Closing a Practice

May 17, 2011 12:48 PM | Anonymous
By Cybele Lolley

Last summer, in late July 2009, I learned that my partners employer was planning on moving the company to a new location so he could be by the ocean and surf. This move was happening in February 2010. We were instantly filled with resistance, rebellion and anger. How could he do that to us, and our comfortable happy world! We reactively went into 'quit and get another job' mode.

With the economy as it was last summer, there were few to no jobs out there, especially in her field. There also was the issues of potential LHFLO-last hired first laid off. At least with the current job position she had job security and great ongoing growth. My practice was sufficient, but not enough to sustain us both if she quit and became unemployed. Within a short period of time we knew we had to follow the company.

This decision caused much anguish. I was loosing all that I had created and used as my professional and personal foundation. I needed to leave my supervisor position, my practice, my networking pool and my support community. My social friendships, my spiritual community and my comforting outlets were not going to be as easily available. My ego identification of 'I' wasn't happy! 'I' had 6 more months to live as 'I' had been living for many years. Influenced by my years working in the hospice and grief field, I was very aware of it all ending, dying. On top of that, I felt great responsibility to do this ending with the least harm possible to my clients for they too may have many internal conflicts with this outcome.

I needed to center and prepare myself before I told my clients. I tried to do this quickly, but it took two months. Holding the news at times felt like a guilty secret eating me up. I scripted personalized wording over and over as to what I would say to each client. I took the time to find how to say the news in a least painful way, to know what I was willing to disclose, and to ready for difficult questioning and reactions. I was grateful for having this grounding time. All clients, including those I had ended with within the year, were told in early October, with only four months remaining. My decision to notify recent terminated clients was based on addressing my unavailability for future services at a non-crisis time.

When other clinicians asked about my process, I referred to this time as 'breaking up with 20 relationships at the same time, one after another, not because they weren't loved or their work was complete, but because I was moving away.' As a way to manage this great emotional difficulty, my mind would create sarcastic humor by remembering popular 'break-up' songs such as Breaking up is Hard to Do, Another One Bites the Dust, and 50 Ways to Leave Your Lover. This technique kept me open, lighter and available.

The therapeutic relationship we had developed through continual brave vulnerability, devoted repairs and tender caressing was ending, was dying. Each client had their own reactions to this painful news so attentive sensitivity and adaptability were required on my part. I had a client point out to me that I was making a 'selfish choice' repetitively and it was a great challenge to not move into justifying my position since it felt like I had little or no choice. Another client wanted to complete her therapy 'to do' list for all the issues she skirted around for years. A couple clients didn't want to be reminded of our little time left and pulled back relationally and behaviorally. One client even terminated early to take control of our situation. However, the majority of my clients stayed until the end, coming back consistently even though they knew it would be difficult. They stayed with their internal process and our relationship ending. Even though I know they were getting their own needs met with returning and staying present with their process, this choice also offered me the treasured gift of care. We could also call it affection or even love.

I worked hard at staying aware when my stuff was too much in the room. There was no way possible to not have my stuff in the room. Although this is an ideal thought, it isn't a human reality. Since we physically share the same space, I believe we are always in the room to some degree. One client, at one point, needed reassurance that my stuff wouldn't infringe on her process, which scared both of us. As a clinician who tends to utilize consistent boundaries around self-disclosure and containment, I felt horrified that I could cause such great damage, and professional failure, if this occurred. My only response was that I would try my best. My clients were aware of my own struggle with our ending. Even though I did do my very best to contain my stuff, I was more transparent then ever before. I cried with some and shared mutual anxieties about not knowing what was next with others.

This was such a beautiful time and such a painful time, each adding to the quality of the other. This was a transcending time. It reminded me of sitting with those who are aware they have limited time left alive due to illness. There's often a vivid and heightened sensory awareness during this time. I watched my clients and myself 'see' my physical office space with new eyes. I noticed myself looking deeply into my clients' faces and eyes as an attempt to imprint them into my memory. I caught myself breathing with them to share the same breath rhythm. Holding the compassionate space for my clients to feel all that they felt - angry, hurt, loved, rejected, abandoned, special, important, meaningful, etc. was both rewarding and challenging. To support my ability to stay open to their pain, I utilized my mindfulness practice and healing beliefs as grounding sources with all the grief emotions in the sessions.

Overall I was aware that I could not 'fix' the situation just as a doctor can't fix a dying patient, but I tried anyway at times as an attempt to ease my guilt around taking ultimate control of our work and leaving them. One of my most challenging clients, also deeply cherished, repetitively called out my attempts to 'fix' the situation. One time she humorously naming my referring efforts as 'passing her on to a rebound'. I was shocked and hurt by her perspective of this 'therapeutic' tool regularly used in our field as equivalent to a romantic rebound. I perceived her response as her resistance and lack of understanding of the 'benefit' in this standard. Over time, I got her point. I was attempting to pass her on to someone she could latch on to with the hope that it would ease her pain and meet her needs when I'm gone, even if it was under the temporary umbrella of 'grief counseling'. My client desired to grieve and process our relational death without professional help. I wonder if maybe her desire wasn't 'resistance', but the desire to rely on her emotional strength developed in our work as her grieving and healing foundation. I may never know, or not know for a few years.

I know that referring is good legal and ethical practice for not abandoning our clients and referrals to other professionals is an important practice. I gave thought-out, specific referring clinician information to all my clients. With that said, I appreciate how my client's perspective has broadened my perspective. It's deepened my understanding that our go-to referral intervention has limits. I'm now more aware that offering referral may not be for a client's sake, but may be for ours alone. Referring helps ease our guilt of abandoning them, which is what we are doing when we leave them. Referring may also be a way we seek continual contact with our clients as the next therapist may get a release to talk to us. Allowing these possibilities to be a true shifts the focus from the client being resistant to recognizing that I, the clinician, have consultation/support needs. The final work then focuses on honoring and supporting the clients plan to do the grief work outside of the therapy structure.

Getting consultation and support during this process was essential for me to stay present with the intensity of the experience. I continue to be so grateful for my consultation colleagues and fellow supervisors for their ability to hold space for my expressed pains, worries and doubts about doing a good-enough job facilitating these breakups. With most of my attention going outward towards packing up my home and closing up my personal and professional relationships, it was healing to have safe and comfortable spaces to grieve, to be scared and to find grounding strength through their trust for my abilities as a clinician.

I've thought of this termination experience often over these months. I've noticed my critical mind finding things I could have done better to maybe ease the mutual pain more. Then I remember a piece of wisdom share with me long ago. The degree of pain we feel is in relationship to the degree of attachment we have. Some may read this and disagree, and that's okay. From this place I know I did the best job I could with an extremely challenging task. I was deeply attached to my clients because they mattered to me. I cared about them. I loved them. My heart embraced them as they shared vulnerabilities with me, strived to improve their lives, and struggled to say good-bye.

As I prepare to close this article, my final thought is towards impermanence. This closing for me has been a symbolic practice death. I chose to use it as a holistic unfolding and releasing, using Stephen Levine's A Year To Live as a spiritual guide. At some point we all will go through this task of closing a practice, or someone close to you will need to do it for you. This may be a voluntary decision like my move or retirement, or involuntary due to illness or death. All things have a birth and a death, a beginning and an end. Currently, I'm in the groundless transitional space between endings and beginnings, the Bardo, the Great Void. I focus on the gifts in my present as I my rebirth, and reincarnation, begins- strengthening my health with beach walks, finding spiritual community & comforting outlets, and saying 'Yes' to auspicious manifestations, like writing this article.
 

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