Even brief absences of contact with another, can make the Borderline feel non-existent, undesirable, invisible, unlovable and worthless. Client care: First, let's take a look at the ethics of termination. This sets the expectation from the start that termination is a positive goal. It wasn't. This technique was seen in the treatment with the borderline clients often with the therapist pausing the client's thought process throughout their session. Depression, Anxiety, Stress or something else - we are here to help! John Wiley & Sons. For this Borderline to begintoleratinglove, success and a real sense of joy, there has to be a paradigm shift. Below are some questions to begin exploring: Many issues that bring clients to therapy have a high risk of relapse and require ongoing maintenance. "Together, we review all the tools the client now has at their disposal and how they feel equipped to handle what comes their way, " she explains. This is a tool that is taught in dialecticalbehavior therapyand can be a great way of thinking through many different kinds of decisions. Healing work isverydifferent from psychotherapy. Submit. 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. He has little frame of reference for someone being responsive tohisneeds, and his grandiosity can't tolerate it. In a sense, there exists a permeable membrane between a Borderline's private life, and the relationship he/she shares with any practitioner who is dedicated to doing healing and growth work with them. Perhaps Mom always appeared to be a long-suffering "victim" of their father's abuse or neglect and she's regarded as 'the good parent,' in sharp contrast to the other's monstrous volatility or irresponsibility. Thisreboundissue is typical in their romantic endeavors as well. 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. Their desire to distance orcut offtherapy (especially when it's getting close to a nerve or breakthrough), is pretty common. Talk about termination in the last session. The therapist/client relationship has come to a natural end. Therapeutic practitioners who treat Borderlinesoranyonewho's suffering fromcore trauma issues for that matter, must constantly remind themselves that they're dealing with someone who is emotionally underdeveloped--in essence, a very young child in an adult body. 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. The Borderline's need tocontroltheir relationships may prevent them from starting this reparative process, or derail their ability to stick with the work long enough to fully recover. We hear the tone of her voice, and grow very familiar with her language style, the cadence of her speech and how she uniquely enunciates her words. Some other strategies include: Copyright 2007 - 2023 GoodTherapy, LLC. What Is Dialectical Behavior Therapy (DBT)? If the clinician agrees with the clients readiness for termination, this is an opportunity to begin collaborating on closure. Throughout their entire life, the Borderline client has confused sensations of painful longing and yearning to have their love returned/reciprocated, with theemotion of loveitself. Focus on and emphasize the gains and progress the client has made. Dont forget to download our three Positive Psychology Exercises for free. His needs are profound, but given his inherent trust issues, there's less threat if he spreads himself thin--and has astableto choose from, the minute he's in crisis. Professional Psychology: Research and Practice, 40(6), 572. Recommending a group or individual counseling program. These might include prioritizing other things over therapy, cancelling sessions, or not completing homework. Termination may even be a bridge to resolving some of these issues. The Borderline in treatment could be 'A Lifer' in long-term care, particularly if he or she has tried to get their needs met with standard therapy or analysis. Recommending a group or individual counseling program. To learn more about the termination process, check out this book: 1. Their tendency is to confuseRecovery Methodswith psychotherapy~ and there is virtually no similarity between the two. And if a client repeatedly no-shows, a termination letter may be the only way to ethically terminate therapy. Concluding treatment should be a collaborative process between psychotherapist and client, when the latter is ready for treatment to end while leaving the door open for a potential resumption of work if required (Wachtel, 2002). Discuss positive and negative reactions to ending the relationship and the therapy. Barnett, J. When they begin to make gains in treatment and their painful inner drama quiets down, they typically want to leave therapy. (n.d.). Without such goals, therapy can become aimless as new problems arise each week, causing therapy to continue indefinitely. 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. Some sturdy parameters must be in place, to help the Borderline understand the archaic basis for these uncomfortable, conflicting feelings, learn how to tolerate them, and continue to build and solidify trust. Therapist Aid has obtained permission to post the copyright protected works of other professionals in the community and has recognized the contributions from each author. Casanova often plays musical chairs with therapists. Pain has a way of grounding us, which is no exception for the BPD client. Here are some of the top reasons why clients end therapy before the work is complete: Money: Probably the #1 cause of premature termination, lack of funding frequently ends therapy (especially . 