Breaking Up Is Hard To Do

Dear Inadequate Graduate,

I’m about to start the fall semester and have to terminate with patients at my current externship site. While ‘goodbyes’ are often hard for me, this is the first time I have had to leave someone I am treating and it feels like a horrible breakup. There is one person in particular with whom I’ve developed a special relationship, and I’m afraid of what will happen to her when I go. I’m looking forward to my next placement and wouldn’t want to stay at my current site, but leaving is so hard.

Have you ever struggled with this type of ‘breakup’ and if so, what helped you through it?


Dear BrokenHearted,

I’m so glad you brought this up as I’m sure many of your colleagues are experiencing something similar, given the time of year and, frankly, the reality one encounters when working with patients. The therapist-client relationship is a special one. Many times, our patients or clients feel more connected to us as providers than they might feel with their family or close friends. That said, although there can be a considerable amount of intimacy present, and those we treat impact us in a very real way, one must remember that it is a professional, and not a personal, relationship. When working with a patient to whom you feel particularly close, it is easy to relate to them more as a friend or loved one, and sometimes boundaries become lenient or confused. Certainly as providers we can love our patients, but it is important to keep in mind that what you are experiencing is a termination, and not a breakup.

With this in mind, patient/clients need advanced notice of your leaving and time to process what it might be like to transfer to someone else, or to end treatment. You should allow space for your patients/clients to voice their concerns and worries, as well as have an opportunity to review the progress that has been made and educate them on what to expect with the upcoming change. Different programs handle the transfer process differently, but I suggest giving people several weeks to several months notice to discuss these points, depending on the patient’s severity level, history of abandonment or personal difficulties with transitions, and the amount of time you have worked together.

As for your end (no pun intended), the termination of a meaningful relationship can also be difficult for the provider. Try to take a little extra time for yourself to review how this patient has impacted your life, and be mindful that your resistance to ‘breaking up’ is not reflective of a need that you might have such as a void your patient is fulfilling for you. It is common for people in a helping profession to focus on others while neglecting his or her self. Similarly, it can be easier or feel more pressing to worry about a patient’s ability to transition while denying our own difficulty with change. Because you mention breakup, I encourage you to explore if this termination is reminiscent of a past break up or loss you have experienced, and what might best to help guide you, and your patient, through the process so that it does not feel so traumatic.

Ultimately, whether the termination goes smoothly or has bumps, remember that no matter what,

You. Are. Enough.



The Inadequate Graduate


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