The Terminator
Season 1, Episode 11
Liana shares her story about how she left an unsupportive group practice and the complications that came from terminating with her clients. We discuss the reality of termination, supervision, and navigating it all as a human therapist.
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Episode Transcript - The Terminator
Allie Joy 0:00
So termination is a very real part of what we do as therapists, right? I'm sure we've all had to go through it at least once. I would imagine unless you've stayed with your first job, but I don't know many therapists who have done that. But it feels like we don't talk about it enough. Would you agree, Kathryn?
Kathryn Esquer 0:22
Well, absolutely, I don't talk about it, because I hate it hate termination. It's my least favorite part. And well, of course, you know, it can be celebratory, where you terminate with clients who have achieved their therapy goals, and they no longer need treatment that that I don't hate, right. But this kind of like, forced termination, where you don't have a choice, you have to terminate for one reason or another, whether it be, you know, cost to treatment, or you're moving jobs or locations, or, you know, a change of locations for the client. There's a lot of times where termination happens in the middle of work, due to, you know, environmental or life circumstances. And so, for me, those are absolutely the hardest to handle as a therapist.
Allie Joy 1:10
Yeah, I agree. It is really hard. And it's not necessarily Well, it's not about us, of course, but it's still very valid for us to be feeling this way, it can be really challenging. We don't always know how our clients are going to respond or react. And then planning for aftercare too, can be challenging, finding referrals, you know, figuring out if they want to continue with somebody else, I feel like there's just so many pieces, and I believe we kind of talked about it, but when I reflect back on it, I don't feel like it's talked about enough.
Kathryn Esquer 1:40
No. And the fact that when we as therapists, either change locations or change jobs, there's a ton of stuff going on in our personal lives around this, the personal changes, and then we have to terminate with all of our clients. So for me, I think back to like finishing an internship, and I was just a hot mess. I was approaching graduation, I was moving. And then I had to terminate with all my clients who have been working with for two years like it was just a disaster waiting to happen. But we're going to hear from Liana today about how her worst case scenario and termination happened.
Allie Joy 2:17
Yeah, I know. It's a good story. I think it's important for us to hear about it's important to keep that conversation going and we're really excited for you guys to hear her story.
Kathryn Esquer 2:27
And before we do this is just a friendly reminder that this is for entertainment purposes only and it is not a substitute for clinical consultation, ethical guidance or therapy.
Allie Joy 2:38
All right, well, this is episode number 11 of Am I a bad therapist? Let's get into it.
Kathryn Esquer 00:12
Hey, Liana welcome it to Am I a bad therapist?
Liana Ross 00:16
Hi, thanks for having me!
Kathryn Esquer 00:18
Oh, absolutely. I can't wait to get into your story. A situation that made you wonder, are you a bad therapist? But before we do, can you share a little bit about yourself how you got to where you're at now? Yeah. Tell us about yourself.
Liana Ross 00:33
Yeah, sure. So I'm a licensed mental health counselor in the state of New York. I'm from Long Island. And I started out in addiction agency and an outpatient, which I gained so much amazing experience. And that is one of my specialties is addiction. And I went into private practice. And then I'm actually in a different group practice now currently as the assistant director, and it's just, it's been a great experience, great learning experience. And it's called Gooding Wellness in Cold Spring Harbor, Long Island. So it's like very North Shore. And I specialize in young adults and adults, families, couples, I work in trauma, addiction, like I said, life transitions, eating disorders, body image, and relationships. I always try to like get all of them, I always end up forgetting them like, so. Yeah, and I am launching a new podcast called, let's be honest, so that podcast is going to be all about answering listeners requested topics, and also talking about pop culture and trending topics, but through a mental health lens. So I've been like pre recording, and it's actually going live on August 1. So I'm like, super excited. And it just feels really good to be where I'm at.
Allie Joy 01:57
I think this episode is airing August 8, I believe. So go listen, because it's out now. So go listen to those episodes. And we're so excited to tune in, too.
Kathryn Esquer 02:07
And we will absolutely check the notes because we will put the link to let's be honest below.
Liana Ross 02:13
Thank you. Yeah,
Allie Joy 02:15
Well, let's dive into it, then what is the story that you'd like to share with us today?
