Termination is the official title of the last therapy session. In this session, ideally, you are reviewing what you have learned in therapy and processing the changing relationship, as you will no longer be meeting with your therapist. I love these sessions, but I can see as a patient/client how they could feel awkward. Do I need to say “thank you” to my therapist? Should I have brought a gift?
Although I can’t answer for all therapists, I have seen quite a few options for doing terminations and I have my personal opinions on the matter. Take a peek behind the scenes of therapy with me...
The Termination Session
In cognitive-behavioral therapy (CBT), termination is strongly emphasized. In fact, from your first day, we are planning ahead for your eventual termination of therapy. The goal is to transfer skills to you, allow you time to show success in using them, and then let you fly from the nest and use your skills without further support. Sometimes this is a very short-term process (e.g., a few weeks or months) and sometimes it takes a bit longer (i.e., a year plus).
As a child therapist, termination is often framed as “graduation.” Many of us legitimately do a little ceremony or celebration. People might give short speeches. There could even be food. In one setting where I worked, the teens actually would make a clay bead that represented something from their time in the Intensive Outpatient Program (IOP).
This session can bring up mixed feelings for people. I hope that people (and their parents/families, if involved) are feeling really proud of themselves on this day. They also likely feel nervous about using skills without the continued support of therapy. They might also feel sad if they had a great connection with their therapist, knowing that they won’t be talking regularly anymore.
Ethics of Termination
Psychologists have some guidelines in their Ethics Code that impact termination. First of all, we are not allowed to begin a friendship with someone after they have been our patient. This is even a bummer for us sometimes! Wouldn’t it be cool if we could attend the family BBQ? This is in the best interest of the patient, however, because we want to maintain the professional relationship that we had with you. Also, you might need to see us again, which wouldn’t really be possible if we had switched into friendship mode.
We are also not allowed to accept large gifts. There is no clear definition of what constitutes “large.” Just know that if you bring your therapist a Ferrari on the last day, they will sadly have to turn it down. Gifts are not necessary or expected. Gifts that can be accepted might be shared with the whole team (for example, a fruit basket), rather than kept by the individual therapist. Gifts that cost way less than the price of therapy or are handmade generally can be accepted.
This one’s honestly a bummer as well. It is so sweet when someone brings a gift and you don’t want to stand there trying to calculate the cost of the gift, figuring out if you’re allowed to accept it. I know, too, that in some people’s cultures, gifts are more important and meaningful or it can actually be an insult when they’re turned down. More thoughts on this below...
Here are three potential responses to termination...
No “Thank You”
Generally, in my graduation sessions, I spend some time with someone talking about their strengths, my favorite sessions with them, and my hopes for their near future. Depending on how long I have known someone, this is more or less gushy. Kids often receive a small prize.
I have definitely had graduation sessions where I did all of the above and then the child, adult, or parent just said, “Okay, bye” without even a simple “thank you.” I have to be honest as a human being – this hurts a bit! Saying “thank you” is certainly not required, but we put a lot of effort into someone’s care and it’s nice when that’s acknowledged.
The Norm
Most graduation sessions, people do say “thank you” and explain a bit of how therapy and my presence was helpful to them. (In fact, I have had quite a few people who will say things like this before even our last day, which truly makes my day/week.) Beyond the little self-esteem boost, as a therapist, it is genuinely so helpful to get feedback on what someone liked in therapy, whether it is a particular topic/lesson/activity, our style of presenting these things, or something else. That helps us to make decisions that benefit other patients and families.
The Dream
Everyone loves a little treat, so I won’t say I don’t like them at all, but gifts are not my love language personally. I also hate the potential of having to turn down a gift from someone. That just feels so awful as the last thing that happens between myself and a patient. What would be the dream for me is a little note, honestly. Maybe just a quick email from a parent. Something that I can read on a bad day and go “Oh yeah, people benefit from therapy!” I have gotten some sweet notes from kids and I cherish them. I have one drawing that is framed above my desk. This is certainly not expected but really does warm my heart when it happens.
My last thing to say is that however you are feeling about the termination session, tell your therapist! If you’re sad and going to miss them, tell them. Get out a nice cry. If you feel really awkward about goodbyes in general, say that! Termination might bring up some feelings that are actually really helpful to process while you still have the chance. You might learn something that is helpful for other goodbyes or changing relationships. And, remember, don’t bring a Bugatti. (You can bring your own, if you have one, and show it off, and then drive home in it.)
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