One of my first social work classes was an undergraduate course. It was a basic overview of the field really, some practice theories, a brief history, etc. I recall that my professor started the course by talking about termination. He told us that termination should start at your very first meeting with a client. It was not the last time I heard this point, of course. Termination is the goal for social workers; the therapeutic relationship has an end date. Sometimes it's because of the barriers of the agency; sometimes it's because the treatment goal has been met; and sometimes, as for me right now, it's because the social worker is changing jobs.
I'm not great at terminating. I also haven't typically had to do it for five years. In hospice, our patients die and bereavement takes over to help the families through their first year after a loss. I make condolence calls but it's understood from my first visit with a patient and family that I won't be there forever.
Now I'm leaving hospice to start a job as a therapist in a doctor's office, where termination will be a much more regular experience. I'm excited to change jobs and nervous and anxious and all the rest. But I'm also really struggling with terminating my current patient relationships.
There are two issues for me here. One, quite frankly, is that some of my patients are near death. It doesn't seem right to tell them I'm leaving after next week if they probably are too. However, I have no crystal ball (see previous blog posts) and I could be wrong in my assessment. Then I've done them a disservice by suddenly saying, "Ok, this is our last visit, see ya!" Proper termination allows for some time. That's why the golden rule is to talk about it at your first visit, as well as throughout the therapeutic relationship. I'm not sure how to handle this thorny time issue; I'm kind of just going with my gut.
The other issue at hand is my own discomfort at letting people down. I've worked hard to build relationships with these patients and their families. And now I'm going to unceremoniously end these relationships just because I want a new job. I'm struggling with the idea that I'm being selfish, even though I know that's a silly thought. Still, it's a thought I'm having. I'm going to meet myself where I am about it.
So what do I do? I've been telling patients in person, when I can, straight forwardly and with kindness, I think. I've accepted congratulations and shouldered comments like, "I'm heartbroken!" I've assured them that they will have a social worker, it just won't be me. Honestly, most of them aren't that worried about it. As with most things, my anxiety about their reaction far outweighs their actual reaction. Still, I have to keep saying the words over and over again and it's really weighing on me. That's my last point about termination: it's hard on the social worker too. We are, as I am constantly reminding myself, only human. I feel attached to some of my patients. It's hard for me to say goodbye.
But here I am. I hope my next blog post about termination is about how I figured out the secret formula to doing it right. I suspect I have a ways to go before that one. For now, I'm going to do it the best way I can.