By: Rayna Edels, M.Ed
What does “termination” refer to in the context of therapy? Termination is the final stage of therapy where clients have the opportunity to apply the skills they have learnt in their environments, without the routine support from their therapist.
For some, this is an exciting experience. They have finally “graduated” and feel prepared to take on life’s events with the toolkit of skills they have developed over months, or years, of hard work in therapy. For others, termination brings about uncomfortable, intense feelings. This may be because of memories of transitions that have brought about feelings like sadness, anger, grief, guilt, rejection, and/or abandonment. Regardless of the feeling that termination brings up for you, there are some concrete steps that you can take that might make the experience more manageable and to maintain therapeutic gains.
Create a Mental Health Maintenance Plan.
What does your body need to maintain health? A balanced diet, regular exercise, and sufficient sleep. Likewise, your mental health needs equal attention. You’ve likely done a good job of attending to your mental health over the course of therapy, with the accountability of your therapist. Maintaining therapeutic gains requires monitoring yourself and applying strategies with persistence.
Prior to termination, you may want to develop a Mental Health Maintenance Plan with your therapist. This plan will act as a roadmap of how to proceed independently, without ongoing guidance from your therapist. It may include features, such as:
- Triggers: Activities, thoughts, people, places, or things that might activate strong emotional reactions.
Identifying triggers brings your awareness to things in your environment that might have a negative impact on your mental health. Identifying triggers can alert you to times where you might want to search your toolbox for strategies appropriate for the given situation.
- Warning signs: Thoughts, feelings, and behaviours that indicate your mental health might be at risk. For example, sleep difficulties, social isolation, arguing with others, self-harm.
Identifying warning signs (…or precursors to warning signs) can help you prepare to execute a strategy before the situation becomes a crisis.
- Self-care: Activities that you do regularly to maintain your mental health. Socializing, engaging in hobbies, and practicing the PLEASE skill.
- PL – Treat physical illlness.
- E- Balance eating.
- A – Avoid mood altering substances.
- S – Balance sleep
- E – Get exercise.
- Coping strategies: Skills that help you manage symptoms or problems when they arise. It can be helpful to identify specific coping skills that you find useful emotionally provoking circumstances.
Together, identifying triggers and coping strategies will help you COPE AHEAD.
- Describe the situation that is likely to prompt problem behaviour. Be specific in describing the situation and name the emotions and actions that are likely to interfere with using your skills.
- Decide what coping or problem-solving skills you want to use in the situation. Be specific! Write in detail how you will cope with the situation and with your emotions and action urges.
- Imagine the situation. Imagine yourself watching the situation unfold with you as the main character.
- Rehearse in your mind coping effectively. Specifically, rehearse: exactly what you can do to cope effectively, your actions/thoughts/what you say/how you say it, coping effectively with new problems that come up, and coping with your most feared catastrophe (i.e., the worst case scenario).
- Practice relaxation AFTER rehearsing.
- Identify when to return to therapy: If challenges become too intense, or last too long, it might be important to consider returning to therapy. With your therapist, you can identify thoughts, behaviours, and emotions that might indicate a need to seek professional help. There are a variety of tools online that you can use to self-monitor, or you can create your own tool!
- For example, you can use existing tools like the Mental Health Continuum Check: www.theworkingmind.ca/continuum-self-check to monitor changes in mood, thinking, behaviour, physical changes, and changes in addictive behaviour over time.
- Remember that you can tailor tools like the Mental Health Continuum Check to include warning signs or signs of well-being that are relevant to you.
Practice, practice, practice.
Terminating therapy doesn’t mean taking a break from building mastery of skills. To reap the benefits of all the hard work you have put into therapy, continue to practice strategies that have been effective in the past and get creative with how you apply skills to new situations. Remember to take note of what works for you.
Schedule booster sessions. Or return to therapy.
For some, returning to therapy sessions feels like a “failure” or a step backwards. Remember, your progress in therapy (and life!) is not always linear. Consider how you might reframe returning to therapy as an investment in your future mental health.
Recruit your support system.
Maintaining your mental health takes time, energy, and persistence. Remember to recruit your various support systems – whether it be friends, family, classmates, and/or work colleagues – to lend a helping hand.