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Psychotherapy Articles

The Doctor is Out: Reflections on the End of a Practice

When my husband retired 4 years ago, he hung up the phone and was done. In the blink of an eye, his company laptop was ready to ship off and his home office was on its way to becoming our guest bedroom again. A new, exciting, responsibility-free horizon met him almost immediately. So he was a bit surprised each time he asked me how my path to retirement was going. (He’s been married to a psychologist long enough to know to ask that question.)  My answer: these last months of practice have been hard and unlike anything else I’ve ever done professionally.

The feeling many people have about their retirement, something along the lines of: “Yippee Ki-Yay!” will come, but I wanted to share what is rarely talked about with regard to ending a private practice: saying goodbye is some of the most moving work you will do.

For me, the process began 12 months prior, when I told clients that I would be retiring in a year. One astute client said, “Well, that gives me enough time to be happy for you without worrying what the ending will look like just yet.” Nearly everyone asked if I would suggest a new therapist (I would) and asked me to refer them to someone just like me (I couldn’t).

I spent months reacquainting myself with colleagues so that I could be sure not to recommend someone who was planning to retire in short order. Before this, meeting for lunch or coffee was something I never made time for, especially during the pandemic. So it was delightful to connect and reconnect with other practitioners who were also eager to hear how my retirement experience was unfolding. After all, there is no manual on thoughtful and caring goodbyes. Just as each clinician’s practice is unique, so is the ending they write.

I looked online for guidance and advice on retiring and/or closing a private practice. There’s no shortage of material on finishing well from an ethical and professional perspective (e.g., informing referral sources, securely storing files, and purchasing extended malpractice insurance, to name a few) but very little about the softer side of retirement. I found one article from a new practitioner who said goodbye to a client after 8 months of work together. As sympathetic as I was to the rookie experience, where every “first” is special, I was looking at goodbyes after 5, 10, 15, even 20+ years.

Shortly after my initial announcement, my clients were eager to return to our ongoing work. Only occasionally did anyone revisit the seismic change that was about to happen. So I made it my job to periodically refer to my timeline, as well as to what to expect. Denial is a powerful thing that serves to protect us, but not prepare us.

One young woman, with whom I expected to meet until I retired, abruptly announced one day, 5 months early, that she was ready to stop therapy. There was nothing natural in her timing, which made me curious. I posed a question to her: “When you were dating, did you break up with people before they broke up with you?” “Oh yes,” she answered quickly, and then it was clear. She was struggling with anticipatory loss and decided to cut things off before the pain grew more intense. We ended that day.

Most other folks wanted to get as much done as possible before we said goodbye, and I felt the same. With each remaining appointment, I wanted to provide not only my best counsel, but also enough to last for many years to come. My sense of responsibility for each person’s well-being kicked into high gear, not surprising to those who know me. It was like the summer before you send your teen off to college. Can they fend for themselves? Are they ready? Will their clothes all shrink in the dormitory dryer? I not only wanted to finish well by making each goodbye a personal one (a book, a poem, a symbolic transitional object), I also wanted them to be able to draw on our insights long after we ended. When colleagues asked me how things were going, I’d typically say two things: finding my way is both daunting and a bit lonely.

I quickly realized I was building a tall order for myself. My hope was that each client could leave with the ability to articulate what our progress together had been, that they would be able to identify the themes within the work and the complexities in finding a path forward, while also knowing when to ask for help. I knew it would be slightly less painful that way. But just like a
parent of a teen, I was reminded that not all birds soar when they leave the nest.

Many clients were right there with me, holding onto our time together, seizing the remaining opportunities, knowing this was not forever. It had never been forever, but now there was a countdown. Two months before closing my practice, I scheduled all final appointments so each person knew how many sessions remained and exactly when our work would be ending. The
countdown was quantifiable now.

