Some will, some won't. 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. Borderline Waifs (female and male) usually begin their requests for therapeutic assistance by informing you of their financial hardshipprior to any inquiries about your fee structure, and may use histrionics to secure your timely response to their initial outreach. 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). A client with borderline or narcissistic traits can enter treatment with a "fix me" demand, but never comprehends the need and importance for an interactive experience within a process that must allow for the gradual growth of trust. I am not a psychotherapist, although having returned to school at forty-one, this was originally the path I was pursuing. They're incapable of managing any sense of peaceful continuity, or appreciating the bigger life picture, due to childlike myopathy or shortsightedness. Interpersonal differences between the clinician and client cannot be overcome. Copyright 2004 - 2023, Shari Schreiber, M.A. Even brief absences of contact with another, can make the Borderline feel non-existent, undesirable, invisible, unlovable and worthless. Sign up for our Clinical Updates email and receive free resources. Allow the client to express their emotions, and validate their experience. Childhood neglect and abuse has left the Borderline with severe entitlement issues, so she continually feels undeserving of love, abundance and/or prosperity. The BPD client craves a sense of intimacy, and yearns to be fully understood andknown during treatment. Barring physical attack or serious threat by the patient, which may require abrupt cessation of therapy, most terminations should be discussed in advance, negotiated, and enacted in a professional process. Some clients may be reluctant to end therapy. Explain to the child, in age-appropriate terms, why therapy must end. When they begin to make gains in treatment and their painful inner drama quiets down, they typically want to leave therapy. Express pride in the new skills learned and strategies achieved. Either way, it can be made easier by recognizing the boundary between the working phase and the termination phase and the shift toward the process of ending therapy (Joyce et al., 2007). 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. If they can orchestrate their own setbacks, at least they can feel in-charge or in-control of their existence, and it gives them a semblance of comfort. If you have borderline personality disorder (BPD), it's very common to feel like you want to quit therapy. Clients' perspectives on therapy termination. You can even consider supervision to help you process your decison. After almost daily contact and 4 hours/week, this most definitely feels like abandonment. With a bit of digging, it became clear the therapist had almost identical feelings as a child in response to a volatile, yet fragile parent (typically, Mother). So its important to be warm and supportive, but also to set clear boundaries. In a sense they're sleepwalking, but their role-play gives them a much needed sense of structure and containment, and helps them adhere to socially acceptable limits and boundaries, so they can maintain some semblance of order and functionality. Thus, his inner narrative becomes;"if I get too close to you, I'll have to relinquish too much of me." Do you have any concerns regarding ending therapy? Disclaimer: The resources available on Therapist Aid do not replace therapy, and are intended to be used by qualified professionals. Learning we have BPD traits is a hard pill to swallow, but it's not a death sentence~ and itispossible to recover with the right kind of help, and one's serious dedication to getting Well. A termination checklist can be helpful as both therapist and client begin to consider the end of the therapeutic relationship (modified from Norcross, Zimmerman, Greenberg, & Swift, 2017): What went well in therapy? ", Leaving the door open can also be a powerful way to help clients feel secure in their decision. If this male's mother hadBPD Waiffeatures, he grew up having to meetherneeds for attention, mirroring, flattery, emotional soothing, etc. Clients may worry that termination is their fault or may fear leaving therapy means they will no longer have support. In both of these cases, a therapist can help you think through what is in your best interest versus what your disorder is telling you to do. As a therapist, you might see positive changes in the client that they have yet to notice. From our personality and behavior to our choices in life, family plays a large role. Borderlines arepassive-aggressive, and prone to leaving you abruptly. It is important to understand why termination of therapy might be necessary and to proceed in a way that is respectful of both parties. Yet, it is not abandonment if the client drops out or cannot meet their obligations, or if therapy ends through mutual agreement and appropriate notice. TheBorderline Waifinstantly triggers your sympathy, and you'll wanna bend over backwards to help him/her untangle the mess they're in, unless you've become a seasoned professional who can spot these folks within seconds of meeting them. From this, he concluded that meaningful, helpful attention, care and assistance were not available to him. Terminating therapy with a borderline client (ending therapy with a borderline client) can be difficult for both the therapist and the client. Sometimes, clients feel content with the progress they have made, and express that they are ready to end therapy. These clients often begin therapy with heightened expectations; they express commitment to the work and idealize their new therapist. No wonder, so many babies succumb to inexplicable SIDS (Sudden Infant Death Syndrome). If the therapist decides to terminate therapy with a borderline client through a letter, there are some things that he or she should keep in mind, The letter should: Here is an example of a termination letter to a borderline client: Thank you for your time and dedication to therapy. Termination should not be a surprise unless unusual circumstances prevail. We then have discarded or split-off facets of the Self which results in a fragmented orpartialpersonality structure, instead of a whole one (fertile soil for BPD seeds to grow). Ask clients to score themselves on the following questions to assess where they are as the end of treatment approaches (1 never, 2 rarely, 3 sometimes, 4 often, 5 always): Questions specific to the termination phase of therapy can gauge the clients readiness through recognizing the clients positive feelings regarding the process ending. Encourage the child to share their feelings. 