ending therapy with a borderline client

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13-10-2024

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Navigating the End of Therapy: Working with Borderline Personality Disorder

Ending therapy with a client diagnosed with Borderline Personality Disorder (BPD) can be a complex and emotionally charged process. It requires careful planning, open communication, and a deep understanding of the unique challenges inherent in working with this population.

Understanding the Dynamics

"Clients with BPD often have difficulty with separation and individuation," explains Dr. Marsha Linehan, a renowned expert in DBT (Dialectical Behavior Therapy) in her article, "Cognitive-Behavioral Treatment of Borderline Personality Disorder." [1] This can lead to heightened anxiety and fear of abandonment as therapy approaches its end.

Navigating the Process:

1. The Importance of Early Preparation:

• Open Communication: Begin discussions about the termination process early on, ideally during the initial assessment phase. This allows for a gradual and collaborative approach, fostering a sense of control and predictability.
• Setting Clear Goals: Establish specific goals for therapy. This can include symptom reduction, improved coping skills, and increased self-awareness. As these goals are achieved, discuss the eventual transition to independence.
• Developing a Plan: Create a structured plan for termination, outlining the steps involved, the timeline, and potential challenges.

2. Addressing Separation Anxiety:

• Acknowledge and Validate: Acknowledge and validate the client's feelings of anxiety and distress related to the ending of therapy. Let them know it's normal to experience these emotions.
• Prepare for the Transition: Help the client develop strategies for coping with their anxieties, such as utilizing coping skills learned in therapy, reaching out to support systems, or exploring alternative forms of support like support groups.

3. Focus on Transferring Skills:

• Enhancing Self-Reliance: Encourage the client to take ownership of their progress. This can involve identifying personal strengths, celebrating successes, and practicing self-care.
• Reframing Dependence: Shift the focus from dependence on the therapist to dependence on their own skills and resources. This can involve practicing self-soothing techniques, recognizing triggers, and engaging in healthy communication.

4. The Importance of Closure:

• Reviewing Progress: Reflect on the client's journey and the skills they have learned. Celebrate their accomplishments and encourage them to maintain their progress.
• A Farewell Ritual: Consider a symbolic farewell ritual, such as writing a letter to oneself reflecting on the journey or sharing their thoughts and feelings with the therapist.

5. Continued Support:

• Post-Termination Resources: Provide the client with a list of resources for ongoing support, such as support groups, websites, or hotlines.
• Maintain Contact: If appropriate, offer to stay in touch with the client on a limited basis to ensure their well-being.

Beyond the Book:

Ending therapy with a borderline client is not a one-size-fits-all approach. Each individual is unique, and their journey will be shaped by their personal experiences, support systems, and resilience. Flexibility, empathy, and a genuine desire to help the client thrive are essential elements of this process.

**It's also important to recognize the therapist's role in this journey. **

• Self-Care for Therapists: It's crucial for therapists to engage in self-care practices to manage potential burnout and maintain their own emotional well-being.
• Seeking Supervision: Regular consultation with experienced colleagues or supervisors can provide valuable support and guidance in navigating the complexities of ending therapy with clients with BPD.

References:

1. Linehan, M. M. (2015). Cognitive-behavioral treatment of borderline personality disorder. In Oxford handbook of personality disorders (pp. 603-627). Oxford University Press.

Keywords: borderline personality disorder, BPD, therapy, termination, ending therapy, separation anxiety, coping skills, self-reliance, support systems, closure, self-care, supervision.