When I first started working as a therapist a little over a year ago, I had a lot of questions about how I was going to start building relationships with my clients. In my job interview, my supervisor made it clear that I’d be working with a fairly wide age range of clients (which turned out to be true–in my time at my current job, my youngest client has been 3 years old, and my oldest 20) with a number of different issues, from anxiety and depression to substance use, behavioral problems, trauma, mood dysregulation, and so on. I was nervous about tackling those different issues, but I was also worried about connecting with clients. What would they think of me? Would they like me? Would they feel comfortable talking to me? What if they didn’t feel that I was trustworthy? What if I couldn’t help them feel safe?
Over the past year and change, I’ve gotten more and more comfortable establishing these relationships. I began to develop a skill set for connecting to clients in the first session, an adaptable script that helped me create a comfortable, safe environment for kids (and their parents, but in all honesty, the kids were and are my main focus) to feel like I was a person they could talk to and trust. It helps that I’ve heard from both clients and parents that they felt I was immediately friendly and comforting–that would help any therapist feel pretty good about themselves, and feel more comfortable starting more clinical relationships.
But none of that–none of that–prepared me for how difficult it would be to end clinical relationships.
When the Husband and I made the decision to leave the Berkshires and relocate somewhere with a larger Jewish community that would be closer to our friends, my biggest resistance to the the idea was not, to my own surprise, about the sheer amount of change that would happen, but rather about my concern for my clients. After spending months (and in some cases, more than a year) working with these kids and their families, the idea of leaving them before they finished their clinical work seemed (
seems) horribly unfair.
By virtue of working for an organization that has a client base coming primarily from state-funded insurance, often with DCF or court involvement, a huge majority of my clients have experienced incredible losses during their short losses. These kids have lost parents to incarceration and drug abuse, have been removed from their parents’ custody due to abuse and neglect, have been separated from siblings and friends and extended family. Many have siblings and half-siblings they aren’t able to see and miss terribly, have had multiple therapists and foster placements, have changed schools more times than they can remember. Some of them are unable to list the traumas they’ve experienced because there have been too many, have been betrayed by more trusted caregivers than could ever be considered fair.
As child and adolescent therapists, we have a number of different jobs. We don’t, contrary to what is apparently popular belief, give advice or judgment about our clients’ problems. Rather, we help our clients build the skills they need to navigate challenges themselves. We teach and practice coping skills, we help clients identify their strengths and use them in positive ways, we help families build relationships and communication skills. We help create and amend safety plans for clients experiencing thoughts about hurting themselves or others. We assist families in navigating the complex systems of state agencies that they often worry about trusting.
But most importantly, our job is to listen, and to be a safe, positive adult figure in these kids’ lives.
Realizing that I was going to be yet another attachment figure that these kids would lose was a sobering moment that broke my heart. Even though I knew (
know) that losing a therapist is hugely different from losing a parent, sibling, or friend, I nonetheless felt that I was somehow betraying my clients by leaving. These kids allowed me into their lives and let me help them through some of their most difficult moments, and now here I am, leaving them behind as I go off to pursue brighter pastures. Even though I know I’m making the right choices for myself and my family, it still feels icky.
When I started looking online for literature or advice for therapists about terminating client relationships before goals had been met, hoping for some stories or recommendations, I ended up with pretty scant results. Most articles were in response to clients terminating therapy early, rather than therapists, and few dealt with the emotional responses that both therapists and clients experience during these processes. It also seemed that most of those articles were written by and about therapists who work with adults, not children–so while the process might be similar in theory, I doubt it’s identical. This article from the Society for the Advancement of Psychology came closer to the emotional examination that I was looking for, but it seems to be the only one of its kind (not counting scholarly sources, which, really, who has the money for those?), but again, it refers to planned terminations coming with the achievement of goals, not a necessary termination due to changes in the therapist’s life. This one about MSW interns terminating client relationships at the end of their field placements came a lot closer, as it explored more of the complex feelings of both therapist and client when therapy comes to an end due to outside factors rather than mutual decision. That one doesn’t attempt nearly as much to beat around the bush, and acknowledges, straight-up, that terminating client relationships before either of you are really ready can be a frustrating, upsetting process for both therapist and client.