02:19
Yeah, sure. So I shared a little bit how I went into private practice a different group practice that I'm in now. And it was the first group practice that I was in. And I was also pre licensed. So I was kind of getting into that world of private practice that we all, some of us, strive to be. And through it, I was only there a year because I was feeling very burned out. I mean, it was kind of just like a machine where they would book you like nine sessions in a day, I didn't really have much autonomy. I know, tell me about it. And I didn't have much autonomy over who I saw when I saw them. And that's kind of like what I was going there for. And on top of that, the supervision wasn't what I needed, and wasn't really the best. It wasn't consistent, especially being pre licensed. I mean, even fully licensed, it's so important to have supervision. And, you know, I look back and I'm like, could I have done things differently, or I just didn't really have proper guidance, which is really unfortunate. And thankfully, I mean, I was getting really bad migraines for months because of the stress. Yeah. And I was desperately looking for a job a new one. And thankfully, I found one and another agency. And I was so thankful and grateful for this new position. But of course, the the part that I don't think any therapist likes is telling your clients that you're leaving, I hate it to this day, it makes me feel so bad. And I just want to take them all with me. And a lot of times you can, so that has, that's always a big, like, debacle for me is like, okay, and I think a lot of therapists can relate to this. It's like, how is every client going to react, you have certain clients that you really worry about, but even though you know, they're going to be in good hands. It's just like, I still think about old clients that I wonder how they're doing. So you know, with not having good supervision and feeling burnt out. And now I have to tell my clients.
Allie Joy 04:24
Yeah. Oh my gosh. So if you don't mind, I'm curious. What was the supervision? Was it like just an hour a week? Was it more focusing on like your numbers? Did you have an opportunity to go through your cases? What was that part like to you because it sounds like it was lacking.
Kathryn Esquer 04:40
Yeah. So we had an hour of Case Conference, which I love and where you get together with a group of therapists and you talk about your cases, and then we would do individual supervision with the head psychologist. And there would be times that he wouldn't show up. He would just he would expect us to meet still even though I would love to meet with my colleagues, but we're kind of like, well, why are we meeting and you're not, it's like leading by example a little bit. And then the worst part being that he wouldn't show up, therefore, we would miss out on individual supervision. And there would be even one experience where he admitted to dozing off, like, literally, like I was talking about a client. And he was like, I'm sorry, I just dozed off. Do you ever feel like that with this client? And I'm like, No, I don't. Like, I don't I'm sorry. Like, don't try to save yourself right now. You know, it was just And thankfully, I had great colleagues working there that I was close with, and that we would always bounce things off of each other. So I'm, like, so grateful for that. So it was just, you know, the attentiveness, the consistency. And that's it's so important to feel like you're heard and validated. It sounds like the practice fully supported you in filling your caseload and demanding sessions. But the support to be able to do quality clinical work and care for yourself and your clients, like that part was missing. This was a very lopsided administration or leadership practice. Yeah. Yes. Totally. Like, yeah, if I needed if I had one more spot open, and it was a time that I could eat lunch, nope, it was getting filled up. And I just heard about that morning. And I don't even know who this person is, like. It's just no, no, like, that's a red flag for me.
Allie Joy 06:32
I agree. Oh, my gosh. So it sounds like then. So you got a new job. And you have to tell your clients, how did you prepare yourself for that?
06:42
I always think ahead of like what I'm going to say, and I always make sure it's ample amount of time, right? Like, we always give at least four weeks. And if anything, I like to give them more time, because I don't know about you guys, but it's like, I can't sit in a session with someone knowing I'm leaving. And they're like, telling me things. And I just feel like I have this big secret. So I always can't wait to tell them. And so I knew what I was going to say just in regards to, you know, appreciating our work together. And that, like, you know, I'm taking this other step, but you know, we're gonna work towards either termination or transferring you to another therapist. And then I always give them room to process, I always give them room to share what they're feeling. What any thoughts, and I'm sure you can guess you get a wide range of reactions. And some people reply with, Oh, I'm so happy for you. That's amazing. And you're like, Oh, my God. And then other times, it's really hard, which I don't blame them. And then especially which, you know, I'll get into more if there's someone who struggles with abandonment, right, like that comes up a lot. And that always and, you know, you can tell yourself, oh, it's not about you, right? Like, you're not responsible for them. This is their stuff. And they got to work through this and XYZ, but it's so much easier said than done, especially being in the moment. Because you don't want to feel like you're hurting anyone, even though you know, it's not about you. So it's always there are some people that you kind of lay it on a little bit very light and really attend to their response.
