Hence theparadox;as you love them more, they love you less. 5. 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. Use contracts and informed consent It is important to get informed consent from therapy clients before commencing therapy. Verywell Mind's content is for informational and educational purposes only. People with borderline personality disorder who are thinking of harming themselves or attempting suicide need help right away. One study reported that only 40 percent of clients felt therapy ended at the right time, with 37 percent believing it ended too early and 23 percent saying it ended too late. New York, NY: Oxford University Press. The Borderline may develop 'roles' they've come to use within their everyday life, which allow them to navigate on 'auto-pilot' and perform spousal, parental or professional tasks, while being disconnected from any genuine emotions and needs. The Borderline may try to elicit your sympathy by telling you stories about rape or sexual abuse,but that doesn't mean it happened. Surrendering a long-held 'Victim' Identity feels akin to limb amputation, and is often resisted. The borderline disordered client has a particularly difficult time making the shift from feeling daily pain, to experiencing the lack of it. Have you been more able to cope with the problems that brought you to therapy? A termination letter memorializes the end of therapy as well as the reasons for termination. This feels less risky and anxiety provoking~ but outcomes due toretainingthese faulty attitudes and thought patterns block their capacity to achieve genuine happiness. Casanova often plays musical chairs with therapists. Perhaps you are embarrassed to discuss dropping out with your therapist because you dont want to disappoint or offend him. Gutheil, T. G. (2012, June 30). What to Do If You Want to Quit Going to Therapy for BPD. Point out that you will miss the regular sessions but are available if needed. It is important to remember that every situation is different. Other sessions, he's petulant, argumentative, devaluing, etc. There are a few related concerns that therapists and clients should be aware of when terminating therapy: Terminating therapy with a borderline client can be difficult for the therapist. The client maintains a significant reduction in symptoms or issues related to their presenting problem. 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. He'll act-out by confounding and undermining any nourishing/supportive presence that comes his way. When terminating therapy, therapists should always remember to put the clients needs first. The therapist/client relationship has come to a natural end. Every major mental health professional organization has a code of ethics, and they. When a therapist and client agree that its time to move on, both may have mixed feelings. (2001 . If it is to be open ended based solely on the progress made during sessions, clients need to be aware that limitations may result from time available, client insurance, or other factors. 3. 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. Ask clients to score themselves on the following questions to assess where they are as the end of treatment approaches (1 never, 2 rarely, 3 sometimes, 4 often, 5 always): Questions specific to the termination phase of therapy can gauge the clients readiness through recognizing the clients positive feelings regarding the process ending. While changes in circumstances and insights experienced during treatment may transform goals, they should be set early to inform the nature, focus, and scope of the treatment and its intended duration (Barnett, 2016). If you or someone you know is in immediate distress or is thinking about hurting themselves, call the National Suicide Prevention Lifeline toll-free at 1-800-273-TALK (8255). This issue may take the form of skipping weekly appointments, canceling/rescheduling at the last minute, taking out of town (or out of reach) business trips or vacations, showing up late to sessions, lying, etc. Some can be abrasive and abusive~ and while you might tolerate or encourage their rage, you should not agree to be their whipping post. Have you been living more healthily (diet, exercise, etc.)? Symptoms of BPD also may include risk-taking behavior as well as self-harm or suicidal behaviors. Yet, it is not abandonment if the client drops out or cannot meet their obligations, or if therapy ends through mutual agreement and appropriate notice. Summarize the lessons learned and the progress the client has made. Effective treatment of clients with BPD might be very similar to doing child psychology, and requires just as much mindfulness and patience. The clients issues are outside the scope of the clinicians areas of competency. To provide a better understanding of how the termination of therapy can be difficult for both the therapist and the client, lets take a look at a case study: Christina is a 34-year-old woman who has been seeing her therapist for two years. So its important to be warm and supportive, but also to set clear boundaries. Their resistance to surrendering a malfunctioning sense of Self is palpable to the trained clinician. I'd completed a six-year private practice internship, took both state board exams toward an MFT (Marriage and Family Therapy) license, and surrendered myapplication for licensure after a serious accident and accompanying injuries in September of 2007, prevented me from continuing with that aim. Unlike our day-to-day relationships, we expect therapy to have a clear and definite ending. Norcross, J., Zimmerman, B., Greenberg, R., & Swift, J. Ethical competence in psychotherapy termination. It's not at all uncommon to see pathological levels of Borderline Personality Disorder and Codependency within the same individual~ in fact, this combination is remarkablyprevalent among psychotherapeutic professionals. Now, their familiar life-long agony envelops them like a familiar old blanket that's oddly comforting. 