A Self Psychologist Approaches Retirement: “Forced” Termination with Highly Vulnerable Clients

Abstract

Since its inception in 1973, Clinical Social Work Journal has consistently emphasized the intersubjective nature of the treatment process and the significance of the therapist’s conscious and unconscious contributions to it. In keeping with this fundamental tenet of clinical social work, which is now endorsed by virtually all psychotherapy disciplines, it is important that we acknowledge our own feelings when preparing for eventual retirement if we are to respond optimally to our clients’ feelings. In this paper, I review both the literature on “forced” terminations and the self psychology literature on termination. Three clinical vignettes are then presented to illustrate the application of these ideas to my work with vulnerable clients in long-term psychotherapy. The clinical material highlights how early introduction of the eventual termination, combined with consistent use of the empathic mode of understanding, can promote structure building and thereby enhance the therapeutic potential of the termination phase, even with clients most vulnerable to pathological regression and fragmentation following loss of the therapist.