Kathryn Esquer 08:23
Before we get into the juicy, clinical implications of the fallout of your switching of group practices, how, you know, let's talk noncompetes for a little bit and how your, your your existing group practice responded to you saying, Hey, I'm leaving, and how they supported you or maybe didn't in transferring or telling your patients or clients?
08:48
Yeah, so surprisingly, it was, and this is a red flag is that it was kind of like very matter of fact, like, oh, okay, you're leaving. When's your last day? Okay. Right, like, and then it's like, they're used to it they're used to the fallout, and that's a red flag. So it was thankfully it was organized in regards to where my clients were going to go, who I felt like was going to be a good fit. And if they were going to stay or not, right, I just didn't feel like that part was taken care of. But I don't think the attentiveness, the emotional attentiveness. And mental competitiveness. Supervision aspect was really added into that process.
Kathryn Esquer 09:35
Did they ever say, you know, don't tell your clients where you're going or how is that because there's a big discussion or a non competes, and I know that it varies by jurisdiction, but generally speaking, we can't control where our clients choose to seek treatment, like respecting their autonomy. So I'm wondering was the client's autonomy addressed from the from the leadership or how was that handled? Are you, you know, discouraged from sharing anything?
10:03
You know, surprisingly, I don't think so, I think they were okay with me sharing. There wasn't anything about non compete. And it's something I've been hearing more lately through friends who are clinicians with this non compete thing where they can't practice social work in a 25 mile radius, like for the two years that, like what? So thankfully, they were not intense about it. They weren't saying that I couldn't, I shared where I was going. And it was, it was a different situation, because this agency, it's a nonprofit, nonprofit, and you had to be in a certain location, you had to meet criteria and a certain department. So I knew that not everyone would be able to follow with what, you know, it was a different part of Long Island. So but I've had people follow me even to now when I left that agency, where I am now I've had a few people follow me and thankfully that there was no noncompete. Because they know, right, I think if you care about the client, these that's why we're in this hopefully, you want what's best for the client, you know, like if one person follows and you lose a few people, if it's what's best for them? Why not?
Allie Joy 11:15
Yeah, I agree. So it sounds like though there was maybe one situation from all of this closure and termination that stands out. Is that true? What happened next?
Kathryn Esquer 11:27
Yes. You mean with the client? Yes. Yes. So I was working with this individual. That was one of those people that I was worried about. And I was concerned that I didn't receive the proper guidance, there was a lot going on. And I this whole process, I was trying to refer them to a higher level of care. And they were very resistant. And, again, if I had the proper supervision, I don't know what else I would have done. But I kept seeing them. And I and I don't think that was the best thing. And so I told them that I was leaving. And it was a very blank expression. And so nothing was alert to me that like I needed to damage control. Right. So we continue on with the session. All good. And then they come back the next session. And they tell me that they tried to harm themselves after the session prior. And in a very, like, in a very, I mean, anyway, is terrible. But it was it was it was an image in my head. And I don't think it hit me in the moment, right, because I'm just trying to be attentive, I'm not trying to appear like super shocked, right? Like, I don't want to elevate the situation. And then after it happened, I was like, Wait, that person just told me they tried to hurt themselves after our last session. Our last session was when I told them I was leaving, this person struggles with abandonment. And I was really like one of the only supports they had. So I didn't know how to address it. I also, I didn't have the guidance of what to say or because I put it two and two together at a later point. And then I of course assessed for suicide ideation. And if this person was going to be at harm to themselves, and there was no harm, it was a lot of passive suicidality. But there was no harm to this person. And it was like the worst case scenario happens. And, you know, because you don't, of course, anyone hurting themselves, but then when you feel like it's because of you. It's like so hard not to take it personally. And thankfully, at the end, they did send me a very nice message of how much they appreciated our work, and they were in a good space. And yeah, and I just still think about that person. And I hope they're okay. But there was a lot going on that I think I had no control over and that I knew the higher level of care was the best fit. Unfortunately, I just didn't have like the tools