Intern Termination
The week of Thanksgiving I had to terminate my entire, full caseload at a site for long-term depth therapy that I had been at for over two years. Still reeling from this the following week, I was talking to a colleague of mine, a fellow MFTi, who reminded me that termination experience for interns can be very different than for those who are licensed in a set career in private practice or otherwise. If a client goes to see an intern therapist, they will be very likely guaranteed an untimely ending to their therapy unless they initiate termination. Interns shuffle around, they often move to different placements, they branch out, they stagger around, they have life events that come up. And if an intern is a woman in her child-bearing years and is like myself - she may leave to have babies and develop her family in the window of time she has to do so.
My friend and I concluded confidently: It’s more likely that as an intern you will encounter termination as a mass exodus - at least once.
What. The. Hell.
Just let that statement soak in for a moment if it hasn't hit you. If it doesn't hit you at all, maybe you approach this work differently than I do and/or just can't relate to the statement at all because it hasn’t happened to you.
Now part of my struggle was given in the policies in the agency I was working for: I was not allowed to give more than 4 weeks notice to clients and they hastened my termination date to ensure I’d follow this rule. 4 weeks to process termination with clients - some of whom I had been working with for over two years. This conflict is not uncommon. Interns don’t often get to rely on their own clinical judgement to inform how things like termination should go because they so often are seen as not having sound judgement to begin with. CAMFT sites it is advisable to provide 60-90 days notice of termination to clients when possible. Often times, however, agencies look out for themselves before anyone else, unintentionally (or intentionally) prioritizing client retention over well-being. This guideline from CAMFT makes sense - it ensures more emotional containment for what is a disruptive and potentially painful event. Not only do the clients need more emotional containment in such a painful transition but the therapist does as well. Managing feelings of guilt, anger, grief, and heartbreak (and others) are often the resulting tasks of the emotionally-available therapist who is terminating with their client.
There is no ideal time to terminate but certainly adequate time allows the process to be staggered and metabolized in a way that is mutually beneficial for both client and therapist. I terminated with the first client I ever sat with, I terminated with powerful transferences still at play, I terminated with unresolved conflicts (in myself as well), I terminated with kids I felt profoundly connected to, I terminated with someone who had just started to let me in... and this was just half of my caseload terminated in one day.
Needless to say, I was not emotionally available to my family or anyone else for the next several days. My husband is not a clinician but thank goodness he was supportive of my despair even though he couldn’t understand it at all. Even fellow interns couldn’t reliably relate to this experience. Many of the interns I know through this site had never had to process termination on this scale. Many experienced clinicians may also miss the emotional significance of termination. It’s easy to deny and discredit termination. It reminds us of the finality of relationships, the frustrating limits of relationships, how messy and unsatisfying endings can be, and the finality and inevitable end of life itself.
I suppose I could do this work in a way where termination didn’t mean so much to me. Another client could be just another client. I often think, however, that if human interaction got a client into the mess they feel they’re in, then human connection is going to be the best way out. To do that, you have to be willing to “get in the car,” as a colleague of mine says. Get in the car.
Is this what we demand of our interns? On one hand, we may not trust their abilities and clinical judgement but then we expect them so hold so much emotional work. I ask without possibly having any right to ask that experienced and skilled licensed clinicians remember this when holding interns under their guidance. Mind you, I have had the privilege to work with many supervisors who are fantastic, who are mindful of the interns’ struggles, who can hold to gravity of the work while holding the humanness of all things. I have also worked with fellow interns who so clearly need more containment and guidance depending on experience, skill level, and so on. We look to our elders for knowledge and guidance. We also look to our elders to learn how to become elders ourselves. We seek the confidence, trust, and support of experienced clinicians to develop, learn more, and do more in a way that is authentic to ourselves.
Now part of my struggle was given in the policies in the agency I was working for: I was not allowed to give more than 4 weeks notice to clients and they hastened my termination date to ensure I’d follow this rule. 4 weeks to process termination with clients - some of whom I had been working with for over two years. This conflict is not uncommon. Interns don’t often get to rely on their own clinical judgement to inform how things like termination should go because they so often are seen as not having sound judgement to begin with. CAMFT sites it is advisable to provide 60-90 days notice of termination to clients when possible. Often times, however, agencies look out for themselves before anyone else, unintentionally (or intentionally) prioritizing client retention over well-being. This guideline from CAMFT makes sense - it ensures more emotional containment for what is a disruptive and potentially painful event. Not only do the clients need more emotional containment in such a painful transition but the therapist does as well. Managing feelings of guilt, anger, grief, and heartbreak (and others) are often the resulting tasks of the emotionally-available therapist who is terminating with their client.
There is no ideal time to terminate but certainly adequate time allows the process to be staggered and metabolized in a way that is mutually beneficial for both client and therapist. I terminated with the first client I ever sat with, I terminated with powerful transferences still at play, I terminated with unresolved conflicts (in myself as well), I terminated with kids I felt profoundly connected to, I terminated with someone who had just started to let me in... and this was just half of my caseload terminated in one day.
Needless to say, I was not emotionally available to my family or anyone else for the next several days. My husband is not a clinician but thank goodness he was supportive of my despair even though he couldn’t understand it at all. Even fellow interns couldn’t reliably relate to this experience. Many of the interns I know through this site had never had to process termination on this scale. Many experienced clinicians may also miss the emotional significance of termination. It’s easy to deny and discredit termination. It reminds us of the finality of relationships, the frustrating limits of relationships, how messy and unsatisfying endings can be, and the finality and inevitable end of life itself.
I suppose I could do this work in a way where termination didn’t mean so much to me. Another client could be just another client. I often think, however, that if human interaction got a client into the mess they feel they’re in, then human connection is going to be the best way out. To do that, you have to be willing to “get in the car,” as a colleague of mine says. Get in the car.
Is this what we demand of our interns? On one hand, we may not trust their abilities and clinical judgement but then we expect them so hold so much emotional work. I ask without possibly having any right to ask that experienced and skilled licensed clinicians remember this when holding interns under their guidance. Mind you, I have had the privilege to work with many supervisors who are fantastic, who are mindful of the interns’ struggles, who can hold to gravity of the work while holding the humanness of all things. I have also worked with fellow interns who so clearly need more containment and guidance depending on experience, skill level, and so on. We look to our elders for knowledge and guidance. We also look to our elders to learn how to become elders ourselves. We seek the confidence, trust, and support of experienced clinicians to develop, learn more, and do more in a way that is authentic to ourselves.
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