Advice please

[confused12]

Could anyone share some advices on what a kinds of things need to be covered between a patient and therapist before the therapist leaves. I have never been in this position before and I am unsure what kinds of things I need to discuss before termination. Is there a usual 'process'?

[WinterSky]

Could anyone share some advices on what a kinds of things need to be covered between a patient and therapist before the therapist leaves. I have never been in this position before and I am unsure what kinds of things I need to discuss before termination. Is there a usual 'process'?

Do you have another therapist lined up yet? I might ask him for some referrals, definitely more than one if possible. You also might ask him what he thinks you need to know about transitioning from him to another therapist before ending the sessions. Ask him what he thinks you should work on. I know it is difficult to see what is needed through all the muck in the mind. But if possible, try and understand his reasoning behind the information he gives you, as a relationship with between a therapist or a doctor is a partnership. At least that is how it is between me and my mental health professionals.

I'm not sure what else you would ask. Perhaps someone else will come along and give you their ideas.

[Guest ASchwartz]

WinterSky and Confused12,

WinterSky, that was great advice for Confused12 and I fully agree.

I have had to deal with what is called "termination" either because I was leaving or because a patient of mine was either leaving or had finished their treatment.

Confused, a lot depends on how you feel about your therapist. If you feel sad about the therapist leaving then it is good to express that. I usually encourage a review of what we have done together. As the therapist, I usually ask "what have you learned or benefitted from and what did you feel disappointed about, angry about or feel that I failed to do. I don't want people to "sugar coat" but to honestly deal with their genuine feelings and ideas.

Hope this helps, and listen to WinterSky,

Allan

[confused12]

Thank you WinterSky and Allan,

No I do not have another therapist lined up as there is not one here. Yes I do think I am sad about my therapist leaving. I will try and talk to my therapist about how I am feeling and discuss the positive things I have learnt. I am not sure about if I feel disappointed or angry about anything because it has all been rather positive even during confusing sessions. I think this is making the termination hard, as there is nothing to be angry or disappointed about just sad such a positive relationship has come to an end.

[Guest ASchwartz]

Hi Confused12,

Well, that is terrific and I am sure your discussion will go well. One more suggestion: Why not talk to this therapist about when someone will replace him/her? It bother me that no one is there after this. Also, is this therapist going into private practice and, if so, could you follow them into their practice?

Just a thought.

Allan:)

[confused12]

Thanks for the suggestions Allan, I will try and ask the questions not one of my strong points but I think I will ask. Are there rules about therapists allowing patients to change into private practice if they have treated them through a public system?

[gordian knot]

confused,

I think the only rules are ones the therapist would need to be worried about, such as they are not supposed to try and 'recruit' you as a private patient from a public setting. As far as I know, there is no ethical conflict regarding a patient asking to remain with a therapist if they are switching locations or transitioning into a new practice. As a patient, you have a great deal of freedom (my therapist says I can ask her ANYTHING--of course she gets to choose how to answer) and it would probably be rewarding for your therapist to hear that you would like to continue the work, even if it means transitioning to a new practice.

[confused12]

Well all I can say it is a rather sucky place to be. I am not liking it at all. I just can't seem to ask the questions I need to. I can't even explain what I am feeling about termination. Who allows this to ever happen, therapists just are not allowed to leave?

Confused12

[Proverbs31:28]

Confused, I am so sorry to hear you are facing this dilemna. I agree that you need to have the discussion, but I also totally understand your heistancy to do so. It will create a sense of vulnerability which equals loss of control which, as we both know, is undesirable for us. It means opening yourself up to the possibility that he/she will not have an answer for you or at least not the answer you want to hear. If he/she is moving into private practice, I would definitely ask about following. There is nothing wrong with you asking to continue the relationship- the only issue would be if she asked you to follow, I would think. I know it is difficult to replace a therapist you have made a connection with. I went without a therapist for over a year when I moved because I just could not stomach the thought of the whole process of finding a new therapist. I do not recommend doing that, however, as I progressively worsened, as a result! Thankfully, I absolutely connected with the very first therapist I went to BUT she was someone that was recommended to me by a friend who is also a SW. If you can't follow your therapist, get her input on another T whether it be her replacement or someone else altogether. Hang in there. I know its tough but you can do this.

[Guest ASchwartz]

Hi Confused,

I think that everyone is giving you excellent suggestions. Yes, you are in a sticky place and one that I am not familiar with. In all of my experience over many decades (ooops, I'm not that old ) when a therapist in a clinic leaves there is always a replacement. Also, it is common practice for a clinic patient to follow their therapist into private practice as long as it is something they agree is a good idea.

I am just baffled that you are being left without a therapist to replace the one who is leaving.

Allan:confused:

[confused12]

Thank you all so much for your support and advice.

I guess I just want to 'run away' from the real issues this whole process is highlighting. The abandonment, loss, lack of control etc. But now I guess it has been intensified by my pdoc suggesting that the termination may not be a good thing right now.

