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Wednesday, July 08, 2009

Termination

I think-- gold watches, retirement parties. Cake.

Or the divorce party. Gonna' wash that man right out of my hair (a real oldie, you're not expected to know it).

The due a person gets for surviving a long association with an institution, sometimes trying, sometimes rewarding. Like marriage or work, or any serious social commitment that’s lasted long enough to feel. . .important.

Endings that beg formality.

Graduations, for example. FD hates going to them. He says, "What's to celebrate? You're just going to have to go back to school in September. There’s always another school."

He’s of the opinion that you learn more on field trips and reading encyclopedias. So he doesn’t get it. Would you ever stop learning, he asks? In his world there’s always something more, something new.*

But for some of us, our relationships are the most exciting something new in our lives. We don't just exchange phone numbers to say, “We’ll keep in touch!” and then not keep in touch. But it's harder, we know, once we've moved on, followed different paths. We become relationship-lazy, perhaps one of the reasons graduations are the perfect places for goodbyes. Give the work, the relationships, their due. And move on.

Then once we've settled down, established some roots, we find we're on the move again. In this economy some of us are moving back to our families of origin.
Where else am I going to go, now that I have no job?!
And some of us are moving away, taking the only jobs available, leaving extended family behind.

A friend of mine has a daughter who is being transferred a continent away, taking her spouse and children with her, the chutzpah, seriously. My friend, isn’t going to be hopping on planes to see her kid, she can’t afford it. This is a separation, not a termination, but it sure feels like a termination. Try convincing her otherwise. I wouldn’t begin. Sometimes people just need to spleen anyway, you know, let the tears roll.

When family moves away, it can hurt pretty bad.**

When it's friends, it might hurt, but the impact has to be different, less intense. We have to be happy for them, stay positive and profess, “We'll still get together, we'll visit. Now we have a good excuse to travel. A free hotel in a new city!” Like this is so easy, traveling. So pleasant, And so affordable.

Years ago, when my best friend (we had one of our kids on the same day, different hospitals) told me she was moving to Miami, I looked at her and without a trace of sadness sighed, “Nice knowing you. I’m terrible at keeping up, just being realistic here.” She wasn't pleased. But some of us get used to separations, terminations, young.

In our case, our time together was regimented, limited really, to one day a week, Saturday. The Jewish Sabbath consists of 25 free hours of not answering the phone, not turning on the television, not traveling, definitely not working. It's more like eating and drinking most of those 24 hours, singing, visiting friends, learning, and going to the synagogue to pray. I know, it's a tough life.

But once she moved I knew she wouldn't be a part of that anymore, that we would have to find time during the work week to talk on the phone, and that wouldn't happen. As it turned out, soon after she moved, my parents bought a condo in Miami. So now, when I visit them, my friend and I either get together for dinner or we talk about getting together, and that’s fun, too. It's like the proverbial call from the cousin at the airport between flights. "I'm here in town! Just called to say hello!"

All this before email, you know, all this drama. Now, we say,
"We'll email!”
Cause we have so much time for this, time to write back and forth about what happened today, yesterday, the past six weeks, six months. But some of us do pull it off, and we know how special it can be. But it’s not easy to keep up, is the truth.

So it can be tough, terminating, facing the reality that what we had together has to change, will go bye bye forever, lost to the past. Those of us who accept it don’t mind calling it what it is, termination. We say, “Goodbye, for now!” and celebrate the relationship we’ve had, redefine one for the future, try not to drop off the face of the earth, and when we do see one another again, try to pick up where we left off.

Negotiating a termination, saying goodbye well, means communicating what to expect from one another. What we would like, optimally from one another in the future. We'll expect more or less communication, depending upon the relationship. We say in therapy that there is no such thing as no communication and that may be true. But people over-diagnose no communication, tend to assume too much. They think,
"Where did you go? You haven't called. You must not like me."
Oy. Maybe nothing could be further from the truth. The squeaky wheel gets the oil. Our time isn't our own. There may be none. There is so much to do. And depending upon our histories, it may be hard not to take it personally. No call back, no letters. We'll perceive that as abandonment, an absence of emotional attachment, not enough, surely, to get the pencils writing, the telephones to ring.

But each of us has probably rejected more than we know, terminated relationships without a thought to those we've left behind. We only notice it when someone disappears on us.

So it can be touchy, this leaving others behind us, doing it well.

None of us wants to hurt anyone's feelings. Some of us can't walk away from a conversation until we're sure we haven't upset anyone. We can't terminate a conversation!