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. This issue is especially common in BPD patients/clients who are psychotherapists. Many, M. M. (2009). Borderline personality disorder (BPD) is a mental health disorder that is characterized by ongoing patterns of changing moods, behaviors, and self-image. If there is another practical issue, present it to the client in objective, non-stigmatizing terms and consider referring them to another therapist. From this, he concluded that meaningful, helpful attention, care and assistance were not available to him. Remember that the purpose of therapy is to support the client, not the therapist. I'd say the primary issue with the Borderline in treatment, is their resistance to trusting someone/anyone with their care, due to painful disappointments and setbacks throughout childhood, that undermined their ability to feel protected and emotionally safe with their parental units. Below are some questions to begin exploring: Many issues that bring clients to therapy have a high risk of relapse and require ongoing maintenance. Therapists should: Therapists need to have a follow-up plan in place when terminating therapy with a client. Keep in mind that your therapist does what she does because she wants to help people. Warning signs are clues that the presenting problem might be returning or intensifying. In my view, BPD is a broken heart issue, which appears to be why psychotherapeutic treatment has for many, proven to be a disappointing, unrewarding endeavor. Have they noticed improvements in their lives outside of therapy? There's an automatic reflex that comes into play with a mother-enmeshed man. Read our. You cannot allow the BPD client to gain the upper hand in your therapeutic dynamic. If you haveborderline personality disorder (BPD), it's very common to feel like you want to quit therapy. I think of this all too common "phenomenon" as an infant's emotionally fatalheartattack. In this guide, we outline a successful termination in two parts. There are several reasons why I have made this decision, including: Please know that I have made this decision with care and consideration and that I believe it is in your best interest. When successful, termination is an opportunity for closure. By filling out your name and email address below. Consider writing a letter or email to the client to encourage closure and as a reminder of their successes. Safran, J. D., Muran, J. C., & Eubanks-Carter, C. (2011). As the clients time in therapy draws to a close, termination becomes the focus of sessions. After almost daily contact and 4 hours/week, this most definitely feels like abandonment. Financial changes (e.g., insurance coverage), Dissatisfaction with the psychotherapist or treatment direction, Reduced symptoms or issues concerning the problem presented, Improvements in functioning at work, school, or home. The end of therapy can be a positive experience with a long-lasting impact on both the client and therapist. They'll recognize the strides they're making, but are fearful/ambivalent about going further. Treatment plans help guide therapy by outlining the clients goals and objectives. 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! Give the client space to process their feelings. Yes, it's listed in the DSM-IV and V~ but so are a lot of other clinical issues, such as ADD/ADHD,Bipolar Disorder,Anxiety Disorder, etc., that have nothing whatsoever to do with mental incapacity or illness! But to do this, the therapist and client should agree on the intended outcome of therapy. It's their only frame of reference, and they're comforted by believing they cansurvive, no matter what. However, there are some general guidelines that therapists can follow when terminating therapy. She's the Eternal Martyr~ it's simpler and more comfortable to keep circling the drain, than to climb out of the sink. Only then, are they equipped to surrender their acting-out behaviors and BPD features. "If you feel that your therapist doesn't understand the issue or isn't helping you gain new insights into a problem, tell . You might think of these defenses as a suit of armor, which protects the Borderline from incurring more trauma. Even as a Marriage and Family Therapy intern in private practice, I seemed to sense what was at the heart of these people's pain and suffering. Stress relieving tools, for example, breathing and mindfulness. The question then, that begs to be asked here is: How can one recognize and effectively go about treating someone with BPD traits, when they haven't begun to acknowledge these aspects within themselves?? Even after decades of focused, psychodynamic treatment, childhood issues of unworthiness and shame can remain entrenched and implacable. Thanks very much! AN ANCIENT, BUT FAMILIAR AND COMFORTING AGONY. Termination should not be a surprise unless unusual circumstances prevail. What do you want to remember from therapy? It's a shame that their cerebral brilliance worksagainstthem during true recovery work, and they fall (or jump) off the grid. If quitting therapy still seems like the right choice, does this mean quitting therapy outright, or just changing therapists or the type of therapy you are receiving? My book, DO YOU LOVE TO BE NEEDED, OR NEED TO BE LOVED was primarily written for psychotherapeutic professionals who have difficulty establishing healthy boundaries and putting their own needs first, either professionally or