Termination sadness

[Doctor Bagel]

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So I'm graduating and not setting up a private practice next year, which means I'm terminating with all my patients, including people I've been working with for close to 3 years. Right now, I'm feeling incredibly sad about this. It's amazing how attached we get to our patients. Anybody else out there feeling this sadness?

 

[xlithiumx]

Yes. 8 months out from termination, I still wonder about some of my closest patients and feel a sense of loss. Of course, some may follow you into your new practice. I had 3 patients do so, even though my new practice setting is 150 miles from where I trained. It seemed frankly absurd to me, but patients value a relationship, it seems.

 

[Doctor Bagel]

Yes. 8 months out from termination, I still wonder about some of my closest patients and feel a sense of loss. Of course, some may follow you into your new practice. I had 3 patients do so, even though my new practice setting is 150 miles from where I trained. It seemed frankly absurd to me, but patients value a relationship, it seems.

Well, I'm doing a fellowship, so no following. I would really like to have at least a parttime private practice after that, so maybe some of them will find me in the future. That's amazing that patients will go 150 miles to see you -- it suggests you're doing something right.

Yeah, I think in residency clinics we undervalue how important these relationships are. We expect patients to tolerate transfers in providers every one to three years. I don't think I'd tolerate it well.

 

[vistaril]

So I'm graduating and not setting up a private practice next year, which means I'm terminating with all my patients, including people I've been working with for close to 3 years. Right now, I'm feeling incredibly sad about this. It's amazing how attached we get to our patients. Anybody else out there feeling this sadness?

I like many of my patients, but I can't say it's a sadness. The goal I have with any patient is to move them *out* of treatment. Obviously with some patients(severe bipolar illness for example) that may not be completely possible, but chronic SMI med check pts aren't the sorts you are talking about I guess. And once stable we shouldn't be seeing them frequently anyways.

 

[Doctor Bagel]

I like many of my patients, but I can't say it's a sadness. The goal I have with any patient is to move them *out* of treatment. Obviously with some patients(severe bipolar illness for example) that may not be completely possible, but chronic SMI med check pts aren't the sorts you are talking about I guess. And once stable we shouldn't be seeing them frequently anyways.

I'm drawn to more psychoanalytic/dynamic type of stuff, so I guess my goal isn't necessarily always to get people out of treatment as quickly as possible. The patients I'm especially going to miss are those who I have been doing more intensive work with. Actually, though, I think I'll miss all (well, almost all) of them.

 

[F0nzie]

It's difficult but it's also the amazing part about psychodynamic therapy. Premature termination will also happen in your future pp (pt moves or insurance drops). Eventually you will need to process termination with your pt in the course of uninterrupted treatment for the sake of completeness.

Through experience I have been able to see the bright side as I let my patients go: helping them process grief/loss in the moment, loss and abandonment issues of the past, their reactions (denial, anger, depression, escape), and how it all interconnects with the work. The work may not be complete but you can give your patients a new set of wings by helping them process it.

Start now.

 

[Ceke2002]

Thanks for posting this, it's been very enlightening (and heartening) to read. Interestingly enough I'll be discussing attachment in therapy with my Psychiatrist next session. A psychotherapy discussion group has piqued my interest in it, so he's given me a recommended reading list and we'll go over with a bit more of an academic focus when he sees me next. Regardless I have and still do to a degree found it I guess 'threatening', although that's not the right word, to think of a Psychiatrist becoming attached to their patients, even though I know I shouldn't feel that way. I'm coming at it from the point of view of someone who has had a very negative past experience though, so I suppose for me it's a conditioned response, and reading posts like this, posts that make the attachment sound sweet and healthy and above all ethical....yeah, it helps, and it's nice, so thank you.

From a patient's point of view I love having my Psychiatrist as my treating physician, it feels good, and it feels like we've forged a strong therapeutic connection that I can build off of for my own progress. Even so I am looking forward to the day when he no longer needs to be my Doctor, because then it'll mean I'm better and that's a good thing. Bittersweet, yes, but ultimately positive