ending therapy with a borderline client

Figure out the 'why' behind it Your reason for ending therapy could run the gamut from thinking "my therapist is frustrated with me" to feeling abandoned. Kristalyn Salters-Pedneault, PhD, is a clinical psychologist and associate professor of psychology at Eastern Connecticut State University. In the January/February 2009 issue of The Therapist, hypothetical situations involving the termination of clients were represented in four vignettes.Members were invited to respond to a set of questions analyzing the potential ethical/legal issues reflected in the vignettes, and to comment on the availability of options for each of the therapists depicted in the vignettes. Ever. In short, if we've never been able to receive nourishing love, warmth and affection within a stable, trusted bond, we never get to learn what the experience of real love actually feels like, and we're not equipped to giveit, either. If she's wrestling withaddictions, they're not just used to numb her pain--they're used to foil her glee, for she is considerably more at ease with struggle. When a therapist and client agree that its time to move on, both may have mixed feelings. Sadly, many psychotherapists seem under-informed about the etiology of this disorder, intimidated about how to work with it effectively, and have no idea what a Borderline client needs from them, in order to embark on their journey toward real wellness. When the mother leaves his/her side, an infant has no ability totrustthat she'll return. This is due to an old 'superstition' which was acquired during their childhood; "If I feeltoogood, somethingreallybad's gonna happen!" Every BPD client whocommitsto effective recovery methods reaches a transitional plateau in their wellness journey. You can watch or listen to this article here. Hence, profound control issues have evolved, and he'll only choose females with whom hethinkshe can maintain the upper hand. If nobody knows when therapy has been successful (because no clear goals were ever defined), then nobody knows when its supposed to finish. A young therapist (someone new to the business) is taken in by this, and never questions the issue of projectionon the Borderline's part. Even the loss of adysfunctionalidentity (en route to becoming sound and whole), is too frightening to ponder. Whether you're a Borderline or a clinician who's attempting to assist one, this literature may give you deeper insights into BPD, and perhaps help you revise some long-standing beliefs and/or assumptions you've held about this disorder. Explain to the child, in age-appropriate terms, why therapy must end. The tragic outcome of this type of upbringing, is the child grows up with the ideation theydeservethis brutality, and perpetuate the parents' abuse by beating up on themselves every day, and attaching to lovers who echo/mirror how badly they truly feel about themselves. If this isn't routinely on the forefrontof a healing professional's mind, helping this individual will feel daunting and extremely frustrating. Without this type of growth, a Borderline cannot heal. Sometimes a therapist is just not a good fit for a client. There is no right length of time to be in therapy. For me, it's become a dead giveaway that they're borderline disordered~ and thus far, I have seen no exceptions. Issues of core shame("I'm not good enough")make it difficult to accept personality disorder features, but how can we effectively work with a problem, unless we understand what it is? Terminating therapy is not intended to make a client feel bad, however, this, unfortunately, can occur. How Do Gifted Adolescents See Themselves? I ask the parts to take back their energy and try and go to a safe place in the client's mind, until our next session. When he/she starts pushing away or finding fault with us, we begin to re-experience the core shame and despair we felt soon after birth when this bond was broken, and we feared it wasour fault that we couldn't get our love for Mother, reciprocated. In short, you'll regularly experience therapeutic burn-out. Thriving is completely out of the question! The client should know they can come back if they need help again, but that the therapist is not a friend with whom the relationship can continue outside of therapy. The impulsivity characteristic in Borderlines can make working with them feel considerably more challenging for the clinician. Sadly, their addiction to pain and struggle usually trumps their desire for growth or change. If this occurs, his entrenched belief that anyone who could have value/importance to him will let him down or leave, becomesprophesy fulfillment. This leaves both you and your therapist to work through feelings brought up by this ending alone - abrupt endings can cause residual feelings of regret, loss, resentment and rejection for both parties and working . Be willing to answer questions about therapy termination, such as where a client can seek additional help if necessary. Crisis and chaos addiction is typical among borderline disordered clients, so as you help them begin to surmount immediate struggles and their pain lessens, they lose impetus/motivation to continue with and complete their emotional development work, and progress is effectively derailed. This outer protection is very stiff and cumbersome, and it keeps them upright when they're feeling a bit vulnerable or fragile. Juli 2021; by . This situation commonly arises when we work with clients with borderline personality disorder (BPD). He's a serial patient, who's unlikely to spend any more than two years (consecutively) in treatment. An absence of anguish makes the Borderline feel uneasy, as it triggers intimidating brand new sensations to which he/she must learn to adapt. You dont need to throw someone out in the cold, but what you do need to do is ensure the outside is warm enough for them. Subscribe today and be the first to know about new releases and promotions. Home Terms of Service Privacy Policy Sitemap Subscribe to The GoodTherapy Blog. In the present study, we report findings regarding the reasons for termination from therapy for 30 outpatients with BPD who had dropped-out of a randomized controlled trial comparing three common. That sounds dramatic, like the therapeutic version of a Dear John letter, but it's actually a routine part of Cognitive Analytic Therapy (CAT), with both the client and therapist writing one to each other at the end of their work together (typically after sixteen sessions). The bottom line is that there are many reasons that people drop out of therapy and sometimes these are unavoidable. 