A therapist who claims to have never terminated a client

My therapist claims he never terminated a client.

Does this seem possible? I wonder if he's just saying that so I wouldn't worry so much about it. I just can't believe in all his years of practice he never encountered a client that was too much for him.

Is he young and new at this?

Mine's been in private practice over 15 years and said he's only terminated one client, and that person physically threatened him. So I definitely believe it's possible. He has said that if in the initial meeting, he feels the client needs more than he'd be able to provide, he'd refer them out. But that would be at the initial meeting, so I don't think of that as termination really.

Nope, he's been doing this for 25+ years.

I think this would probably be the norm across therapists in general practice. Most Ts treat horses, not zebras. It's like asking a family practice physician if they've ever diagnosed a patient with a very rare disease; most would not have had that experience. Statistically, most Ts see a lot of depression/anxiety/adjustment disorders, rather than extremely challenging diagnoses.

He's a psychologist, so I really can't believe he hasn't had maybe a few extremely challenging cases, but then again I really don't know what I'm talking about.

He may have had really challenging cases but just stuck with them.

I don't think the degree particularly has much to do with what types of cases therapists take on, nor does it particularly correlate to frequency of therapy terminations.

And "challenging" is open to interpretation I suppose.

I was a "challenging" case by my therapist's and my pdoc's description; it was about symptomatology, duration and level of distress and level of safety issues. But I wasn't "challenging" to work with personally; I was pretty darn adherent to safety plans, medications, appointments, etc., so termination wasn't ever a consideration with the exception of consideration of need for a 2nd opinion and /or possible change of care so that I could be better served. We did follow through with the 2nd opinion, but in the end we continued to work together when we had a better handle on what was going on with me.

I think it is completely possible for a therapist to never find themselves in a situation with a client where they felt they need to terminate them. I don't consider referring to a better equipped therapist a termination; that's a responsible move if a therapist feels they cannot help their client. Yes, the client may feel "terminated," but sometimes those kinds of changes have to happen.

I'd find it *really* hard to believe that in 25 years he hasn't had to terminate anyone.

I had one session with a therapist who had practiced about that long, and I asked her if she'd ever terminated anyone. She said no, so I asked under what conditions she might feel the need to do that... and she said that she couldn't think of any reasons she'd ever terminate someone.

That felt completely unbelievable to me. I mean, surely if someone is threatening physical violence, or repeatedly breaking boundaries, that would lead to termination?

I didn't go back. I was willing, in the moment, to give her the benefit of the doubt that maybe she really hadn't terminated anyone, but I can't believe she couldn't think of one plausible reason to terminate someone (especially as I've been terminated - so I know it happens!).

Do you worry about him terminating you? If so... are there specific reasons that you worry about? It might be worth talking to him about those (like, if you're worried you're not making enough progress, or that you call him too much, etc)...

The first woman claimed she had been in practice over 30+ years and that she never had quit a client.
She lied about other things so I have no idea if she was telling the truth about this or not. The idea that therapists quit working for a client wasn't ever a big worry for me.

I wonder if this T has such a thorough intake process that he can weed out the clients who present a strong probability for early termination?

This is a good question - I’m gonna ask my Ts this. They’ve both been in private practice for well over 25 years.

My psychiatrist/therapist told me at the beginning that it was always up to the client to leave. He kept me 15 years till he retired, so there's that. With the one I have now I asked her in the first session what she would say if she didn't want to work with a new client. She said she would tell them she didn't work with trauma patients. I never asked, but I took it to mean no matter what they had wrong if she just didn't think it would work out. I find it funny if that's always her answer. (I suppose it's not, really.)

Mine said she never terminated a client, clients decide when they are ready and if she can be of any help. She has been in practice for quite some time. So I believe it.

I feel Ts terminating people should be pretty rare if this term does not include referring people out to other Ts. But if that's included, I'd feel weird about it.

Don't therapists have to refer you to another therapist after termination?

It was comforting to hear he is not big on termination, but if things get stale, like if he believes I'm wasting my time, I'm afraid he won't tell me and it will be up to me to figure it out. And if I'm too slow to connect the dots, he may end up resenting me. I'm sure that sounds a bit ridiculous. I already feel like a fraud in therapy sometimes, so it stresses me out a bit.

I was terminated, overtly, because I was too much for the therapist. And she did refer me on, but I didn't try it. I had tried a lot of T's already, she was a trauma specialist, so I had thought she could handle my stuff. She diagnosed DDNOS and PDNOS, which other therapists had not -- so I thought if she saw it, then she could -- was supposed to be able to -- deal with it. Or help me help myself deal with it. But she couldn't. I didn't see any good reason to expect that anybody else could, either, and I was tired and disgusted with trying.

It makes sense to me that some therapists could handle things more passive aggressively, like you described, without being direct about it. May not even understand themselves that's what they're doing -- despite being therapists my experience with them is that they are not all that self-aware either sometimes. That may not be how your therapist is, but I don't think what you wrote sounds at all ridiculous. Could be true, could not be.

