TERMINATION THE CONCLUDING

PHASE OF GROUP THERAPY; A CRITICALLY IMPORTANT BUT FREQUENTLY NEGLECTED PART OF TREATMENT.
Yalom p. 382 - 390

TERMINATION
Word Termination often has negative connotations However, a mutual, planned ending to therapy is an integral part of therapeutic work It includes: Review Mourning Celebration of and preparation for commencement of the next phase of life

TERMINATION
Feelings about termination must be explored from different perspectives: The individual member The therapist The group as a whole

TERMINATION OF THE INDIVIDUAL MEMBER

Largely dependent on the length and goals of therapy Even though further potential for growth may be clear, therapist must, in some cases ask, will further growth be countertherapeutic? E.g. A client might, with further change, outgrow her spouse rupturing of an irreplaceable relationship unless concomitant changes occur in the spouse

TERMINATION OF THE INDIVIDUAL MEMBER

Termination is appropriate when the client is able to use psychotherapeutic resources constructively in their personal environment Prepare for setbacks after termination some will need to seek short term help from time to time

TERMINATION OF THE INDIVIDUAL MEMBER

Almost all members experience anxiety and depression just before or after leaving a group A period of mourning is an inevitable part of the termination process Termination may evoke memories of earlier losses

BEHAVIOURS TO LOOK OUT FOR

Process may be so intolerable that some individuals: Withdraw prematurely to avoid the issue entirely Act out and devalue the group/members Experience a brief recurrence of original symptomotology Manifest increased tardiness/absence Begin to share hitherto concealed material Invent reasons why they must stay in the group Therapists role is to help client understand the behaviours for what they are: protest against

TERMINATION OF THE INDIVIDUAL MEMBER

N.B. Termination can be very problematic for clients particularly sensitized to abandonment illness/symptoms become the tool through which they remain in the group In an attempt to avoid termination, these clients may minimise or conceal progress

TERMINATION OF THE INDIVIDUAL MEMBER

Fear of endings may dictate clients whole pattern of avoiding connections and avoiding intimacy They may also have a history of abruptly ending relationships in a manner that is cold and jarring Therefore to ignore this phase of therapy is to neglect an important area of human relationships throughout ones life, one must say goodbye to important people

TERMINATION OF THE INDIVIDUAL MEMBER

Many terminating members attempt to lessen the shock of departure by creating bridges to the group they can use in the future Therapist must not collude in the denial of termination ending should be clear and focused, not a petering out As a rule, clients who complete individual therapy may return, but clients who leave the group can never return

EFFECT OF ONE MEMBER LEAVING

Each members graduation from the group must be processed: Competitive members may rush toward premature separation Senior members may feel envy or shame (in extreme cases devalue the achievement of the graduating member) Newer members may feel intimidated Therefore, generally wise not to bring in new members without reserving one or two meetings to process loss of a member

TERMINATION AND THE THERAPIST

Therapists MUST examine their own feelings about the termination process and goodbyes We may unaccountably and unnecessarily delay a clients termination Perfectionist therapists may expect too much, refusing to accept less than perfect resolution Pride may step in: difficult to say goodbye to someone who is, in part, our creation We may lack faith that client can go on without us

TERMINATION AND THE THERAPIST

Therapist must work through own issues surrounding terminating the group/group member in order to become an effective model of letting go It is no easy task: Therapists as well as members, will miss the group/group members Work is best facilitated by therapist disclosing true feelings