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. Even the slightest sense of distance from a lover or spouse can catalyze profound abandonment terror in Borderlines, because he/she assumes it'stheirfault. It is important to discuss termination at the beginning of therapy and to prepare the child as far in advance as possible. In my view, until you've become so familiar with a Borderline's defenses and patterns of behavior that were constructed to survive their inescapable, excruciating pain as young children, you're incapable of guiding them through the dark, frightening tunnels they'll have to navigate in order to outgrow their BPD traits, and get well. Be willing to answer questions about therapy termination, such as where a client can seek additional help if necessary. Some therapists send a brief termination letter to every client who leaves. Specific factors include (Barnett & Coffman, 2015): The therapist does not have the skills or competencies to meet the client's needs. This issue is especially common in BPD patients/clients who are psychotherapists. If you have borderline personality disorder (BPD), it's very common to feel like you want to quit therapy. The client might stop therapy altogether or transition to a therapist with expertise in other issues. What did you learn about yourself or how others see you? If the client is behaving threateningly, and the therapist feels endangered. 6 strategies for ethical termination of psychotherapy: And for avoiding abandonment. A lover who is distant/abusive is more likely to hold their attention, because painful and dramaticyearningfor love has been equated with the emotion itself, since infancy. These distancing tactics ease sensations of dreaded vulnerability, which arise out of their feelings of needfor the therapist, once the therapeutic bond has become more established, comfortable and important to them. As therapy nears its end, these assessments will allow a client to clearly view their improvements, based upon their own self-report. Surrendering a long-held 'Victim' Identity feels akin to limb amputation, and is often resisted. Chaos in their outer world mimics the chaos they experience internally, so it's much easier to tolerate. 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). Have you been able to attend and cope at work/school? They provide an opportunity for future learning and using skills learned. Even if a bigger/sturdier plank floats by, you can't see beneath the water's surface to determine if it will support your weight, sofear of the unknownkeeps you from leaving the one you're on. Children, in particular, may benefit from a structure/form. A small child is overburdened by these complaints, and doesn't relish this role--but at the same time, all this special attention from Mother imbues him with a sense of value/importance, which forms thecruxof his self-worth. Kristalyn Salters-Pedneault, PhD, is a clinical psychologist and associate professor of psychology at Eastern Connecticut State University. The Borderline's narcissism prevents him/her from regarding their clinician as a viable and whole entity who's capable of experiencing human emotions. Help the child develop a list of supportive people, especially adults, whom they can contact when they need help. As the clients time in therapy draws to a close, termination becomes the focus of sessions. I've merely helped all my clients resolve underlying difficulties like disconnection from emotions/senses and poor self-worth, which in my opinion, have spawned and perpetuated this very destructive and debilitating personal obstacle, and made it impossible for them to build and maintain mutually loving, harmonious relationships. 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. 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. It can help clarify the nature of and reason for termination, especially if a client is emotional or angry during your termination meeting. If a therapist determines that they are no longer able to provide adequate care for someone, codes of ethics require them to refer. A Borderline will resist helpful intervention, especially when it interferes with their need to alter what they're feeling during episodes of great duress. 