Group Termination Shapiro2002

International Journal of Group Psychotherapy
ISSN: 0020-7284 (Print) 1943-2836 (Online) Journal homepage: http://www.tandfonline.com/loi/ujgp20
Parting Gifts: Termination Rituals In Group

Therapy
Elizabeth L. Shapiro Ph.D. & Rachel Ginzberg Psy.D.
To cite this article: Elizabeth L. Shapiro Ph.D. & Rachel Ginzberg Psy.D. (2002) Parting Gifts:
Termination Rituals In Group Therapy, International Journal of Group Psychotherapy, 52:3,
319-336
To link to this article: http://dx.doi.org/10.1521/ijgp.52.3.319.45507
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INTERNATIONAL JOURNAL OF GROUP PSYCHOTHERAPY, 52(3) 2002
SHAPIRO AND GINzbERG

TERMINATION RITUALS
Parting Gifts: Termination Rituals In

Group Therapy
ELIZABETH L. SHAPIRO, PH.D.

RACHEL GINZBERG, PSY.D.
Downloaded by [ECU Libraries] at 01:25 22 March 2016
ABSTRACT
A patient’s termination from group therapy is a powerful experience for the de-
parting patient, the therapist, and all group members. Unless the feelings evoked
are channeled into constructive expression, they may undermine this potentially
valuable phase of both the departing patient’s group treatment and the life of the
group as a whole. A termination ritual, styled by a particular patient according
to his or her own need, therapy goals, and personality may help the patient
achieve a more clearly defined sense of self. The authors suggest that the group
therapist’s careful attunement to and thorough exploration of the significance of
any termination ritual or gift will help to extract maximum therapeutic benefit
for the departing member and the group as a whole.
Termination of one’s membership in group therapy is an impor-

tant rite of passage that can potentially solidify a patient’s gains in
treatment and provide an opportunity to rework past losses and
unresolved separations. In addition, unlike the case of the individ-
ual therapy dyad, the departing patient’s termination process is a
communal affair with substantial impact on all remaining group
members. This means that each group member influences and is
influenced by the termination experience of the departing group
Elizabeth L. Shapiro is Assistant Clinical Professor of Psychology, Department of Psychi-

atry, Harvard Medical School; and Associate Director of The Center for Psychoanalytic
Studies at Massachusetts General Hospital. Rachel Ginzberg is in private practice in Phila-
delphia and Swarthmore, PA.
The authors are indebted to the following colleagues for their constructive feedback and
careful editing: Drs. Anne Alonso, Virginia Brabender, Jacqueline Duci, Jerome Gans,
Kathleen Ulman, and Mr. Michael Palazzo.
319
320 SHAPIRO AND GINZBERG
member. How a patient can best navigate this passage is not ade-
quately explicated in the literature. We know more about what
this complicated termination task is and less about how it is actu-
ally accomplished. One such way that some patients negotiate the
termination process is with the use of a ritual.
The term ritual is used here to describe a ceremonial act not part
of the usual repertoire of behavioral and verbal exchanges found
in most psychodynamic therapy groups. In this article we will dis-
cuss the use of termination rituals as a tool in the goodbye process
and explore both the positive and negative potential of such ritu-
als. Clinical examples are used to illustrate how rituals affect group
members, leaders, and the group process. In discussing the case
examples, we pay particular attention to the following variables af-
fecting the usefulness of termination rituals:
Is the ritual suggested by the group leader or the patient?

Are the group members included in the development and planning of
the ritual?
What is the exact timing of the ritual relative to the group member’s de-
parture?
Does the ritual reflect the work that the departing patient originally
came to do?
In order to appreciate the potential value of rituals in group ther-

apy, we must consider the metaphors and symbols that emerge.
The process by which the group creates the termination ritual and
its attendant symbols provides opportunities for members to gain
self-understanding as they explore the themes the symbols mani-
fest (Ettin, 1994).
To begin, we examine the literature on termination with a spe-
cial emphasis on the actual method of termination. We then ad-
dress the few examples in the literature of the use of rituals in ter-
mination. Because rituals can easily be seen as a kind of gift from
the departing patient, both in the figurative and sometimes even
in the literal sense, we borrow from the literature on gifts in psy-
chotherapy. Examining this literature enables us to more clearly
TERMINATION RITUALS 321
understand the impact of rituals and therapists’ complex reactions