After an agonizingly long week of telling all of my clients that I was leaving, which included a lot of tears in-session from them and post-session from me, I complained to my own therapist about how crappy this process was. As necessary as I knew it was, it just sucked. I felt guilty, worried, and upset, and emotionally exhausted, and by Friday (when I met with her), had come to the conclusion that I was a Terrible Horrible No Good Very Bad Therapist for leaving all of my kids behind.
My therapist knows that I’m a therapist as well, and was pretty frank with me in asking if I’d done any of the usual cognitive-emotional exercises to try and challenge this idea, since I obviously knew that I’m not a Terrible Horrible No Good Very Bad Therapist for leaving all my kids, because if I was, I wouldn’t give a crap that I was leaving in the first place. I had, of course, done a bunch of them, but pointed out to her (as I have on multiple occasions, because that’s how I roll) that A. you can’t CBT yourself, and B. my cognitive triangle process is apparently broken, because no amount of pointing out rational thoughts distracted from the fact that my feelings were throwing the internal emotional equivalent of a temper tantrum.
Once we’d talked about this for a bit, she leaned forward, propped her chin on her hand, and said, “You know what? I think I’m going to be honest with you, and tell you what I think you’ve already figured out. This process sucks. It doesn’t feel good. And that’s okay. Sometimes it doesn’t feel good. We feel like we’re leaving things unfinished, and that we’re not doing what we set out to do. But you did the best that you could with the time that you had, and I believe that you’re going to do the best you can in the time you have left. And I think that’s enough. But you don’t have to be okay with this right now. It’s okay that it hurts.”
What was that about embracing vulnerability?
By trying to smooth this process over and force myself to push away the uncomfortable emotions it’s brought out in me, I’m effectively trying to put on a face to my clients that says I’m not impacted by leaving them. And in all honesty, that’s unfair–not just to me, but to them.
These kids have been left behind, again and again and again–by parents, caregivers, teachers, case workers, therapists. With each loss, they turn themselves off a little more and shut themselves away from forming connections, and they carry each loss with them: a parent’s anger or anxiety, an abuser’s harsh words or painful hands, a case worker’s stress; each loss a marked burden they begin to bear. Some of the ones who have left these kids behind leave a positive mark–a foster parent’s kindness, a grandparent’s determination, a sibling’s love of school or art or sports–but the goodbyes are carried nonetheless.
The fact that these kids allowed me to connect to them–some of them for over a year, some for only a few weeks–has been so meaningful to me that I can’t put it into words. I owe them the honesty of telling them that leaving them means something to me, and that I, too, feel sad and scared and upset. This isn’t to make this termination about my feelings rather than theirs–even if it was ethical, which it isn’t, it wouldn’t be fair to them. But each and every client I’ve worked with has taught me something, has helped shape me into the person I am. Not just as a therapist, though of course they have, but as a person in general. They’ve helped me learn to listen better, to teach without expecting perfection, to offer space for messiness and failure and setback, to acknowledge and celebrate small victories.
Here is what I am telling myself, as I come into the next several weeks of hard conversations, difficult transitions, and painful goodbyes: In these relationships, I have learned, and I have grown, and I have helped my clients to learn and to grow. In these relationships, I have offered safety, compassion, and kindness, and have been granted the privilege to help and to teach. As these relationships end, I may receive anger and frustration, but these emotions often come as the vanguard to sadness and anxiety. As these relationships end, I will give each client the individual attention that they need and all the care and processing that I can offer.
In these relationships, I have given the best of myself, and I have done my best work. I am the one who is leaving, but if I leave some of myself behind for these kids to carry with them, may it be the best of me.
That would be enough.