My tribe is particularly neurotic this way. Saying goodbye at a party takes two hours, seriously. Maybe this is a universal, for sure you don't have to be Jewish to worry about hurting peoples' feelings. As you turn to leave the party you can hear, in your head, the accusatory thinking. . . She didn't even say goodbye!

Long way around to talk about termination in therapy.
It symbolizes the death of an important relationship.
So we have to ask the question: Can a relationship really die?

We know our memories are buried in the hippocampus of our brains, probably wrapped in cozy blankets, stuffed into crowded, but air conditioned storage units. We pay by the year. If the memories are there, tucked in a tiny address in our brains, can a relationship, a metaphysical bundle of memories, really die?

They're all in our heads, somewhere, these relationships.

We used to say in family therapy, that there are invisible rubber bands around relationships, that it doesn’t matter what we call them-- married, divorced, separated. It is the relationship that defines the couple. And if they haven’t got a decent rubber band around that, if they don’t feel intimately connected, then guess what? They are already separated, even in a committed, married relationship, they may even be emotionally divorced.

The relationship between the therapist and her patient is also a metaphysical, cognitive entity, also bound by a rubber band. It can be very close, actually, intimate in some ways. But it isn’t marriage. The commitment of therapy is to treatment goals and objectives. It is the work we're committed to, and the intimacy is work intimacy, with no promise of ever-lasting, never-ending love. When the work is done, it is time to pack up our skill sets and go home. The imaginary rubber band becomes very thin, very, very large. You're gone, but not forgotten.

That’s the ultimate message the therapist has to convey to the patient in the process of letting go.
You are unforgettable. Your story is unique and you are amazing. I have learned from you. I’ll miss you, and if you need to come back, just give a shout. Thank you for trusting me, for sharing with me. I hope it helped, our time together.
They used to teach an entire course on termination, thirty years ago, in graduate schools, but I don't remember hearing this, that it is the therapist's obligation to convey these things to the patient, the meaning of the relationship.

What we do learn is that every one of us has or will have so many cut-offs in our lives, so many disappointments in relationships, so many deaths, both real and imagined, that a professional should be the last person to add to that class of aggravation.

Leave people miserable about the termination, unsatisfied, and unfulfilled, and they’ll bad talk you for years. I think that’s how they put it at the University of Illinois. They may even sue you.

And we can’t let that happen.

But you can’t please everyone all of the time, can you? And sometimes a therapist knows that a patient needs something more, someone else. It’s not easy sometimes to hear
We're not meeting your goals, and that's not good; it’s time for you to move on. You’re not getting better under my watch.
We make this call, by the way, not the patient. If we believe this to be true, then we have to insist upon another opinion, at the fatal six month mark, at least social workers do.
Am I helping this person? Should I get a consult? Should I punt?
We have to think this way. If we feel that punting will be detrimental, we need to get a consult, discuss the case with someone else, get a fresh opinion. And our consultant might say, punt. Each time I've done this, by the way, referred out, it has always been a positive thing to do. People need permission to move on, and we have to give it to them.

Sometimes we know that we're just exhausted, or we have exhausted our bag of tricks, and we're sure that a new perspective has to be better for the patient than to rehash the same old themes every week. Easing this human, our patient, down gently, feels next to impossible at first, especially if he or she has learned a certain amount of dependency in the therapy. First you crawl, then you walk, but a good mama wants her kid up and running, exercising.

The booby prize of therapy, surely, is a very quiet voice in the head, one that directs emotional wellness, fights off panic, and keeps you rational.

Up and running, exercising in the playground, no longer looking back, you hear, "Been nice to know ya'! Drop me a line!"

Because in this virtual world of ours, termination might just be a thing of the past.

therapydoc

*A complete exaggeration about FD to embellish the post. He does keep up with a few friends and some of his hundreds of cousins, and he never misses a barbecue.

** If you're my kid, and you're reading too much into this, CUT IT OUT! (cut it out is American English slang for Please stop! I assume everyone knows by now the meaning of chuzpah. (Let me know if you don't.)

***See Cat's post (I fired my first sponsor) about changing sponsors, one that prompted me to write Changing Sponsors, Changing Therapists on the Second Road

38 comments:

Jack said...

at the fatal six month mark,

That comes off as being rather harsh, the word "fatal" that is. I probably infer too much into it, but it just strikes me.

Isle Dance said...

Does this mean my therapist really meant all the meaningful stuff she said? (I thought so, since she was also sweetly emotional about saying goodbye, which I never would have predicted. But maybe I'm wrong...!)

therapydoc said...

JACK, you're reading way too much into it. You have to get off of words.