to the use of such rituals.
Obviously there are many different types and circumstances of
termination in group treatment. We focus on termination that oc-
curs when the group member has completed the work he or she
came to group to do with the acknowledgment that work on one-
self is never complete and always an ongoing endeavor. Our focus
is on planned and mutually agreed upon terminations, not on
dropouts. Furthermore, we are addressing terminations that oc-
cur within the context of long-term psychodynamic groups with
both the remaining members and the group leader or leaders con-
tinuing to attend. Short-term groups and groups run within differ-
ent theoretical models present too many additional variables to
address within the scope of this article and lay outside our area of
expertise.
REVIEW OF THE LITERATURE
Termination
It was many years before termination was given its due in the litera-
ture alongside explorations of other phases of treatment. Initially,
the prevailing view was that once all neuroses were analyzed, there
was nothing else to do but end the relationship. The importance of
the patient’s attachment to the real person of the analyst was either
minimized as the positive alliance that would remain unanalyzed,
or it was seen as indicative of a lack of therapeutic neutrality. In-
deed, Helene Deutsch, pioneering woman analyst, was asked on
her deathbed if she had any regrets and her reply was, “I wish I
could have finished my analysis with Dr. Freud. One day he came
in and said, ‘This is our last day,’ and he made room for the Wolf
Man” (Anne Alonso, personal communication, December 7,
2000). It was believed that people returned to therapy only be-
cause of a failure in the treatment and not because of something of
value in the relationship. Even today, most of the literature on ter-
mination is focused on individual therapy and, in particular, ad-
dresses just a few of the parameters surrounding termination; for

example, how to know when it is time to stop, the criteria for termi-
nation, and the importance of addressing feelings around separa-
tion and loss—past and present.
The literature on termination of both individual and group anal-
ysis is fairly consistent in its explication of the themes of termina-
tion: attachment, loss, mourning, and internalization (Orgel,
2000). The termination, if it proceeds productively, allows the pa-
tient to weather the regressive pull of the separation inherent in
the termination and to consolidate gains he or she has already
made. Kauff (1977) developed the notion that disturbances in the

separation-individuation period in childhood will be re-experi-
enced during the termination process. Additionally, she noted
that group therapy presents a particularly powerful setting in
which to revisit patients’ experiences with separation from the
mother because of the multiple transferences evoked in the group
therapy setting (fellow group members, the group leader, and the
group as a whole), as well as the multiple opportunities to explore
termination.
Yalom (1985) stated, “termination is thus more than an extrane-
ous event in the group; it is the microcosmic representation of
some of life’s most crucial and painful issues” (p. 373). A termina-
tion from group therapy sets a model for the group members re-
maining in treatment and activates many complex feelings in
them. Flapan and Fenchel (1987) pointed to some of the feelings
that are activated in the remaining group members during the ter-
mination process: envy and competitiveness; rejection and hurt;
and hope that they, too, may sometime successfully terminate
their group treatment.
It is common to expect group members to involve the group in
the decision to leave and that a specified period of time be allowed
for the process of saying goodbye. Furthermore, there is a general
acknowldgement that group members must be helped to attend to
the unconscious meanings of the separation and encouraged to
work through past, perhaps incompletely resolved, separations
(e.g., Flapan & Fenchel, 1987; Rutan & Stone, 1993). Despite these
kinds of general guidelines, there are few instances in the litera-

