He had told me that he intended to schedule an appointment to see me in about two months. Over six months had passed and I hadn’t heard from him. I hoped that he was doing well.

“I got your letter,” he said in his voice message. “Thank you so much for sending it. I would like to see you before you graduate. There are still a few things going on that I’d like to talk about.”

I called him back and after we had scheduled an appointment, he casually remarked, “So you’re departing after graduation?”

“Yes,” I answered.

“So you’re departing in June,” he clarified.

“Yes,” I replied, “I am leaving Seattle.”

“Okay—not a wise move, but—″

I laughed. We both knew he was poking fun at me.

“Termination” is the term used to describe the process of ending a therapeutic relationship. Termination represents a loss. Some therapists suggest that termination represents death: “With your departure, you are dying to him. Soon, you will be dead.”

Termination sounds like a single, discrete event. It is rather a process, an unfolding sequence. In psychotherapy, the general guideline is to begin to discuss termination at least three months prior to the expected end of the relationship.

“If you don’t talk about it, your departure can manifest itself as abandonment,” supervisors consistently counsel. “Plus, most people often have strong reactions to loss. Discussing termination allows people to learn a lot about themselves and to learn that the ending of a relationship doesn’t have to be bad.”

How many of us have experienced the loss of a loved one to an unexpected death? or been dumped with no warning? or suddenly realized that a friend is no longer one?

Where’s the “closure”?

Ideally, termination should enable, not disable. Termination allows people to review what they have learned about themselves and the world in which they live. They can then look to the future and focus on how to achieve other goals in their lives, whether that involves a therapist or not. (Remember, life happens outside of the office, not inside.)

That being said, termination is not necessarily easy. Loss can kinda suck.

Psychotherapy relationships are unlike any other relationships I have ever experienced. (This may sound hand-wavey and new-agey; I trust that you’ll cope somehow.) These people are not my friends, nor are they family members. These relationships are asymmetrical, as I know more about them than they do about me. The relationships are artificial; some have argued that psychotherapy relationships are merely paid friendships. Regardless, there is a contractual aspect to these interactions.

And yet, I find that I care about these people. I worry about them when they are not doing well and I delight in their successes. I hope that, through learning about themselves, they will reach their goals, whatever they may be.

It’s cool to watch people change. Often, they do that in spite of what we do, not because of what we do.

If termination represents the process of one loss, mass termination represents the process of many losses.

The process of terminating with my entire panel of patients kinda sucks. Let me rephrase that in less judgmental terms: I do not enjoy the process of terminating with my entire panel of patients.

Furthermore, in an effort to create extra buffer space in my psyche, I use the clinical term “termination” to describe my departure from my training program. I am in the process of terminating with all of my supervisors, many faculty members, nursing staff, case managers, and clerical staff.

I’m also terminating with my colleagues, those people within my training cohort.

Then there are all of my friends.

And the people I have danced with on a regular basis for the past two-plus years.

And the beautiful city of Seattle.

Would it be easier for me to terminate with my entire panel of patients if I was not terminating from my life in Seattle? I do not believe that the two could be mutually exclusive. This is such an artificial termination.

Is death the only “natural” termination?

I’ve been thinking about termination (in gross terms, not merely in the clinical sense) since I learned of my pending relocation to New York. I’ve considered writing a series on termination, much like my relationship series. I anticipate, though, that writing about termination will be more challenging.

(Somewhere, a psychoanalyst is writhing in agony because I’ve written this entry. God forbid I actually reveal that I’m not a blank slate, that I actually care about people, about what I do.)