From time to time I think about how therapy ends. I get upset when it is suggested, as it not uncommonly is, that therapists encourage people to stay in therapy because they want the money. I am certain there are some therapists like that. Like there are lawyers or accountants or plumbers or mechanics who place income above ethics. I have been in therapy with a number of therapists myself and I have never encountered this as in issue with any them. And I know that I and the people I have supervised have dealt with anxiety about money in supervision a lot in order to keep that anxiety as much out of the work as possible.
When a patient abruptly announces she is leaving therapy, it can be upsetting. It means a hit to income, yes, but it is far more upsetting when a patient does this without being willing to talk about it. The money part of it is inconvenient but comes with the territory.
I know that a consequence of being in private practice is that my income is never really predictable and so I have to be able to absorb losses and be careful to keep my resources such that I never have to worry that losing a patient will lead to disaster for me - that is part of my job, to ensure that so that I do not make decisions based on income. I won't take on a patient I know I can't work with, no matter how much they can pay. I work with people who pay me less than half of my full fee and they do not get any less of my time and attention than do the people who pay full fee. That is how it works.
It's my job to challenge any changes in our work that patients bring up. It is my job to ask when someone announces they want to leave therapy to ask why now and to raise what I see as possible issues. It is not about wanting to control the patient or protect my income. It is my job. I ask at the beginning of therapy why they are seeking therapy now and we look at that. I ask at the end why they want to leave now and we look at that.
I think it is hard to remember that the therapist is a person and that therapy is a relationship. It is a RELATIONSHIP. Patients and I spend an hour or so together every week and they live in my thoughts and occupy space in me beyond that hour. It's a relationship. So when a patient says to me, "I want to stop now", I ask why now and I ask that we look at this because it is part of our relationship, because I am a part of this relationship. And if that patient won't talk about it, won't look at why and leaves, maybe in a huff and full of mutterings about me, then she leaves. But she will still occupy space in my thoughts as I try to understand what happened and what might have led to this. And when she wants to return, as often happens, my door is open and we begin again and I do so without carrying resentment.
It all comes with the territory.
Ending is hard. It is hard no matter where in our lives we do it. And we tend to end in therapy in the same style we end other relationships. There are good endings and bad endings and healing endings and wounding endings. And they are all hard. And we can, all of us, learn to do them with more grace when we are willing to look at how we do it and what endings mean to us and have meant in our lives.