#termination activities

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Ending the Therapeutic Relationship: Creative Termination Activities

Termination is a highly important part of every therapeutic relationship that should be addressed throughout each stage of the process. While many adult clients have the ability to easily think back to their experience in therapy, for youth this is often...

Termination Activity

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Creative Termination Activities

Termination is a highly important part of every therapeutic relationship that should be addressed throughout each stage of the process.  While many adult clients have the ability to easily think back to their experience in therapy, for youth this is often more difficult.  Because of this I like to provide clients with some sort of physical representation of their time in therapy that will help them reflect on their experiences, highlight their strengths, remind them of what they learned and provide them with tools they can use to help prevent regression (ex. coping tools/CBT reminders, resources, etc).  These activities lets you both reflect on their time in therapy and transition out of services in an engaging way.

Click here for instructions for the pictured activities and here to view socialworktech's self-care plan.  Good luck to all of you getting ready to end your internships!

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Session Trackers: It is sometimes helpful for young children to be able to have a visual representation of how many sessions are left (verbal reminders may not be enough), and it can help them better prepare for termination.  One way to do this is to create a session-tracking chart.  

In the examples above clients color in one image, or choose a sticker, at the end of each session.  The activity is quick and also provides a good opportunity for therapists to check-in with clients and help process any feelings surrounding termination that come up throughout the process.  These examples can be found here (I created them using “Pages”)

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Grief Memory Box: After a loved one dies and time passes, significant items are sometimes lost track of, and memories may begin to fade.  I like helping clients to create a central place where they can keep these items and go to think about that person.  A memory box can help contain grief and aid in processing and emotional regulation.  Have the client personalize the box themselves.  A memory box:

Preserves memories through photos, home videos, notes/writing from the deceased, a memory book (one of my favorite grief activities), etc.

Keeps small items that belonged to the deceased safe

Increases communication by encouraging family members to contribute to the box, share memories and reflect on their loss together.

Increases self-expression when art supplies, journals, a memory book, etc. are included

Aids in emotional-regulation (and can be combined with a “calm box” to aid in coping)

Helps clients face grief/pain, rather than avoiding it

Provides as a transitional object at the termination of grief therapy

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Grief Memory Book (Example not client artwork)

This is a great intervention for grief and loss clients that I continue throughout treatment and compile at termination.  Many clients who lose a loved one have difficulty talking directly about the loss and art provides a medium for them to express themselves and face difficult emotions without feeling too overwhelmed.  For people who are not ready to draw directly about their grief, drawing their memories of their loved one lets them put more distance between them and their grief so that they can begin to process it at their own pace.

Goals: Process grief; Create traumatic grief narrative; Increase-self expression; Preserve memories (especially important for young children); Provide transitional object; Increase family communication; Teach coping skills.

Spend part of each session creating a “memory page.”  If the client does not want to talk about their work that is fine, instead process with them how it felt to do the activity.  When the client is comfortable you can have them speak about their memory and help them to verbally process their grief.  Remark about what you notice and ask questions.  After the session I would write down the client’s quotes on their work.  Ideally family can be involved with the process throughout.

Encourage the inclusion of a wide range of memories that shows a realistic depiction of the person.  So not all the memories are just of the most fond times, but also mundane events (ex. walking the dog together, being put to bed), and negative memories (ex. getting in an argument, being disappointed). Many child will begin to idolize their passed loved on and then feel a sense of shame when they have any sort of negative feelings towards them.  This activity can help normalize those feelings.

Eventually, I start introducing memories of the loss into the book.  An example of this would be a picture of a loved one’s wake (which can be a traumatic experience for many children).  This book can be used to process grief and create a traumatic grief narrative, especially if the death was sudden or they witnessed the tragedy.

Other things to include: Other art directives; Photos of sand trays and other activities; Copies of family photos; Writing (ex. poems, letters); Blank pages for them to add memories at home; A laminated “dry erase” page for them to use when they fill the book; Pages created by family members; Anything the client wants included

This activity can be easily modified to fit a number of therapeutic issues.  For example, I’ve used this with children coping with divorce (make a copy so they could keep one at each house).

Before the last session I compile all of their work into the book.  This is an intervention that they will likely always keep and use to continue their progress so I make try to make it durable and look nice.  Laminating and binding really makes this look amazing and something that they may keep forever.

If the client created the book without the parent present, during the last session I encourage a family session where they share the book.  This is a great time for me to work with parents on how to encourage healthy self-expression and processing at home (Example is not client work).

This is a perfect activity to go into a Grief Memory Box

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Putting the Pieces Back Together: This idea is inspired by the Japanese art, “kintsugi,” which involves fixing broken pottery with a gold resin, leaving the cracked, repaired piece more beautiful than the original.  The idea is to recognize the piece's history by highlight the repair, rather than trying to hide it.  This is a great analogy to use with clients.

Instructions

Supplies: Ceramic bowl, plate, cup, etc; Strong glue or ceramic cement; Paint pens, paint or liquid gold leaf (available at most craft stores); Beads, jewels, glitter, etc.

Carefully break the ceramic into large pieces.  I suggest putting it in a zip lock bag to contain the shards.  It is best to smash the bowl when it is on its side because cracking the base too much makes repair difficult.  This is symbolic of the perceived impact that life events can have and can lead to a discussion about the client's own experience.

Have the client repair the piece with glue as they reflect on what they have done in their recovery.

Then have them decorate their piece and outline the cracks while they discuss what strengths they have discovered in themselves in the process.  They may want to include symbolic words or drawings on each of the pieces.

This would be a great termination activity and could be easily adapted to a number of therapeutic issues.  Further guidance on how to repair the piece can be found here.

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You've Got Mail: Group Termination Activity

Directions: First, have your clients create their own paper mailbox (click here for a tutorial).  Then, each person, including the therapist, writes a short note to every other member of the group.  You can instruct them to write something that they have gained by knowing that person, a strength they can identify, a motivating message, etc.  The notes are then placed in the mailboxes for the group members to take home.

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Suitcase Termination Activity (By Jodi Smith, LCSW, RPT-S at "Play is Powerful"): At termination, your client is finally ready to continue their journey on their own.  Even though they will be leaving you behind, they can symbolically pack up everything that they have learned during their time with you to take with them.  This metaphor is easy for most people to identify with and it is a fun activity. 

Supplies: Plastic or cardboard suitcase (see tutorial here); Blank sticker labels; Paper luggage tag (real ones are cheap, but you could also just use the template); String; Cards; Travel stickers (optional)

Goals: Process termination; Provide transitional object; Help prevent regression; Identify accomplishments, goals, coping tools, etc.

Directions:

Have your client make and/or decorate their suitcase. 

Then they write something they will "take with them" from their time in therapy on each card provided (I print cards with travel clip-art on the back).  This can be things they have learned, coping skills, supports, resources etc. 

You can also integrate this with the after-care kit I posted.

On the labels they write or draw goals they have accomplished.  (Like the old suitcases in movies that are covered with stickers of past travels).  I also provide additional travel stickers.

On the luggage tag they write where they are going next.  This could be a new life stage (ex. my 8th graders usually write "high school") or a goal they would like to accomplish that the contents of the box will help them achieve on their own.

Process feelings about termination throughout the activity.