ISLE She meant it, you bet! How could she not mean it? We're talking about you, here.

Walter Paul said...

I work alone - by myself most or all of the day - when I am handing out my cards in the street in the city to let people know that I can provide them with either my photography for their needs or that they can enjoy my images on my websites - they are in touch with me for a brief moment as they walk by take the card sometimes say thank you or on a few occasions ask me a question or two that they can come up with - and I always think perhaps they will call - maybe they will need me to photograph them - and for those who do come - we both have a grand time or perhaps it is a who;e family with many different dynamics - but then it is always sad to see them go - leave happy with their pictures - but will I ever see them again - sometimes customers do come back - some even every year - some send their spouses for a portrait needed for a real estate career - but all in all I never know when they will ever if at all step back into my life -

I never plan to retire - and perhaps one of the reasons is that this way I will always be leaving the door open for any one of those nice people to step back in through the door and even for a brief moment - back into my world where we have a few short moments of creating together - Life is so much shorter and more fragile than any one of us really realizes -

Lou said...

I've never had a therapist (can you tell;), but I do know a lot about terminations, having had a very nomadic life.

Often I know that I will never see someone again, and I would LOVE to say "good bye, have a nice life." But as you pointed out, people get upset with that kind of pointed honesty. After I made a few people cry, I stopped doing that.

therapydoc said...

WALTER, thanks. I hope I don't either (retire).

LOU, some of us learn the hard way ;)

Attachment Girl said...

Thanks so much for this. Some of it was difficult to hear but it was all good. I've done a tremendous amount of healing with my present therapist and have learned to more fully inhabit my life. A big part of the healing was accomplished by my being dependent on my therapist so I could learn from him how handle my emotions, be aware of my needs, express them both and get my needs met. I have a growing sense that it may be time to leave home, but its difficult because in some ways this is the most intimate relationship, and certainly the most trusting one, I've ever experienced (and that includes a 23 year marriage to a really wonderful man which was also considerably improved by therapy). Bottom line, I will deeply miss my therapist but we've spent some time discussing the whole idea of how we carry our relationships and the connection with us. And I know this is true because my relationship with him has affected me in very deep ways; it is now a part of me in a way I can't undo, even if I wanted to.

But being able to realize that this goodbye is just another part of life and can be dealt with (which come to think of it sums up a lot of what I learned) makes it easier to contemplate. OK, that and knowing his door always remains open.

It's difficult to put what I'm trying to say into words, but I deeply appreciate how clear and empathetic your understanding is while still presenting the truth. Thank you.

Anonymous said...

"JACK, you're reading way too much into it. You have to get off of words."


TD, I love it! You have a marvelous sense of irony!!!!

mmaaggnnaa said...

Hey, therapydoc -

I have to chuckle a bit at this post . . . I'm very "good" at terminations . . my switch flips and I become angry at the other party, give him or her a good verbal whipping and I'm OUTTA THERE! I'm the queen of good-byes!

(sigh) One of my "things to do" is to learn to be more broken up over terminations.

- Marie (Coming Out of the Trees)
http://mmaaggnnaa.wordpress.com/

Amy said...

I too have been the type to express the "good bye, have a nice life" when parting from friends, lovers, that I know I will not be able to (or wish to) stay in touch with.

The problem shows up years, sometimes decades later when I realize that the person may have been more important to me than I realized at the time.

Also, I think it's the little strings that are tied to the memories of those parted friends. I think this is what makes terminations so difficult.

It's not always about the person, the individual, but about those memories triggered that are like little "Youtube" videos of our lives - tied to our times spent with the person.

The older I get the more annoying this little cats cradle game becomes.

Jack said...

I said that I was probably reading too much into it. But lately I have been especially sensitive to what words I and others use, so...

The Rebbetzin's Husband said...

I'm reading this as I'm in the middle of writing a couple hundred goodbye letters... I decided to personalize all of them and not go with a single model, so this is going to take a while.

Shosh said...

My brother made Aliyah this week. But between Skype and Facebook I figure it won't be quite so bad!

Isle Dance said...

Now I'm sending extra of these: :o) to you both.

JMH said...

Just a quick note, as I'm at work, but I find most everything you write to be amazingly useful.

therapydoc said...

Thanks!

Ally said...

TD, can you say something about how a patient/client knows it is time to terminate, how do they know they are "done" and have grown their own wings?

What you said about "leave people miserable about the termination," that was my experience with a therapist I had 5 years ago and makes me scared about my current therapist abandoning me. Probably something I should discuss with her!

therapydoc said...