I looked high and low for poems to give as parting gifts, knowing that poems, like music and metaphors, express emotion for which we often can’t find words. While a thousand pithy quotes turned up, the poem search grew frustrating. Was I looking for one perfect poem, a unique one for each client (if that’s your goal, I suggest you start today), or a set of poems that would apply to almost everyone? I stopped looking and rethought my plan.

I’ve always been drawn to writing, so I settled on the idea that I would write each client an individualized card. My initial goal of writing one card per day for 35 days quickly transformed into late night card writing sessions on the weekends before the final goodbyes. In retrospect, I don’t think that my heart had the words I needed to say goodbye until the time was ripe.

In Psychotherapy and Process, Bugental writes: “Finally there comes the time of relinquishment. We have grown together a good working relationship; now we must let go of it. This is not a light matter, but it is not a tragic one either.” He adds, “The ending needs the authenticity we have sought all along.”

As the last 2 weeks of practice approached, I prepared for the final goodbyes. I was now fully in the moments when you try to express all final thoughts, offer a hug or warm handshake, and then wish them well. Oh, it’s a doozy of an experience. Would we ever see each other again? If we did, would the time be right to greet, hug, or get a quick update? Or would we have to quietly smile at one another to protect the privacy of the relationship? And if we did talk, would it feel all too brief compared to the weeks, months, and years of trust-building, risk-taking, laughter, and tears?

Hour after hour, my heart was in my throat as I talked with each person for a final time. I wanted to reflect their strengths, talents, determination, beauty, and goodness back to them. I wanted to remind them of the themes in our work that would carry forward, with a touch of realism about how old patterns can return when we least expect them. I also wanted to make room for their expressions of appreciation and warmth. There were many tears, words of appreciation, a spontaneous “I love you, Dr. Connor” or two, and even a beautiful prayer from a seminarian client.

While still their psychologist, I had come to care about each person, human to human.

How life-giving this work is! After all, where else is truth so singularly the focus? And where else are you given the gift of seeing beyond the tangible to the essential core of the soul, where a story about family traditions or vacation disasters or irrational arguments becomes the basis for seeing love, shame, hurt, vulnerability, and resilience?

In a time when, thanks to social media, we don’t have to let go of any human being we’ve met along the way, this was one time where the goodbyes had to be firm. But it felt so strange to many folks, and a bit to me as well.

It really was goodbye to people who have been part of my professional life, and to the special role that we get to have in others’ lives. I knew I could and would talk honestly and intimately with my loved ones, but never quite in the way that this career has allowed me to. I feel lucky to have had hours and hours of meaningful conversation over the last 32 years of practice; some tough, some inspiring, some both.

I read Mitch Albom’s Tuesdays with Morrie earlier this year for the first time. Towards the end of his remarkable life, Morrie tells Mitch that “death ends a life, not a relationship.” I feel the same way about retirement, which for me grew into a sacred and tender experience. Saying goodbye with each client offered a steppingstone to my next chapter. And I am grateful to have
experienced it.

Leslie Connor is a recently retired Licensed Psychologist from Wilmington DE. For 32 years she worked in private practice, with prior experience at the University of Delaware's Counseling Center. From her website: Often my work involves addressing the most basic, yet profound, issues of life — trust, self-acceptance, love, guilt and shame, loss, and resilience. Sometimes therapy involves making peace with unresolvable situations and other times it means finding ways to make lasting changes. Dr. Connor continues to provide consultation and supervision to licensed therapists.

Cite This Article

Connor, L. (2024, January). The doctor is out: Reflections on the end of a practice. Psychotherapy Bulletin, 59(2). 24-26.

References

Albom, Mitch (1997). Tuesdays with Morrie: An Old Man, A Young Man and Life’s Greatest Lesson (1st ed.). New York, NY: Doubleday.

Bugental, J. F. T. (1978). Psychotherapy and process: The fundamentals of an existential-humanistic approach. Boston, MA: McGraw-Hill

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