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! Anyone who violates the exclusive rights of the copyright owner is an infringer of the copyrights in violation of the US Copyright Act. The client is the customer, and the goal of therapy is to help and support themnot defend yourself or protect your ego. Professional Psychology: Research and Practice, 40(6), 572. What will the end be like? Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Begin laying the groundwork for successful termination from the very first session by describing therapy as a time-limited process. The trouble is, they've never been able totrustreal intimacy and closeness, for those responsible for their care in the earliest stages of life, weren't equipped to provide solid, nourishing attachment experiences. This has left them emotionally underdeveloped, which is always at the baseline for people with personality disorders. If the termination process is begun early, with clear therapeutic goals, it can be a positive experience with a long-lasting impact (Barnett, 2016). "If you feel that your therapist doesn't understand the issue or isn't helping you gain new insights into a problem, tell . It's like a little black cloud always follows them around--but they've orchestrated a lot of their own pain by pursuing partners who aren't single or available, making unwise financial decisions, impulsively leaping before they look romantically, neglecting their health, etc. Feeling work can help Borderlines connect with both intense and subtle emotions. Unlike our day-to-day relationships, we expect therapy to have a clear and definite ending. Often this means the end of treatment. Talk about personal growth as an ongoing process and give the client guidelines for when it might be appropriate to return to therapy. Assessment throughout the therapy process is crucial, particularly as the end approaches. Discuss the clients future coping and functioning. It never dissuades me from accepting somebody into my practice, unless I sense we'll have a continuous power struggle, which will deter him/her from making substantial gains here. (2017). Built with love in the Netherlands. Have you been able to attend and cope at work/school? We will also hear from experts on this topic, and learn about one therapists experience with the termination of therapy. The therapist should provide closure for the therapeutic relationship and make sure that the client has a follow-up plan in place. Dr. Andres Duarte. The questions and worksheets within this article highlight issues that should be considered before termination while reminding the client of their work and success in reaching their goals. Gutheil, T. G. (2012, June 30). A needy, BPD female perfectly fits this paradigm--at least at the onset. Use contracts and informed consent It is important to get informed consent from therapy clients before commencing therapy. Yes, it's listed in the DSM-IV and V~ but so are a lot of other clinical issues, such as ADD/ADHD,Bipolar Disorder,Anxiety Disorder, etc., that have nothing whatsoever to do with mental incapacity or illness! If the clinician has concerns about the clients readiness, this is an opportunity to discuss those concerns. Anynon-abusive touch from a parent was experienced as nourishing or loving, even if it came by way of perfunctory or obligatory care. Some of the most common methods include: Providing closure for the therapeutic relationship. There exist striking similarities between borderlines and their partners, as both suffered trauma to their emerging sense of Self during infancy, which caused important feelings to be discarded. In truth, when core damaged individuals are helped to resolve their self-worth issues, and connect with all their emotionswithout compulsively analyzing or judging any of them, personality disorder features are eliminated. Previous Post Next Post This 'emotional purgatory' phase of treatment is every client's pit-stop along their route from Hell to Heaven, but it feels uncomfortable for awhile. Help the child develop a list of supportive people, especially adults, whom they can contact when they need help. It's mostly this client's manipulation tactic~ so try to resist indulging them by giving into it. Explain to the client that your job is to ensure they get excellent care and that you do not feel you can meet their needs. The information below will help you facilitate a smooth and successful termination process. Life has been painful, and that's all the Borderline knows. By clicking Accept All Cookies, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts. By filling out your name and email address below. I'd say the primary issue with the Borderline in treatment, is their resistance to trusting someone/anyone with their care, due to painful disappointments and setbacks throughout childhood, that undermined their ability to feel protected and emotionally safe with their parental units. 6 strategies for ethical termination of psychotherapy: And for avoiding abandonment. Even if a portion. The goals of psychotherapy are to help you: Reduce your impulsiveness by helping you observe feelings rather than acting on them. Any psychic and/or emotional wounds incurred thereafter, reinforce one's sense that he/she isn't lovable, or worthy of genuine affection, protection and care. Healing work isverydifferent from psychotherapy. The therapist feels that he or she is no longer able to help the client. While changes in circumstances and insights experienced during treatment may transform goals, they should be set early to inform the nature, focus, and scope of the treatment and its intended duration (Barnett, 2016). Yes. If you are sure that you need to drop out, consider other avenues of treatment. Estimates can be based on therapeutic experience or suggestions from manualized treatments. There are several reasons why I have made this decision, including: Please know that I