ture of specific termination techniques. For example, Yalom
(1985) restricted a discussion of termination to the timing and cri-
teria for termination, with a brief acknowledgement of how termi-
nation stimulates important work on separation and loss.
One exception to this reluctance to spell out techniques of ter-
mination is an article by Maholick and Turner (1979). These au-
thors listed eight steps in the termination process, including such
requirements as having the patient “write and/or present orally a
final progress report of what the person has or has not achieved in
the group” (p. 589). They also described the use of some tech-
niques not as commonly seen in psychodynamic groups as a “per-
sonal inventory kit” against which the departing patient compares
his or her progress in therapy. Maholick and Turner formalized
much of what probably goes on with the termination process in
many long-term psychodynamic groups by insuring that the de-
parting member and each individual remaining member have an
opportunity to say a direct goodbye to each other, as well as re-
peated invitations to all group members to share feelings and fan-
tasies regarding separation and loss.
There are few examples of the use of rituals during termination
in group therapy. Dies (1994) suggested that the closing interven-
tions, such as “a moment of silence, a certificate of participation or
group or individual hugs” (p. 95), are all rituals that may be part of
termination. Dies cited another example where a ball of yarn is
passed among members and is used to symbolize member interac-
tions. The yarn is cut to mark the group’s end and members leave
group with pieces of the yarn.
There is some discussion in the literature about discouraging
the use of parties or celebrations (e.g., McGee, Schuman, &
Racusen, 1972). Rutan and Stone (1993) suggested that as the
specified final session approaches, it may be increasingly difficult
for group members to tolerate the feelings of sadness, separation
and anger. They suggested that as these feelings intensify, group
members may begin expressing ideas of planning a social gather-
ing. In one poignant clinical example, Rutan and Stone described
how a group member foisted a party upon her group to avoid the
grief associated with a member’s departure. The group therapist,
who, upon arrival, was surprised by the food and wine, pressed
group members to explore their feelings about the individual’s ter-
mination rather than participate. Soon the “party giver” was able
to see her own behavior as a reenactment of her behavior at her
mother’s funeral. We wonder whether a group discussion of a
planned ritual may have helped the party-giver understand her im-
pulses and defenses against the grief of saying goodbye.
We wish to distinguish rituals from parties. A potentially useful
ritual is one that is more directly linked to the work of the therapy
group, while a party may serve as a defense against the affects sur-
rounding termination. While a ritual may have celebratory as-
pects, we concur with Rutan and Stone (1993) and McGee and col-
leagues(1972) that parties should be discouraged.
Gift-Giving
The therapist is faced with a challenge and opportunity when a pa-

tient gives a gift. Because receiving a gift may arouse anxiety or
conflict for the therapist, it may be difficult to maintain objectivity
and effectively analyze the communication. The gift presents an
opportunity for empathic understanding and exploration of un-
conscious material (Kritzberg, 1980). The gift may be a defense
against hostile or erotic impulses, a displacement, a concealment,
or an attempt at reparation (Hahn, 1998).
In training, psychologists receive caveats about gifts. Often we
are encouraged to provide an analytic interpretation if not an out-
right refusal of patients’ gifts. As one colleague expressed: “Every-
one tells you to analyze and refuse [gifts], yet everyone accepts all
but the most extravagant ones.” Perhaps it is an overstatement, but
it certainly points to the powerful discrepancies between what is
taught and what is, in fact, done in practice but not openly and
comfortably talked about. Therapists may be vulnerable either to
an overly analytic stance in relation to gifts or a guilty and there-
fore quick acceptance of a gift.
One of the unusual aspects of psychotherapy is the relative lack

of reciprocity of social relations. Therapists are most often in the
position of providing care and then receiving money in return.
While we are paid to maintain a concerned and attentive relation-
ship, patients are expected to consistently receive. Therapists may
experience a disequilibrium when faced with an unexpected gift,
and it may arouse feelings related to their own conflicts about giv-
ing and receiving love. Countertransference feelings may inter-
fere with the therapist’s ability to objectively inquire into the
meaning of a gift (Kritzberg, 1980).
We wish to emphasize the importance of understanding the pa-

tient and his or her underlying dynamics. Stein (1965) states, “It is
far easier to refuse a gift, but one must know how and when to ac-
cept a gift” (p. 485). A therapist’s empathic acceptance of a gift
during termination may foster a patient’s sense of self by “making
room for autonomous actions” (Appelbaum, 1994). The challenge
to therapists is to know how to maintain boundaries and be flexi-
ble when indicated. A common theme in the literature on gift-giv-
ing is expressed by Winnicott (1992):
If a neurotic patient brings me a present I tend to refuse it because I

know I will have to pay for it in inflated currency. In the case of a psy-
chotic, however (and here I was really meaning to include the de-
pressive anxieties which are not fully available to the patient), I find
that presents have to do with damage already done. In other words
I nearly always accept, and I find that there is not much difference
between accepting two peaches and accepting a cooperative mood
or an affectionate attitude. (p. 151)
Winnicott’s position suggests that our higher functioning patients

can and should tolerate their gifts being refused in treatment. He
posits that we may want to view gifts as part of the positive transfer-
ence that remains unanalyzed for our lower functioning patients.
A gift to the therapist, when analyzed and understood, may
bring tremendous meaning to the therapy relationship. Similarly,
a therapist’s empathic failure when presented with a gift may cause
a significant breach in treatment or highlight a fragile alliance that
cannot sustain an additional narcissistic injury. For example, a col-

