This outer protection is very stiff and cumbersome, and it keeps them upright when they're feeling a bit vulnerable or fragile. Terminating therapy with a borderline client can be difficult for both the therapist and the client. 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. Clear therapeutic goals and beginning termination early can have positive, long-lasting impacts, consolidating learnings and readying the client to move forward positively when treatment ends (Barnett, 2016). These clients often feel compelled toreconstitute the early frustrations and deficits that prompted their intense need forcontrol. The borderline disordered therapist hyper-analyzes every single feeling, rather than learning how to experience it in the body. This is actually the defining difference between those who get well, and those who do not. As this was the only way for many BPD'ers to receive a modicum of nurturant attention, their tendency to solicit help by inspiring another's sympathy, became an automatic and strategic survival defense. Others won't cancel standing appointments, even at considerable monetary sacrifice. Remind the client how you approached or unpacked the problem. Sadly, this reflex becomes habituated, for it eases his fear of impending disappointment and ensuing devastation from any/allunforeseendisasters that 'might' lay ahead, but it also spawns serious control issues,anxiety disorders, OCD (Obsessive-Compulsive Disorder) traits, and their need to argue or distance, after especially enjoyable episodes with you. I always challenge this stance, for there are two sides to every coin, and children seldom get to see who's holding the flame that has ignited their father's fuse. This therapeutictransferenceissue is very natural/normal within context of doing meaningful, growth-oriented work withall clients, whether borderline disordered or not. A professional will should be drawn up to identify who can access client records, perform an assessment, and arrange referral. 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