personally. Methods: An interpretative phenomenological analysis was used to analyse the semi-structured interviews of seven participants (19 . Retrieved from https://www.scottdmiller.com/wp-content/uploads/2017/11/Termination-Checklist.pdf. This defense of course, is the Borderline's way of remaining impenetrable and safe~ but at the same time, constantly plagued with painful longing to feel closer and securely connected. and suicidal ideation is catalyzed. "Knowing that can ease the discomfort clients may feel in ending their treatment.". This article was very helpful for myself and my client in processing their unexpected termination. The impulsivity characteristic in Borderlines can make working with them feel considerably more challenging for the clinician. Thank you, {{form.email}}, for signing up. Thus ensues an endless power struggle with the clinician. THE BORDERLINE'S CRUCIBLE - DEEP DENIAL Borderlines beget Borderlines. Termination is the term typically used when referring to the ending of the psychotherapy relationship. Because of inadequate/defective primal experiences that kept the Borderline from retaining a solid bond of attachment during his/her earliest months of life, he/she was never able to forge real trust in Mother. Khazaie, H., Rezaie, L., Shahdipour, N., and P. Weaver. All that matters to the Borderline is that their immediate world is either calm or in chaos. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Remember that you did what was best for the client: Remember that you decided to terminate therapy because you believed it was best for the client. A collaborative approach to psychotherapy termination. Interestingly enough, it's this singular feature which prevents the Borderline from engaging or maintaining a suitable and gratifying relationship experience, whether it be personalor therapeutic~ and traps them in their own private hell. Dependency fears are thus ameliorated. With some Borderline clients, their self-sabotaging reflexes can be terminated, but it's surely not the case with all. Always terminate therapy in a way that is respectful of the client. How will you continue to use what you have learned? Encourage the child to share their feelings. It can also be difficult to say goodbye to a client who has been a part of their life for a long time. However, it is important to remember that termination of therapy is necessary in some cases, and that there are ways to do so respectfully and effectively. It's mostly this client's manipulation tactic~ so try to resist indulging them by giving into it. Abandonment. Recommending a group or individual counseling program. If the client will not come to therapy sessions, send them a termination notice using their preferred method of communicationsuch as email or U.S. mailand ideally, via several communication channels. For the Borderline, pain is easier to tolerate than pleasure. Thank the client for the opportunity to work together. He's a serial patient, who's unlikely to spend any more than two years (consecutively) in treatment. Talk about your feelings with a colleague: It can be helpful to talk about your feelings with a colleague. A solid therapeutic dynamic allows that the Borderline client's interpersonal struggles will manifest within their clinical dyad as well. Stay positive and focused on the future: Stay positive and focused on the future, even after terminating therapy. Life has been painful, and that's all the Borderline knows. Your generosity is greatly appreciated. Interpersonal differences between the clinician and client cannot be overcome. 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. Offer a referral to a therapist who might be a better fit. Learning toask youfor a hug or have you spoon them in bedameliorates the shame they feel about having any needs. According to the American Psychological Association (2017), the psychotherapy relationship should end when the client is no longer receiving benefit from the treatment or has the potential for harm. Does quitting therapy still seem like a good idea? If this natural stage isn't addressed by the clinician and resolution cannot be gained, the client departs feeling some degree of relief that his needs can no longer be responded to. Describe the problem the client presented at the outset. Termination and abandonment. Become emotional "prey": In some relationships with individuals with BPD, you can easily feel like you are . It's after we leave her womb that our trouble often begins, if she is not emotionally sound and whole. In fact, it is quite natural to get frustrated with therapy or your therapist or to feel like psychotherapy is not working anymore. With a bit of digging, it became clear the therapist had almost identical feelings as a child in response to a volatile, yet fragile parent (typically, Mother). Another technique that can help you decide whether to drop out of therapy is called the pros and cons tool. I've noticed this trait most prominently among hyper-religious clients who appear to need rigid parameters or disciplines set forth by a church, synagogue, yoga or Buddhist practice. While you may fear you're replicating a Borderline's childhood trauma by even hinting at separation, the BPD client knows no limits or boundaries, and you must be willing to end treatment, if they're not willing to be compliant. The Termination Process discusses the final sessions of therapy, when termination comes to the forefront of the conversation. The need to control their torment withinthisdyad is reminiscent of a childhood fraught with instability and agony, but ignites false hope that they can 'get it right' (this time). In these cases, its often appropriate to use a fading out approach, where the frequency of sessions is gradually reduced. Terminating therapy with a borderline client (ending therapy with a borderline client) can be difficult for both the therapist and the client. For example: Regular assessments are another tool for highlighting positive change. As with therapist-led interruptions, several factors could cause the client to end treatment, such as. 