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. DBT therapy differs from traditional cognitive behavioral therapy (CBT) in that it emphasizes personal validation. All Rights Reserved. Your generosity is greatly appreciated. If I could go back to my first breakdown in my early 20s and speak again with my first psychiatrist, I would ask one question: although . For the Borderline, pain is easier to tolerate than pleasure. A client attends an outpatient mental health clinic accompanied by the client's spouse for an assessment. Remember that the purpose of therapy is to support the client, not the therapist. But sometimes people drop out of therapy prematurely without thinking it through and talking to their therapists about it. The termination checklist [PDF]. Ending therapy is a big step for both you and your client. * People who are deaf or hard of hearing can reach Lifeline via TTY by dialing 1-800-799-4889 or use the Lifeline Live Chat service online. He or she is merely 'an object' to the BPD client who is trying to obtain essential supplies tosurvive, much like a newly born infant. It's not right to keep someone in therapy when they no longer need it. Some can be abrasive and abusive~ and while you might tolerate or encourage their rage, you should not agree to be their whipping post. When terminating because you believe they are a danger to you or someone else, and you are therefore unwilling to meet with them in person. Whatever the motives, abrupt endings leave both client and therapist to do the 'ending work' by themselves to handle residual feelings of regret, loss, disappointment, resentment, shame and rejection. Formally, ending therapy is called termination.. As this was the only way for many BPD'ers to receive a modicum of nurturant attention, their tendency to solicit help by inspiring another's sympathy, became an automatic and strategic survival defense. These days, knowing how to terminate therapy elegantly is a core therapeutic skill. When life starts feeling good, they're filled with anxiety, asgoodfeelings (whether in personal or professional realms) are totally foreign to their experience, and must be gotten rid of. Surrendering a long-held 'Victim' Identity feels akin to limb amputation, and is often resisted. You might think of these defenses as a suit of armor, which protects the Borderline from incurring more trauma. Dependency fears are thus ameliorated. Any psychic and/or emotional wounds incurred thereafter, reinforce one's sense that he/she isn't lovable, or worthy of genuine affection, protection and care. When the ending of therapy is a one-sided decision - you may one day decide you have had enough of therapy and stop coming. I don't believe in withholding diagnostic impressions from my clients. Is it normal to have mixed feelings about ending therapy? Diane Gleim LMFT, CST, CST-S on December 13, 2022 in Underneath the Sheets. Many adhere to the once a client, always a client rule; they leave the door open for clients to return to therapy after termination, and aim to maintain firm boundaries in case that occurs. In short, there are times you'll have to play The Heavy. The core of their difficulties with these people, was they invariably wrestled with a significant amount of counter-transference during client sessions with a Borderline. This is no easy task of course, because the Borderline's been in his/her head lifelong,mentallyanalyzingall their feelings(like you have)since they were about two years old, and gained vocabulary. And remember - they're paying! How do you heal a borderline personality? The purpose of this study was to explicate the interventions used in a successful group therapy program developed for community mental health center clients with borderline personality disorder. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. This type of client seldom stays in treatment long enough to achieve their wellness goal, and typically blames this failure on even the most gifted practitioner. Many of these people have been physically beaten as kids, but most wereemotionallybrutalized. Make an accurate diagnosis early. Of course, the rule is that if you've been put on a pedestal, at some stage you have to fall off. Reflect on the Decision to Breakup Nothing about this faulty mechanism is held on aconsciouslevel, so it's compulsively repeated until solid, specialized help is engaged to dismantle and eliminate it. Their common need for personality changes can better guide treatment. Have you considered making a donation to keep this web material available to others who might need it? Wow! I've called on this cumulative wisdom to help people grow, and together we have worked to repair and restore the Self. Others won't cancel standing appointments, even at considerable monetary sacrifice. If you dont actively encourage and help your client to meet these needs outside of their therapy with you, then theyll feel dependent on you. The unique struggle this can present to clinicians is monumental, as their natural priority is to be gentle with the patient/client, but this might entail dangerous disregard of the Self, to where a professional can feel off-center and completely undone, while treating some of these individuals. The initial Honeymoon phase in a new romance with a BPD lover replicates the initial bonding period we had with our mothersin-utero. Only then, are they equipped to surrender their acting-out behaviors and BPD features. Therapy termination can make both the therapist and client feel insecure. Begin talking about the current setting and lead her to think and talk about the present. Does trauma illness such as PTSD need different treatment than moral injury? If you confront them about their emotional see-saw, they brush aside or trivialize any detailsyou'veretained from their latest session. If they ask what happens if they dont feel better, I might suggest that if after four or five sessions they feel they havent benefitted (above and beyond enjoying the companionship of therapy), then I will refer them onto someone else. 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.
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