At what point does a therapist decide to terminate a client because their relationship has broken down? Over the past three years writing my blog I have received many emails from therapy clients telling me that their therapists terminated them, either for no reason or for a small infraction within the relationship.

Are therapists being over-sensitive or are clients diagnosed with borderline personality disorder unaware of their own personal lack of empathy towards someone who is on their side? Being terminated for relationship issues with the therapist does not make sense to me. The entire reason we are in therapy is because we have huge external relationship problems and this plays out in the therapeutic relationship and the therapist should be aware of this.

When therapy is over and you are healed to the best of your ability, is it time to mourn or celebrate the end of the therapeutic relationship?

Dear XXXXX,

I thought it was safe to let you know how I was doing. I thought it was safe to email you about what my thoughts were regarding brief psychosis –v- depression (which is something I have finally made sense of and wanted your opinion on because I trusted you). I told you what my current working life was like and I felt as though I got a rubber stamp response because nothing in your email referred specifically to what I had actually said or achieved.

In therapy once, you asked me to always let you know how I was doing because you didn’t want me to move on and disappear out of your therapy life. You also once told me you loved me and trusted me deeply and that you would never abandon me.

With those bold statements comes a considerable amount of post-therapy responsibility to clients, even to the most adjusted but vulnerable client who has left your therapy and your rooms. With that comes a duty of care to accept that sometimes the client who wants to move on feels much dissonance, ambivalence and an overwhelmingly disproportionate sense of obligation and responsibility to her former therapist to keep her informed lest she feels abandoned by her.

Over the years, I’ve been fired, resigned or walked out (before I was pushed) on more jobs than there are symptoms of Borderline Personality Disorder.  I never understood why this was happening to me and I always thought it was the company’s fault, the other employees fault or that the Universe hated me.

There was always a honeymoon period where I fitted in for a couple of months, then came unstuck when the first small drama occurred.  This was always followed by a huge behavioural reaction from me.  I had not learned how to accept the vagaries of how companies operated, the diverse range of personalities concerned and my own borderline reaction to real or perceived workplace situations.  I reacted before I reasoned.

I was recently at a social function and eagerly went up to this woman I work with, touched her shoulder and said, “Hi, how are you?”  She stared at me, looked very uncomfortable and frantically searched around for either someone more interesting to talk to or someone to rescue her from me.

This is a woman I have found curt, abrupt, dismissive, snappy and abrasive in the past.  I have never had an interaction with her where I have left feeling as though a warm breeze has blown through me, but rather a cold, icy wind that has left my whole being feeling fractured and discombobulated.

I knew this and yet I still went up to talk to her because, as a chronic masochistic people-pleaser, I unfailingly seek approval and acceptance from totally wrong and inappropriate graceless women.  I cannot bear the pain of rejection and abandonment from anyone even though I did not like her and essentially had split her into the “bad” part of the good and bad.  I always had an intense negative emotional reaction to her, felt deflated, empty and questioned who I thought was, and after an interaction with her I wanted to throw myself off a cliff. 

We all know good therapy when we experience it, that warm fuzzy feeling where we are heard, understood, validated and start healing from the inside.  But what about bad therapy, what does that feel like?  And what if bad therapy turns ugly and ends in termination?  Here are five reasons why good therapy turns bad and ends in termination.

1.  Countertransference – when a client triggers the therapist’s issues.

It has been a long established rule of good therapists never to take on a client who will trigger personal issues.  The therapist who has been raped may not be able to cope with the raped client.  The therapist with children who finds out her client is a paedophile or the client who triggers off mother-issues with the therapist who has not resolved her own childhood.  These well-meaning people can sometimes unwittingly do more damage than good if they have not received their own therapy or supervision.

Nancy McWilliams admits in her book Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process that she can sometimes be a masochist with a depressive personality, which can gear itself up towards rescuing her clients from themselves.

In her section “Therapeutic Implications of the Diagnosis of Obsessive or Compulsive Personality,” she says “… by accepting compulsively self-harming people into analytic treatment unconditionally, the therapist may unwittingly contribute to their fantasies that therapy will operate magically, without their having at some point to exert self-control …”

This is known universally in Therapy World as “rescue fantasies.” Sometimes there is a repeat pattern of trauma in therapy where the obsessive, compulsive self-harming client with abandonment issues regresses and imploringly begs the therapist for extracurricular activities, and the therapist panics and enables the client to regress further by trying to pull them out of their regression with a magical cure, trying to rescue the client by crawling into their fantasies and merging with them. This can cause the client to withdraw and disintegrate or verbally attack the therapist in a sadistic manner due to feelings of overwhelming engulfment. This is where the cure can be worse than the disease.