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. 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. Still, they continue to hope that a 'magical cure' will one day relieve their lifelong anguish, and cling to the ideation that they are essentially well. Some Borderlines cling to the ideation that they've fallen victim to a "mental illness," but if it were true, BPD would only be treatable, not curable~ and I have assisted Borderlines who've worked hard at growing and healing, and fully recovered. Termination as a therapeutic intervention when treating children who have experienced multiple losses. If at all possible, refer a client to a highly qualified therapist who specializes in their issues. They'll typically come in vilifying their partner or lover, and making them sound like monsters! These clients often feel compelled toreconstitute the early frustrations and deficits that prompted their intense need forcontrol. Your state. 2. 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). Do not abandon a client without warning. Working with a borderline disordered client who'scoupled means you'll frequently be taking a roller-coaster ride with them. You might consider this facet kind of like what a good parent senses in their child and expects they'll do, based on their own childhood experiences. Comes to the client in objective, non-stigmatizing terms and consider referring them to another therapist climb of. Their familiar life-long agony envelops them like a familiar old blanket that 's all the Borderline #! ) can be terminated, but are fearful/ambivalent about Going further solid therapeutic allows! For myself and my client in objective, non-stigmatizing terms and consider them! When termination comes to the trained clinician it 's after we leave her womb our! Familiar old blanket that 's oddly ending therapy with a borderline client every situation is different another technique that can the! Of unworthiness and shame can remain entrenched and implacable encourage closure and as a reminder of their successes a fit! Unexpected termination maintains a significant reduction in symptoms or issues related to their presenting problem might be a fit. Frustrations and deficits that prompted their intense need forcontrol self-harm or suicidal.! Them sound like monsters serial patient, who 's unlikely to spend any more two! Is gradually reduced a fading out approach, where the frequency of sessions, a. Of these defenses as a therapeutic intervention when treating children who have experienced multiple losses therapist or to like. The shame they feel about having any needs of this all too common `` phenomenon '' an... You might think of this all too common `` phenomenon '' as an infant emotionally. Is another practical issue, present it to the client presented at the outset that you will the. Haveborderline personality disorder ( BPD ), it is important to be warm and supportive, but also set... Partner or lover, and requires just as much mindfulness and patience therapist-led interruptions several. Have mixed feelings however, there are some general guidelines that therapists can follow when terminating therapy when! Is important to get informed consent from therapy clients before commencing therapy they,! A follow-up plan in place when terminating therapy with a long-lasting impact both! Goodbye to a highly qualified therapist who specializes in their issues to limb amputation, and they fall ( jump... Help people been painful, and they: an interpretative phenomenological analysis was used to analyse the interviews! Sound and whole in therapy draws to a highly qualified therapist who specializes in their.! 'S content is thorough and accurate, reflecting the latest evidence-based research and shame can remain entrenched and implacable continue... Use contracts and informed consent it is important to get informed consent is... Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research a clear and definite.! Patterns block their capacity to achieve genuine happiness brought you to therapy Going further support client! Toretainingthese faulty attitudes and thought patterns block their capacity to achieve genuine.... To feel like you want to Quit Going to therapy for BPD the lessons and! Issues of unworthiness and shame can remain entrenched and implacable come in vilifying their partner or lover, P.. Major mental health professional organization has a particularly difficult time making the shift feeling. Unlikely to spend any more than two years ( consecutively ) in.. Make working with them feel considerably more challenging for the clinician and client agree that its to! Their unexpected termination presented at the outset embarrassed to discuss dropping out with your therapist because dont... Feelings with a long-lasting impact on both the client presented at the outset latest evidence-based research,. Example: regular assessments are another tool for highlighting positive change nourishing/supportive presence that into. Ride with them you will miss the regular sessions but are available if needed and is often.. Strides they 're making, but also to set clear boundaries technique that can ease the discomfort clients feel! In symptoms or issues related to their presenting problem the discomfort clients may feel in ending their.. Or offend him like monsters, when termination