Group Termination

When a therapy group ends, the ending is part of the treatment. It is the last stage of the group's work, not an added step that follows once the work is over.¹ The word termination sounds harsher than the thing it names.

Written by Team TherapyRoute, the clinician-run team behind this directory.

What happens when a therapy group ends

A consensus model of group development sets out five stages, the last of them adjourning, or separation.²

In an open group, one event often marks the start of this stage: a member announces a plan to stop, because they feel they have reached their treatment goals.¹

A planned ending is not a discharge; it is not a sign of failure, and it is not being dropped.

This page sets out what the closing phase of a group involves, drawn from two clinical textbooks and staying inside what they say.

Which ending is yours?

Four different situations get the same name.

People leave in two main ways: some go before their goals are met, and the reasons for that are psychological or practical. Others go having reached what they came for.³

Whether a group is open or closed changes what happens next.

• Open groups expect members to come and go over the group's life.³
• Many short-term groups run to a set protocol and do not change membership once under way.
• When someone drops out of a brief group, the place is not refilled.³

What people feel as the end comes closer

The closing stage of therapy groups is known for a triad of denial, regression and recapitulation.^1,4 In plain words:

• Denial: carrying on as though the ending is not coming.⁵
• Regression: old ways of coping returning.⁵
• Recapitulation: earlier problems showing up again.⁵

Admiration and a share in someone else's progress come together with loss, competition, envy and anger. A valued member's leaving brings mixed feelings, and members worry about how the group will manage without them.¹

None of this means something has gone wrong: these feelings belong to the closing stage of a group.

When old symptoms come back before the end

Original symptoms sometimes return shortly before leaving, which Yalom and Leszcz read as protest against the ending.⁶

A therapist need not hold the person back. The return can instead be used to revisit what first brought the person to treatment, and to work out what the person will do if things get hard again.⁶

One man re-experienced his depression three meetings before the end, looking for a reason not to leave. It cleared quickly once the therapist named it.⁶

Ending does not undo the work already done.⁶

Ready to leave, or leaving to avoid the goodbye?

Has the person genuinely resolved what they came to work on, or is the wish to leave a flight from the group?⁵ Flight here means leaving to get away from something in the group, rather than because the work is done.

A flight is mainly fear-based. Where that is the case the person is asked to stay, and the unresolved issues that prompted the wish to go are worked through first.⁵

Feeling ready is examined rather than accepted as it stands. Behaviour here can be aimed at the leader, to show that ending would be a damaging decision.⁵

The decision is therefore talked through in the group rather than simply announced.

What the closing sessions involve

The leader reviews the leaving person's course and the group's progress, naming out loud what other members contributed.⁵

The review does two things at once. It helps consolidate what everyone gained, and helps members manage the feelings that come with the last sessions.⁵

Despair, loss, hopelessness and sadness regularly come with the final sessions.⁵ Naming them in the room is part of the work.

Groups often avoid the difficult work of ending by denying or ignoring it; the leader has to keep it in focus. In a brief group the leader names the approaching end regularly and keeps members working towards their goals.⁷ An ending named only in the last meeting leaves no time for that work.

Staying in touch, reunions and social meetings

A group will try to avoid its own ending, and members may pretend it carries on somewhere else. Reunions and regular social meetings are two of the forms.⁷

The ending is a real loss, and the therapist says so. A group can never really be reconvened. Pairs and smaller subgroups may keep meeting, but the group you know, in that room, is gone.⁷

Your therapist may be cautious about such plans. The aim is to face the loss rather than leave it unspoken. Nothing is being forbidden here: the group is being asked to look at what it is doing.

When the whole group ends

Some groups have an end date from the outset. One described in the literature ran for twenty-five sessions.⁸ It is fair to ask where your group's end date came from.

An open group may end when the therapist retires or moves away. That is not automatic. Where there is a co-therapist, the group can carry on. A therapist may also end a group when most members are ready together.⁷

Plans to keep meeting after the group's last session are covered in staying in touch.

When your therapist is the one leaving

This is one of the ways an open group reaches its end.⁷ The reason lies in the therapist's circumstances, and it is not a judgement on any member's work in the group.

An ending is not the only outcome. A second therapist running the group may continue it.⁷

Ask your therapist directly what is planned. The answer determines what happens next, and the feelings described earlier apply here too.