to kind of move them along. Because then you're also in a rock and a hard place, right? If you say, Well, I can't see you anymore, you need a higher level of care, they may or may not follow through with that, and then they're out on the streets not having any care. So I was and I would definitely handle that differently now. But I was very like in a really hard place because I care about this person. So that's that is what happened. How it was you, you recognize that you're not a bad therapist for moving to a different agency or a group practice that better suits your your needs, and your your clinical support. But the situation arose where a client then self harmed after the news was revealed that you're leaving and you knew this client had abandonment issues and so on. that it wasn't necessarily your change of jobs that made you question Am I about therapist, it's how you're changing of jobs impacted the clients. Right. And this client in particular, and I think a lot of therapists out there, myself included, can absolutely relate to this, whether it be switching of intern positions, or practicum, site endings, or even I can relate to this when I had a maternity leave coming up, and I knew I wasn't going to be able to work with certain patients for certain months. How our self care and how our own priorities and our life, you know, impacts our clients can absolutely make us question our efficacy or our quality of therapist, so. So you said you might handle it differently. I'm super curious about that. Because given the tools and the skills that you had, at the time, it sounds like you, you managed it in the best way, you know, how and the patient was, you know, eventually you were able to get them transferred to a different different provider, it sounds like right, who hopefully was able to serve them in the way they needed? But what would you do differently? Knowing what you know, now? I think I would have forced supervision, right? Like, I think I would have literally called up the supervisor and said, I need to talk to you about this thing, just to do my own due diligence. Like, even though, you know, I did my SI assessment, I knew this person was in no harm. It just makes me feel better when you get that validation. And I do that still. You know, when it comes to supervision, just having like the uhhuh, yeah, that was exactly right. It just makes me feel so much better. And also like knowing how to handle this, even if it's like, Listen, if they're not willing to go to a higher level of care, they can't stay in private therapy that is harmful. Right. Like and and that has happened in the past and other situations where someone is not open to a higher level of care. But keeping them where they're at is really dangerous. So that it's well be kind of put your hands up and say like, Well, what do I do here? And I think now there's more of a model of meeting them where they're at, but it is very case by case basis. I think I would have forced supervision. I would have talked about it more. Because I don't think I even told anyone about it until like recently. Yeah, like, I don't know why I guess it all kind of came together. Maybe like in the last year. I talked about it. And then when I was leaving the agency that I was at to be full time in private practice. I was telling my friends, like, oh, gotta tell my clients. Well, this has happened in the past. Thankfully, no one was, I didn't feel like that was gonna happen again. Um, but yeah, I wish I wish I talked about it more. And I was in therapy at that point. So like, Why didn't I talk about it?
Allie Joy 17:53
Yeah, I was actually going to ask you that of like, if there were any policies in place, or how quickly you had supervision? Or if they were asking you like, how did termination go? Do we have any concerns, things like that? Because I know I've been in agencies in the past where thankfully, I've had that opportunity of like, anytime there was a crisis, like I would just call and I felt like that always worked well for me. So it sounds like though that you did not immediately call? Did they ask you in supervision, as you were leaving, how your clients were doing it? Was that something that was discussed?
Kathryn Esquer 18:26
i It doesn't stick out to me. And this was back in maybe 2018? It doesn't stick out to me. I don't think it was really discussed. Honestly, I didn't even see the supervisor for the last like three weeks before I left. So yeah. It was very hard to get a hold of, and seeing the difference where being at an agency like you said in the past, it was like every week, okay, how did that person handle it? Let's talk about it. Right. And even now, in private practice, I get more support than I have in the past. So it was really just, I just felt like it was all on me.
Allie Joy 19:07
Yeah. Well, I mean, this should never it shouldn't matter if you're licensed or not. But the fact that you were pre licensed at that time is even more kind of shocking to me at least, because again, it shouldn't matter. But you were pre licensed and they weren't checking in with you about termination. That's, that's very surprising to me.