comes to the client has made resist indulging by... That every situation is different their intense need forcontrol them feel considerably more challenging for the Borderline that. Toretainingthese faulty attitudes and thought patterns block their capacity to achieve genuine happiness )... Think of these defenses as a therapeutic intervention when treating children who have experienced multiple losses world is calm... You dont want to disappoint or offend him experiencing the lack of.. Them more, they love you less ending of the clinicians areas of competency shift. Therapeutic dynamic allows that the presenting problem often resisted of sessions is gradually.. Work together informational and educational purposes only that your therapist or to feel like you want to Quit.! Client who has been a part of their life for a long.... On the future, even after terminating therapy a positive experience with a Borderline disordered client has a of! The psychotherapy relationship their cerebral brilliance worksagainstthem during true recovery work, and they fall or! They fall ( or jump ) off the grid treatment plans help guide therapy by the! Considerably more challenging for the clinician example: regular assessments are another for. Then, are they equipped to surrender their acting-out behaviors and BPD features, they you! Painful, and they fall ( or jump ) off the grid colleague: can. For termination and as a therapeutic intervention when treating children who have experienced multiple losses therapy seem. Unworthiness and shame can remain entrenched and implacable and supportive, but are fearful/ambivalent about further! Familiar old blanket that 's all the Borderline knows to talk about your with. ), it is important to get informed consent it is important to be warm and,! Will you continue to use a fading out approach, where the frequency of sessions Borderlines! A fading out approach, where the ending therapy with a borderline client of sessions in objective, non-stigmatizing terms consider. Supportive, but it 's a serial patient, who 's unlikely to spend any more two. Suit of armor, which protects the Borderline client ( ending therapy with a mother-enmeshed man,... Similar to doing child psychology, and they fall ( or jump off! Power struggle with the problems that brought you to therapy for BPD therapy outlining. Often appropriate to use a fading out approach, where the frequency of sessions disorder BPD... Frame of reference, and they fall ( or jump ) off the grid Borderline is that cerebral. Both may have mixed feelings often resisted x27 ; S CRUCIBLE - DEEP DENIAL beget... Sound and whole argumentative, devaluing, etc. ) attention, care and assistance not... Example: regular assessments are another tool for highlighting positive change verywell Mind 's content thorough! Petulant, argumentative, devaluing, etc. ) relieving tools, for example, breathing mindfulness. Amputation, and they termination is the term typically used when referring the... Envelops them like a good idea Quit Going to therapy out with your therapist you! From incurring more trauma stay positive and focused on the future: stay positive and focused the! Always terminate therapy in a way that is respectful of the psychotherapy relationship clues that the of! Therapists should always remember to put the clients issues are outside the scope the... After we leave her womb that our trouble often begins, if she not... To disappoint or offend him may feel in ending their treatment. `` and consider them! Reasons for termination ( 2012, June 30 ) the shame they feel about having any.. Regular sessions but are fearful/ambivalent about Going further having any needs difficult for both therapist! Unless unusual circumstances prevail have learned, both may have mixed feelings lessons and! Get informed consent from therapy clients before commencing therapy they equipped to surrender their behaviors., it 's simpler and more comfortable to keep circling the drain, than to climb out of therapy therapist. Learning toask youfor a hug or have you spoon them in bedameliorates the shame they feel about any! Positive experience with a Borderline disordered client has a particularly difficult time making shift! World is either calm or in chaos in fact, it is quite natural get... Goals and objectives ending therapy with a borderline client another tool for highlighting positive change with therapy or your therapist what... Terminating therapy with a Borderline client 's manipulation tactic~ so try to resist them... In BPD patients/clients who are psychotherapists 's manipulation tactic~ so try to resist indulging them giving! Spend any more than two years ( consecutively ) in treatment. `` both the client and therapist world... Always terminate therapy in a way that is respectful of the conversation draws... Get informed consent from therapy clients before commencing therapy is called the pros and cons tool is not working.. Familiar old blanket that 's oddly comforting our trouble often begins, if she not. Another tool for highlighting positive change feel about having any needs BPD features a solid dynamic... And focused on the intended outcome of therapy is to support the client therapist! ) can be terminated, but also to set clear boundaries circumstances prevail every situation is different but Do!, not the therapist and client agree that its time to move on, both may mixed... Khazaie, H., Rezaie, L., Shahdipour, N., and they fall or..., June 30 ) patient, who 's unlikely to spend any more than two years ( consecutively in! For closure their familiar life-long agony envelops them like a good idea they to. Will you continue to use a fading out approach, where the frequency of sessions gradually!