Maybe the bigger issue is that you can't accept what he says at face value, or you don't trust him. It's a fact rather than a perception, so I think at least in his construct of "termination", he has never told a client not to come back. But has he suggested s/he consider other options for therapy, or to seek a higher level of care, or perhaps that they are done or that therapy isn't helpful?

I also think that "too much" is a bit of an ambiguous concept, and most people who think they are too much are probably more of a poor fit for a particular therapist. Maybe he's good at figuring out how to discourage people from the beginning of therapy that he thinks are not a good fit, which I think is not that hard. Scheduling "issues," or maybe just challenging or pushing people prematurely, with the side benefit that if they're not ready, they'll find it uncomfortable and leave. So I'd be all cross-examining about the meaning of these words.

But I also think people's windows of tolerance are different. I've worked with people who are "too much" because they were aggressive and reactive and mean-spirited. But they did just fine with others; it's just that I have particular sensitivities to some things and I can make choices about what I do and who I do it with. But I know other people who are lawyers who enjoy working with people i don't.

But your T's comment does remind me of lawyers who brag that they've never lost a case. That's definitely a case selection process, especially if they do litigation. When you take easy cases it's easy to "win." Or maybe you take a broad view of "winning." Whatever it is, I think this is less about your T and more about you, but it seems interesting to explore.

In theory, yup, they're supposed to give you referrals. In practice, ehhhh... it doesn't always work out that way. And sometimes, they don't really give you *good* referrals.

The stuff you're worrying about would be GREAT stuff to talk to your T about, there's a lot there to work on!

If it helps, a T that I saw a couple years ago (one who actually thought about the "have you ever terminated anyone?" question when I asked and gave a really good answer) - told me that if we got to the point that he thought I was wasting my time and not getting anything out of therapy, he'd absolutely tell me. And, if I said that I wanted to continue, he'd be fine with that. That felt fair, and I believed him.

For the record, when I asked if he ever terminated anyone, he actually thought for a second and then told me there was one client with an active drug addiction. She didn't want to work on her addiction, AND she only wanted to come to therapy once every 6-8 weeks or so! So, he told her that he couldn't really be helpful under those circumstances. Totally fair, in my mind, and not related to any of my stuff - so a little reassuring!

RE: my terminations:

- My first T. I saw him for a year. I was totally freaked out by therapy in general, a friend had pushed me to go, I had a trauma history and was easily freaked out. I ended up bringing up dissociation, which he *didn't believe in*. He finally sent me out for a consult, I was diagnosed with a dissociative disorder, and he told me that it was basically outside of his scope of practice.

He didn't give me referrals, but the T that we consulted with did.

I had left (and come back to him) previously, and he DID give me referrals then... one of which was...

- First T's wife! I saw her for 3-4 sessions, and then she told me that she couldn't help me. She actually said, and I remember very distinctly, "You need immediate support and I'm going to be going on vacation for a couple weeks, so... I can't see you any more." I wasn't suicidal, and I thought she *was* seeing me - I didn't realize that we were in a trial period. No referrals either... (I still feel a little bitter over the whole thing). I ended up bouncing back to the first T!

- My last T. Technically, it wasn't a termination. It was the threat of termination though, so I quit on the spot (I'm usually not so dramatic, I swear!) She said that I needed to set specific goals with a timeline, and if I didn't accomplish those goals, she'd refer me out. (But I also found out she was still feeling afraid that I was judging her, so there was apparently some weirdness that I thought had passed.)

I couldn't get my head around the idea of "stop being depressed in 3 months, or you're getting kicked out" - so I quit on the spot. It was actually kind of horrible. She emailed and offered to help me find a new therapist, but honestly, at that point I didn't want anything more to do with her, so I didn't reply.

Soooooooo.... I don't know if that's helpful. I think it happens. I feel *much* less trusting at this point then I did before, and honestly, anyone who tells me, "Why no, of course I'd never terminate you!" - I just think is just saying what they need to gain your trust. I'd rather someone be upfront and say, "Yeah, look... under these circumstances, I'd probably have to stop working with you."

I think it is possible that a T never terminated a client. Many people never resign from a job formally for issues of personal discomfort, dissatisfaction and perceived competency. Many Ts are also not super ethical in terms of assessing their abilities, they want to keep the income coming even if they don't do much else than sitting there and listening. I personally don't see a Ts pattern to never terminate as a necessarily positive sign exactly for this reason: if they continue taking money and implanting false hopes while not being able to contribute anything constructive, is that good practice? I would have respected my Ts much more if they honestly assessed my therapy and admitted it was not going anywhere much. Instead, they did the opposite and tried to convince me not to leave in all sorts of ways.

The T not terminating clients does not necessarily mean a T who doesn't tell clients if in doubt if she can help the client or not. It just means the final decision belongs to the client.