When someone else leaves and you stay

Whatever the reason for it, a departure is felt by the whole group. Some long-term groups are dynamically oriented, meaning they focus on the relationships between the members in the room, and in those groups the empty place is not filled straight away. Time is allowed for what the loss brings up.³

Powerful themes come with the exit of a long-standing member: death, abandonment, separation, competition and loss. Family re-enactment is another, meaning old family roles repeated inside the group.³

Envy and competition can appear alongside real admiration. People also worry whether the group can carry on.¹

These feelings are part of the work. The therapist's task is to help members stay engaged with them.⁵

The months after the group ends

No one leaves a group with a guarantee: one can never be certain, and everyone stays vulnerable.⁶

Change can arrive later than the last session. A group may end with no sign of what it did.⁸

One man spent a time-limited group talking about his fear of approaching women. Nothing visible changed while it ran. At the last meeting he brought a going-away present: a local newspaper carrying the personal ad he placed.⁸

A group may do no more than prompt a person to use what is already there. Newspapers, friends, relatives, study and work opportunities were available all along.⁸

Members and therapists may miss this at the time, and improvement can be met with puzzlement or doubt.⁸ Some people leave before their goals are met,³ and the reasons are psychological or practical.

If the ending leaves you struggling, it is worth speaking to a professional. The last section covers where to look.

For group therapists and trainees

Knowing where the group is in its development lets a leader choose interventions that fit that stage. Interventions can be poorly timed or badly sequenced, and the cost is not only a missed opportunity: they can damage individuals and the work of the whole group.²

Stages are not necessarily linear. They relate to the group's makeup, its goals, and ego strength, meaning how much strain members can hold.²

Five things fall to the leader in the closing stage:

• Tell genuine resolution of a person's agenda apart from flight out of the group.⁵
• Keep the ending in focus, and name it regularly in a brief group.⁷
• Review the leaving person's course, and say what others contributed.⁵
• Leave the place open in a long-term dynamically oriented group rather than replacing at once.³
• Allow the group time for what the loss brings up.³

Handover to an incoming leader is not covered by these sources. Trainees rotating out of a service should take it to supervision.

What the evidence supports, and what it does not

What is on this page comes from clinical textbooks, not from trials.

The five-stage model was drawn together by the American Group Psychotherapy Association, reading historical models alongside research findings. That is one country's professional body, and the stages are not a rule. They are not necessarily linear, and they depend on the group.²

Two editions of the same psychiatry textbook describe the triad alike.^1,4 That is one source carried forward, not two independent ones.

Three things are not claimed, for want of a source:

• No rate is given for how many people leave a group early.
• No claim is made about attachment style and how endings are felt.
• No promise is made that gains hold, or that endings prevent relapse.

Finding a group or a group therapist

You can search the TherapyRoute directory for a therapist who runs groups. Our guide on how to find the right therapist covers what to ask.

Three questions are worth putting to any group therapist:

• What training and supervised experience do you have in group work?
• Is this group open or closed, and how long does it run?
• How much notice do members give before they leave?

The last answer tells you how that group handles endings.

This article is for general information and is not a substitute for professional assessment or care. If this is affecting your life, consider reaching out to a qualified mental health professional.

References

1. [1] Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 10th ed (2017): K&S 10e 33.5 - adjourning/separation stage and its triad.
2. [2] Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 10th ed (2017): K&S 10e 33.5 - five-stage model of group development.
3. [3] Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 9th ed (2009): K&S 9e - the two ways members leave, and the gaps left behind.
4. [4] Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 9th ed (2009): K&S 9e - adjourning/separation triad (cross-edition corroboration).
5. [5] Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 10th ed (2017): K&S 10e 33.5 - resolution versus fear-based flight from the group.
6. [6] Yalom & Leszcz - The Theory and Practice of Group Psychotherapy, 5th ed: yalom - pretermination return of symptoms as protest against termination.
7. [7] Yalom & Leszcz - The Theory and Practice of Group Psychotherapy, 5th ed: yalom - groups avoid the work of ending; the leader keeps it in focus.
8. [8] Yalom & Leszcz - The Theory and Practice of Group Psychotherapy, 5th ed: yalom - change can surface at the very last meeting.