Deconstructing Goodbyes: What Termination of the Therapeutic Relationship Can Teach Us About Reframing Endings

Whether we're providing therapy in person or online, the core of the work as mental health providers is in developing and nurturing a strong therapeutic alliance ("building therapeutic rapport") with our clients. We engage in this process by leaning into many concepts, including reflection, unconditional positive regard, nonjudgment, empathy, and active listening, to develop trust and attunement in therapy. The bricks of rapport are built from the very first session, usually your intake session, where the therapist will explore your presenting concerns while simultaneously cultivating a space of safety and expression. As a relational and attachment-based trauma therapist, it's my mission to ensure that I am helping my clients feel safe and secure in this space, so that we can collaboratively explore uncharted and potentially deeply wounded parts of your life that have contributed to your current distress.

Through consistency, collaboration, engagement, and reflection, the therapeutic alliance shows us time and again--and the research backs this--that it is the client-therapist relationship that drives change and healing. Clients who feel safe and seen in the therapeutic space--whether in person or online--often experience positive treatment outcomes, including decreased symptom acuity, improved confidence, and personal healing.

But what happens when the therapeutic alliance comes to an end?

There are several reasons why therapists and clients facilitate termination, whether it's relocation out of state where a therapist is not licensed; graduation from therapy due to treatment plan goals met and symptom alleviation; incongruence within the therapeutic alliance; or, what I am experiencing presently: a therapist leaving the practice.

Developing a strong therapeutic alliance is incredibly transformative, and it can be deeply impactful when it has to end because your therapist is leaving a practice.

Goodbyes are often riddled with complex emotions, including confusion, apprehension, frustration, anger, and even grief. Goodbyes and grief due to loss can look very similar, and when we break it down into smaller pieces, it can resurface attachment. Oftentimes, goodbyes are unanticipated: a deeply dysregulating shock to the system that triggers fight, flight, freeze, or even fawn responses. Whether we're losing a loved one due to anticipated or sudden death, or grieving the end of a relationship, goodbyes can feel destabilizing.

But what would it look like to reframe the goodbye?

Termination of the therapeutic relationship can be extended across several sessions (this is my preference with clients) to support the potential for the constellation of emotions that may surface as clients are processing the information. When we have time to process this change, we have time to feel those uncomfortable emotions, even potentially experience the quintessential 5 stages of grief (denial, anger, bargaining, depression, and acceptance). But did you know there is a 6th stage of grief? Yes! It's known as memorialization: a meaningful and intentional review of the experience of the person and the role they played in your life in its totality; the good, the not-so-good, and the in-betweens.

By memorializing the therapeutic alliance and embracing the challenges and the triumphs of the process, there is space to acknowledge the pain of the goodbye while celebrating the healing that the therapeutic relationship nurtured. We can feel the sadness of the end of this relationship while relishing the beautiful journey it supported.

The goal of therapy is not to create a dependence on the relationship: instead, it aims to show clients that they can do hard things, like saying goodbye to pieces of their lived experiences and people who mean so much to their journey, and holding more than one truth simultaneously.

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Justine Brathwaite, LMHC-D, is a licensed psychotherapist providing online trauma therapy to adults in New York using modalities including EMDR, CBT, and ACT.