The whole concept of a 'team' approach which I understood was to at some stage be discussing treatment plans but I get the impression that know one actually knows what either one is doing. They just ask me questions which I don't have answers to as they are answers which only the T or pdoc themselves can ask each other. And me in my confused messy emotional state I am trying to wade through my perceptions and still do not seem to get to any real point of understanding.

I think I am a bit lost amongst the issues. Am I avoiding?

Confused12

[appleby]

Hi 12 --

If I remember correctly, you only have a couple more sessions before your therapist leaves. Part of the termination process should be making future plans and the therapist should be helping you to find another therapist to work with unless you both are in agreement that it's time for you to stop therapy. It doesn't sound like that's the case to me, it wasn't your choice to terminate and his announcing that he was leaving was just as you were beginning to touch on issues of trust with your therapist.

I think that you need to address this issue with both the therapist and the psychiatrist, and if you are at an agency that doesn't have a therapist available, ask them to help you find a suitable therapist outside of the system. I'm sorry that this is becoming such an issue. It's normal and approprite to be given referrals from therapists who are leaving. Having a referal should not be the concern, more like whether you will see another therapist or which one you will work with should be the issue at this time.

And there are all the other pieces to address like how you have grown while in therapy with your current therapist and what some of your goals would be as you move on, and expressing the grief and loss of this important relationship.

Thinking of you Confused 12 --

Appleby

[confused12]

Well the final session took place and I found out I am in a messy situation. I actually empathise with my therapist as I understand the situation he is in to. He is doing the best under the circumstance. He has offered to see me a couple more sessions to work through the emotions/reactions of this termination. But he seemed to also be rather hesitant about offering it as well.

I am in two minds about it to. I went into the 'last' session thinking it was my last. The weeks leading up to the session has be chaotic emotionally as the session drew closer I seemed to repress more. So during the session I was fine. Too fine even. I didn't feel as I could express any of the emotional discomfort I had had. Is this normal? So when we discuss the termination and the situation of the clinic I attend I found out it was possible to see my therapist again. I was offered another appointment but I could not answer if I wanted another session. I replied that I would have to think about it.

So the two mind thing is about if I want to go to another session to work some more on the termination feelings or leave it. Can I deal with prolonging the inevitable? Or do I have more to gain from working on this part of therapy? How do I even work through this decision when emotion fogs perception?

(lol, time is on my side as I will have 6 weeks to wait until this next session).

I wish I could just stand back and look at this situation from the outside but tried to and it just doesn't work.

Any ideas?

[Guest ASchwartz]

Hi Confused,

How can you feel comfortable expressing your emotions about your therapist leaving when there appears to be no explanation for why there is no replacement. In fact, I feel as confused about it as you do. Yes, therapists leave but they are replaced. I have never heard of a clinic where there was no replacement for someone who is leaving. Is the clinic closing down? There is nothing abnormal about your feelings. If I was you I would feel abandoned and would not feel comfortable about expressing it. Is there another clinic you could attend?

This is just my personal opinion and everyone is welcome to disagree (well, you can disagree with me whether I welcome it or not:) ) I would not go back for another appointment. Why? Why would I? They are doing nothing for me in terms of the future. I would not go back to that clinic but find another one that is more reliable.

What do others think about this???????

Allan:confused:

[appleby]

Allan --

I am right there with you --

Confused --what's the plan from here on? If there is no therapist available at that agency, is there another one available nearby? Your therapist ended with you prematurely -- for his reasons, I would think that he should have been helping you to find someone to transition to if that was something you wanted/needed. And it would seem that it would be a good idea to pursue having a new therapist as right before he announced he was leaving, you spoke about beginning to trust him and making him important in terms of your growth. It seems that you still had things you wanted to work on in therapy.

I don't think that I would go back for another appointment, either, unless there is really something you could get from this session (like a referral for another therapist).Otherwise, I don't really see a reason to go back again. It was not a fully satisfying termination but it was what it was. It's understandable that you may have cut some of the emotion off -- having the therapist leave is a loss and after experiencing a loss, people often experience a sort of shock and numbness.

So, those are some of my thoughts

Appleby

[confused12]

Thanks Appleby and Allan,

To clear up a few things a new therapist has been employed but there is no start date :confused:. And this therapist may not be able to service this area even. There are no local private therapists who are suitable to deal with me either. So the public system although lacking in some areas has been my only choice, otherwise my 2nd option is to travel an eight hour round trip to the city to see a suitable therapist there.

Before reading your responses I actually made the appointment for next month. As I have said earlier that I have had such a positive experience with therapy this last 11 months. I don't want to throw away an opportunity to end the best way possible. Although last session went well, I need to sort out future stuff like you both discuss.

Confused12

[Guest ASchwartz]

Hi Confused,

That makes a lot of sense. I can fully understand your wanting to end on a positive note since the therapy has been helpful. I agree and support your decision.

Allan:)