It's the therapist's call, Ally, although surely if the patient gives us the message then we start weaning. Yes, discuss it.

TechnoBabe said...

Good post. I have been in therapy almost a year and we have decided together to work together another 6 months and then is I still want to she will refer me to someone to help with the next phase. We are getting so much accomplished. I appreciate her input and I keep records now of how I am doing and wow, I am doing so much better. I am an expert on saying goodbye, I have moved at least 100 times in my life. I am excited about the help I am getting right now to become a healthy woman, but I am looking forward to the final session. It will mean so much to me.

Maha said...

Therapydoc, I’m reading your post at an uncanny time – I was just rehashing the details of a 15 year friendship gone slightly (actually, very) sour by both of us living in different continents, having jobs that consume so much of our time and slowly becoming very different from the people we were in high school. Long story short, I just feel like the friendship has run its course and I’m not sure if I want to promise to keep in touch but not really follow through and then be faced with more hurt feelings. Sadly, I wish I were more eloquent in presenting my thoughts to my friend without hurting her feelings. Termination – not my favourite activity.

Stormy said...

therapydoc, this isn't your way of terminating with all of US, is it?

therapydoc said...
This comment has been removed by the author.
therapydoc said...

Stormy, no way.

Dreaming again said...

I need to re read this. I read it, but all that was going through my mind was the renumeration of

But I *know* that song (wash that man right out of my hair) and what does that say about me????

So, I need to re read .... heading back to the top!

nashbabe said...

The Second Road article seems to have been 404ed. :-(

therapydoc said...

grrrr. I'll find it, thanks nash.

Anonymous said...

Theapydoc, I would normally email this or comment it privately but I couldn't figure out how to do it from your page. I apologize that it is off topic. My question for you is "Would you ever knowingly, if asked, subscribe to a client's blog?"
Thanks
Shoedrop

shoedrop.wordpress.com (from NJ and NOT one of your clients :) )

therapydoc said...

SHOEDROP, of course I'd want to read a patient's blog, but there are so many things wrong with it. As a blogger I know how much easier it is to write things and publish them, then wonder if that was the right thing to do. At least in therapy a person has a chance to think about it first. It's the blurt phenomena that bothers me.

I'd rather the patient write it, and then if she or he wants me to read it, print it out and bring it with to therapy, or we just go there, to that particular post, during the visit.

prozac nation said...

Very nice post. I think your blog have things everyone should know about.

therapydoc said...

Like taking prozac? Not without a doctor recommending it. In other words, you don't go to the doc and say, "How about Prozac?" You talk about your emotional life and let the doc evaluate or suggest. Thanks for the reminder, NATION.

Anonymous said...

I wonder what you do when your therapist dies unexpectedly. That's a goodbye, a termination of the relationship, but no opportunity to go back say the goodbyes. Yes, that happened to me, nearly three years ago.

Scraps said...

Termination has always been a hard thing for me. I've lost/been cut off from so many people I've been close to over the course of my life that I have a serious abandonment complex. I'm in therapy now and not sure how I'm going to handle when my therapist goes on maternity leave, let alone what I'm gonna do when she tells me it's good-bye for good...

therapydoc said...

ANON, sorry for your loss. It's just like any relationship. You grieve, right?

And SCRAPS, you don't know who's going to say goodbye first. I think the maternity leave is a good way to break into it, though, lessen the dependency, start to integrate what you're getting out of it. And you'll have your buddies on line to kvetch to, anyway.

Glimmer said...

I literally hate goodbyes. John Keats speaks the why for me: "I can scarcely bid you goodbye, even in a letter. I always made an awkward bow."

So, T.D., I would be a scandal in your family, hastily rushing out, hiding eyes beginning to tear up.

therapydoc said...

Yup, Glimmer.

Cat said...

I thought I had commented on this ! I was hear - I read it and , I guess I must have gotten distracted? Or not saved it?

Oh well - here I am - and I am honored to have been inspiration for you. Seriously.

Cat

Ella said...

My T asked me a few weeks ago if I would miss coming in when we are done. "Of Course!" I said. It was such an odd, out of place question, due to the timing of where we are in our work. The next week I asked if it was some type of test, to see if I was ready for termination. He said he's not that clever. Still wonder why he asked, was he asking if I would miss *him*?
But, pleased that I could say "I do know that it will end at some point, and I'll graduate." It will be part of the natural order of our relationship. Still, I will never forget him - I love him, he's very dear to me - and I would hope he won't forget me. Our joke: if we live another 30 years, maybe we will re-connect at senior day care.

therapydoc said...

Senior day care! That's thinking positive, I guess.