have made this decision with care and consideration and that I believe it is in your best interest. Inevitably, the same issues resurface in hisnextromantic catastrophe, and he begins anew with another therapist. The BPD patient enters therapy feeling ashamed and unlovable, so it's difficult to imagine that anyone might view him/her more favorably. Most are extremely talented, and you can't help but like them~ but at the start of contact or during treatment, they may come across as combative and belligerent. The bottom line is that there are many reasons that people drop out of therapy and sometimes these are unavoidable. When therapeutic goals are nearing completion, discuss the clients readiness to terminate and their feelings--whether positive, negative, or ambivalent--related to ending therapy. Are you finding this information helpful? Davis, D. D., & Younggren, J. N. (2009). It can help clarify the nature of and reason for termination, especially if a client is emotional or angry during your termination meeting. Copyright Notice: Therapist Aid LLC is the owner of the copyright for this website and all original materials/works that are included. Systems Training for Emotional Predictability and Problem Solving (STEPPS): Program Efficacy and Personality Features as Predictors of Drop-Out -- an Italian Study. I don't believe in withholding diagnostic impressions from my clients. Kristalyn Salters-Pedneault, PhD, is a clinical psychologist and associate professor of psychology at Eastern Connecticut State University. If a therapist determines that they are no longer able to provide adequate care for someone, codes of ethics require them to refer. A solid therapeutic dynamic allows that the Borderline client's interpersonal struggles will manifest within their clinical dyad as well. It may occur as an anticipated and well-articulated treatment plan that indicates the next phase of the psychotherapy process or it may occur precipitously or by surprise. Only then, are they equipped to surrender their acting-out behaviors and BPD features. These effective strategies can be taught to a Borderline, making it possible for them to construct more harmonious relationships. Remind the client of the improvements you have seen in them. Give the client space to process their feelings. Providing closure for the therapeutic relationship. Acknowledge this fact and be understanding. Acknowledge enjoyment in working together, and express some of the therapists feelings about ending the relationship. The therapist/client relationship has come to a natural end. Repairing alliance ruptures. At TherapyMantra, we have a team of therapists who provide affordable online therapy to assist you with issues such as depression, anxiety, stress, workplace Issues, addiction, relationship, OCD, LGBTQ, and PTSD. Terminating therapy can be difficult for both the therapist and the client. Core traumatized people are programmed to accept that it's far easier toexpect disappointment, thanbedisappointed. The Society for the Advancement of Psychotherapy suggests six strategies for the ethical termination of psychotherapy to avoid feelings of abandonment (Barnett, 2016). Referring the client to another therapist. I get 3 closure sessions. This sets the expectation from the start that termination is a positive goal. If you went to a physician complaining that you were hurting, wouldn't he/she need to discern where you felt pain and the nature of that discomfort, to assist you? This passivity issue continues to play-out in all their adult attachments, and invites ongoing conflictual dynamicsorstagnancy and deadness in their romantic life, which prompts Borderlines to blame 'boredom' on a partner, and leave in search of greater stimulation. Create a copy of the treatment plan for your records and for the client to keep. When handled correctly and without evoking shame in the client for their intense feelings of attachment, they can successfully navigate this delicate phase of treatment, and resolve their infatuation. Sadly, their addiction to pain and struggle usually trumps their desire for growth or change. What has been noticeably helpful? Regularly assess whether the client is progressing toward their desired outcomes and begin planning early for the end of treatment. Is there anything you regret not saying or sharing? The Borderline client has learned to avoid, distract and run from vital and important feelings since the first few years of life, in order to survive intense pain. Your email address will not be published. In essence, only when you've gained intimate understanding and knowledge though years of working with BPD clients directly, can you can anticipate and expect how they'll emotionally react and what they'll do, before they even think of doing it. 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Issues resurface in hisnextromantic catastrophe, and express that they are no have! And assistance were not available to him 6 ), 572 these are unavoidable therapy, and their... Might be necessary and to proceed in a way that is respectful of both parties express... Discuss those concerns are to help and support themnot defend yourself or protect your ego progress have... Filling out your name and email address below in working together, and he begins with! Will no longer able to help you process your decison to attend and cope at work/school continually feels undeserving love! Copyright 2004 - 2023, Shari Schreiber, M.A begin therapy with heightened expectations ; they express commitment the... About personal growth as an ongoing process and give the client that they are no longer able to provide care... Is important to understand why termination of therapy and sometimes these are unavoidable ending therapy with a borderline client... List of supportive people, especially adults, whom they can contact when they need help therapy. Clear and definite ending 40 ( 6 ), 572 do n't believe withholding! And give the client guidelines for when it might be necessary and to proceed in a that. Only then, are they equipped to surrender their acting-out behaviors and BPD features not a psychotherapist although. Changes in the new skills learned and strategies achieved by giving into it may fear therapy... To provide adequate care for someone, codes of ethics require them to more!