league reported to us that she felt her poor response to a gift
caused a patient to end treatment. The patient, who worked for a
major sports team, casually offered tickets to an important game.
This occurred in those ending moments of therapy as patient and
therapist walked to the door. The patient remarked offhandedly,
“I could get you tickets . . . . The therapist responded, ”Oh, no
thanks, it’s not necessary" in an equally casual tone. Subsequently,
the patient expressed rage at this experience, especially the thera-
pist’s blunder for not recognizing the importance of this interac-
tion. The therapist was not able to encourage this patient to re-
main in treatment because the narcissistic injury was not available
for exploration, and the patient ended therapy.
In the group therapy literature, Rutan and Stone (1993) are
unique in briefly discussing gifts during termination. They predict
that departing members may bring gifts either as transitional ob-
jects meant to help the group remember them, or as a celebration
of the group therapy experience.
When the second author (R.G.) of this article was in the early part
of her training as a group therapist, a maternity leave interrupted
her work with an ongoing psychotherapy group. Fortunately, her
cotherapist alerted her prior to her return to work that the group
had bought a baby gift (a stuffed animal). R.G. was uncomfortable
and sought guidance from her more senior cotherapist. She was ad-
vised to simply accept it. This group was a lower functioning group
with several members who frequently faced hospitalization and psy-
chological crises. The cotherapist maintained that extensive inter-
pretation and inquiry would not have been productive. In retro-
spect, we wonder if the group members might have been capable of
exploring more about the experience related to the group thera-
pist’s pregnancy and the feelings embedded in the gift.
THERAPISTS’ RESPONSES TO TERMINATION RITUALS
Perhaps one of the reasons that therapists write relatively little on

the actual process of termination is that in some important ways
the ending is a time when responses are called forth from the ana-
lytic therapist that are not traditionally perceived as analytic.
Ziskin (1994) writes that termination “cannot be itself an act of in-
terpreting the unconscious and, in some way the analyst has to
stop analyzing and have a different sort of conversation” (p. 17).
It is not, for instance, an analytic response to relay to a departing
patient in individual or group therapy that it has been a pleasure
to work with him or her. I (E.L.S.) remember well being in my
mid-twenties and feeling stunned when my therapist, who was a
proper European analyst, looked at me with tears in her eyes and
told me how sad she was to say goodbye. Nothing in her prior be-
havior would have led me to predict that she would feel that way,
no less that she would express it to me. Indeed, how many col-
leagues do we know who routinely voice such feelings at the time
of separation, and yet do not reveal this except when pressed?
Balint (1950) writes, “Usually the patient leaves after the last ses-
sion happy but with tears in his eyes and—I think I may admit—the
analyst is in a very similar mood (p. 197).” The portion of the
quote that stands out is the “I think I may admit,” expressing, we
believe, the guilty experience of being a real person in the room
with the departing patient feeling one’s own pain around separa-
tion. And perhaps one way we as therapists have of coping with
this pain is to continue up until the last moment of treatment our
penchant for making brilliant interpretations (Jerome S. Gans,
personal communication, February 4, 2001). This tendency
would certainly interfere with the departing patient’s need to
construct a meaningful termination ritual that puts him or her at
the helm. This is probably similar to therapists’ behavior around
receiving gifts, as previously addressed. Both termination rituals
and patient gifts temporarily create shifts in roles for both pa-
tient and therapist. This aspect of the experience may cause some
therapists to dismiss the usefulness of termination rituals,
thereby enabling them to seek comfort in familiar roles.Another
aspect of termination rituals is the gratitude a patient may show
toward the therapist. Gabbard (2000) writes eloquently on how
our wish for our patients to show gratitude is deeply connected to
our unconscious choice of profession, and yet “some analysts feel

guilty about their need for the patient’s gratitude and actively de-
fend against it” (p. 701). It is possible that some group therapists’
dismissal of any type of termination ritual may be in the service of
such a defense. We can easily feel guilty for getting paid for our
work in any form other than our fee, and even sometimes we feel
guilty for that. Some therapists may become rigid in reaction to
the guilt and rush to judge its usefulness. Certainly the training of
analytic group therapists traditionally teaches that all thoughts
and feelings must be put into words, but sometimes we can rely
on this dictum without taking the time to understand the mean-