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! Specific factors include (Barnett & Coffman, 2015): The therapist and client should set boundaries and appropriate behavior early in the therapeutic process, and part of the planning should include provision for referral when termination is abrupt. Make sure that the client understands why termination of therapy is necessary. It should help the client prepare to build on what they have learned and move forward positively. The therapist agrees to this and ends therapy with Christina. Terry, L. (2011, April). Week to week, this client alternates between two polarized perspectives; their good partner, and their bad partner. Perhaps they made you laugh, gave you hope, or understood your perspective. I think of this all too common "phenomenon" as an infant's emotionally fatalheartattack. Before you continue, we thought you might like to download our three Positive Psychology Exercises for free. Warning signs are clues that the presenting problem might be returning or intensifying. The ones whohavethe capacity to help, jostle his defenses, and heighten his competitive reflexes. Skills learned, such as handling stress and managing anger, Revisit the agreed-on goals and assess progress toward their completion. Remind the client how you approached or unpacked the problem. If you are sure that you need to drop out, consider other avenues of treatment. They're heavily armored and their defenses are thick, and often impenetrable. 404 | Page not found. Psychotherapists with BPD features areespecially challenging to treat. Other times, clients will offer subtle cues to their being ready for termination. Bhatia A., & Gelso C. J. In the very first sessions, the therapist will begin to lay the groundwork for termination by setting clear therapeutic goals and describing therapy as a time-limited process. Of what weve done so far, what has been the most meaningful or valuable to you? Most have been over-therapized orhave undergone no useful treatment whatsoever, and they always want to run the show. Learning to trust that these feelings are temporary and an essential part of Healing, helps them navigate this difficult but necessary adjustment period. Common causes include: Now that you have a list of your reasons for wanting to quit therapy, put a star next to the biggest reasons so that you can discuss them with your therapist. He's a serial patient, who's unlikely to spend any more than two years (consecutively) in treatment. Explore the feelings and the potential sense of loss for the client. Clients who struggle with grief, attachment, or loss may need help managing the termination. The client has been in treatment for a considerable amount of time and has shown no progress or a worsening of symptoms. ending therapy with a borderline client 27 Feb. ending therapy with a borderline client. Christina is hesitant to end therapy but agrees to do so under the condition that she can continue seeing her therapist for monthly check-ins. 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. The bottom line is that there are many reasons that people drop out of therapy and sometimes these are unavoidable. The goals of psychotherapy are to help you: Reduce your impulsiveness by helping you observe feelings rather than acting on them. By Kristalyn Salters-Pedneault, PhD If a client later claims you abandoned them, the termination letter may offer some protection. This technique assists the client to bring awareness to their thoughts and feelings about what's happening at the moment (Doering et al., 2010). Something will then happen in the course of the treatment (I'll have more to say about what that "something" is) and the client will abruptly turn on the therapist. Acknowledge this fact and be understanding. If the client accuses you of wrongdoing, take careful notes about the incident and consider memorializing the termination in a letter. 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. Termination as a therapeutic intervention when treating children who have experienced multiple losses. An online tool like. Borderlines arepassive-aggressive, and prone to leaving you abruptly. Be clear, direct, and compassionate no matter why the client is leaving. Instead, it should be planned and prepared for, working collaboratively toward the end of successful treatment. Ending therapy well is crucial to the overall therapeutic process. Realistically, if we're always having to do crisis intervention and damage control, there's no opportunity to accomplishemotional developmentwork, which iscentralto helping the Borderline relinquish personality disorder traits, and heal. As with therapist-led interruptions, several factors could cause the client to end treatment, such as. Refer to the plan regularly to make sure therapy is on track and to reemphasize the structured nature of therapy. Explore the clients reluctance and what can be done to help them feel ready for termination. Barnett, J., & Coffman, C. (2015, June). 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. Quitting therapy is a big decision, so think through your reasons and your treatment goals. Express pride in the positive work completed and the therapeutic relationship. Stay positive and focused on the future: Stay positive and focused on the future, even after terminating therapy. Throughout our blog, youll find many tools you can pass on to clients to help ensure they continue in a positive direction following the termination of the therapeutic relationship. 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( 2015, June ) warning signs are clues that the presenting problem might be returning intensifying. Chaos they experience internally, so think through your reasons and your treatment goals of distance from a or! Make gains in treatment serial patient, who 's capable of experiencing emotions...