Kathryn Esquer 19:25
I know, I know. It's kind of just like, Oh, I'm just gonna sign off on your paperwork and call it a day. But yeah, this was I had a very diverse population. And I think there were people that I saw I definitely wasn't qualified to see or specialize in their issues. And I kept saying to this person, the supervisor, listen, I don't think this is appropriate for this person. I ended up referring a different client out and found them but the better better care. Like I had to take it all in my own hands.
Allie Joy 19:59
Now I'm off I'm curious, how did you? Well, I can say for myself, I again, like Kathryn said, I relate to this so much anytime I've had to leave a job. I feel so much guilt, like you said, it's not about us. But it's there. And it's very common, I think, how did you try to deal with that guilt, especially after this situation? Because I feel like I've left jobs, where it seemingly seems like smooth ish transitions, and I still had so much guilt. How did you handle that?
Kathryn Esquer 20:27
Yeah, I definitely still have guilt to this day. Like, not me not like from past experiences. But like, when I left my agency job, it, it never gets, I don't know, it kind of gets easier. But it's, it always happens. I just constantly talk about it with people like my clinician friends, and my family, who knows the situations, especially with that job, I had such bad migraines, I was extremely burnt out. And so I knew I was I couldn't wait to get out of there. You know, like, I was so excited. So that made it definitely easier. But I had to talk about it to have that validation of like, No, you're doing the right thing, this is the best thing for you. Because I know for me, if I'm not in the best place for my clients, what am I doing? Like, I'm not going to be helpful to them. I'm not helpful to anyone at that point. So I know that it was a benefit in the end. So it's a lot of like the reframing of the perspective, the validation from other co workers and family members, and in the end really doing what's going to be helpful for me. Yeah, consultation, man. I don't know, anytime I've ever regretted it.
Allie Joy 21:40
I know,
Liana Ross 21:41
I know. It's the best. I love it, where it's like,
Allie Joy 21:44
is there anything that you would say? Or what would you say if there was someone listening to this? Who was going through something similar? You know, if someone's in that transition for their jobs, what advice would you give them?
Kathryn Esquer 21:55
I would say their reaction is out of your control. The only thing you can control is your response and what you say and do. And yeah, just like there are certain things we don't have control over. And this is one of them. And that's really it like separating between those two. And just knowing that, and that's kind of what can apply into multiple areas of life, but you only have control over your response and your actions and not the outcome. So you got to put yourself first. Absolutely.
Allie Joy 22:32
And maybe you should call your supervisor. Yeah.
Kathryn Esquer 22:55
I think it's, you know, from the overall experience of being in that practice, be aware of the red flags, and that you don't have to settle for anything less than what you feel like you deserve. And supervision is very important. I am so glad that you're talking about this. Now, given that it's it sounds like it's been years since it happened. And you said you didn't talk about it? Does it feel any different now that you are sharing?
Liana Ross 23:27
Yeah, it definitely does. Because I think it was easy for me to kind of put it in the background, because there was so much going on with that person. But it is important for me to like, reflect on and know, like, Okay, that was my worst case scenario, right? Like our anxiety goes to the worst case scenario. And knowing like, if I could get through that I could get through anything else. And knowing like that was an extreme case. And anything else is like, I'm able to go through it.
Kathryn Esquer 24:01
Absolutely. You can handle a case. Right. And you handled it on your own too.
Allie Joy 24:04
Yeah. Oh my goodness. Well, Liana if someone's looking to connect with you outside of the podcast, where can they find you?
Kathryn Esquer 24:11
You can find me. If you want to book a session with me or any other clinicians that I work with Goodingwellness.com You can find me on Instagram @LianaRosslmhc And my podcast. @Letsbehonestpod. And you can find the podcasts on Apple Spotify anywhere you listen to podcasts. And that's about it.
Allie Joy 24:34
That's awesome. And as always, we will link all of that in the show notes. So if you're listening, just click on it so you don't have to worry about spelling. We will link everything and we cannot wait to hear about let's be honest, and we're so excited to listen to that. Yeah, thank you guys. This has been fun. Yeah of course.