ing of this “action” on a particular patient’s part at a specific mo-
ment in the treatment.
CLINICAL VIGNETTES
As with so many events in group therapy, termination provides a

tremendous opportunity for growth. Through the following clini-
cal vignettes, the authors illustrate how members in two long-term
psychotherapy groups struggled with conflict around separation
and the difficult process of saying goodbye.
Case Example: Edward
Edward was a 36-year-old single man who entered group therapy es-
tranged from his family and unable to make lasting friendships or
romantic relationships. He was aloof and sometimes condescend-
ing to fellow group members. He spent the first several years ada-
mant about his lack of investment in the group and being
unaffected by disruptions in the group, including the leader’s vaca-
tions and other members’ departures from the group. Edward grad-
ually moved to a position in the group that was marked by
vacillations between unexpected fondness for a few of the members
and periods of withdrawal similar to his early stance in the group.
After seven years, Edward began to show affect in the group, includ-
ing sadness about his life and empathy for others’ expressed pain. It
was at this time that Edward’s law firm offered him a position in
their foreign office. He claimed that the financial rewards of this
new offer were too good to refuse and he showed delight in his col-
lege roommate’s excitement about showing him around in a new

country and offer to share his apartment.
The group was quite mixed in its reaction to Edward’s announce-
ment. They were annoyed by his failure to really involve the group
in what amounted to a foregone conclusion that he would leave. To
his credit, Edward left four months to say goodbye to the group—no
small accomplishment for a man who had never bothered to say
goodbye to most of the people he had left in his various jobs and
moves across the country. The group remained ambivalent about
his decision throughout the termination process but nonetheless
gave him useful feedback about the ways they had seen him grow
and the remainder of the work left to be done in future therapy.

In a surprise move, Edward came into the final session with a cou-
ple of typed pages he read to the group. There was a paragraph ad-
dressed to each member about how he experienced each of them
and what was left unexplored between them. Some members re-
sponded to what he said with a mixture of warmth—because he had
taken the time to think out what they had meant to him and what he
wanted for them—and hostility, because he seemed to be reading a
kind of proclamation about the group from on high. The group
leader was forced to simply acknowledge the unexpectedness of this
action and the lack of time for an in-depth response. Final goodbyes
were said and the group was left to digest the experience in the ensu-
ing months without Edward.
Discussion of Edward
The group leader felt that the partial success of Edward’s ritual
paralleled the partial success of his group experience. Edward’s
work in the group had not come to a natural stopping place;
rather, his leaving for a job in a distant city was the spur to his end-
ing therapy. Edward’s written words to each group member were
both an attempt to connect with the group and a familiar pushing
away from others. Edward’s ritual enacted the ambivalence that
characterized his relationships in the group. On the one hand, he
expressed caring and concern for members. On the other hand,
his actions served as a vehicle for expressing his hostility and need
for control; he allotted insufficient time for responses in the group
and assumed a leader-like stance.
Lack of planning increases the likelihood that the ritual is serv-

ing as an enactment that is never fully understood by the depart-
ing member, and increases the possibility that some members
will feel “sideswiped” and resentful, as some of the members of
this group felt. In Edward’s case, the absence of the group’s in-
volvement in the creation of the termination ritual precluded Ed-
ward’s obtaining support from the group members. It is also
true, however, that a group’s conscious prior agreement does not
inoculate it against subsequent disappointment and distress.
Spontaneity is a natural and desirable component of group pro-
cess and spontaneous rituals may emerge from individuals or the

group as a whole. Therapists must rely on their experience and
attunement to help the group find meaning in a ritual, planned
or unplanned.
Case Example: Anne
Anne, a member of one long-term outpatient group, announced

that she might move several hundred miles away to accept a “once
in a lifetime” job offer. It took several months for the position to
coalesce into reality, and group members, including Anne, grap-
pled with uncertainty, sadness, and separation. The group had ex-
perienced the departure of only one other member in the past.
That member, Wendy, had joined the group at the urging of her in-
dividual therapist. She had not fully internalized her commitment
to the group and left after one year. When Wendy chose to leave
she gave the required notice of four weeks, but she did not use the
termination phase as an opportunity for growth. Interestingly, an
acting out occurred among the group members in “preparing” for
Wendy’s leaving. Following Wendy’s next-to-last group session, in
the waiting room, members decided to purchase a card and pres-
ents for Wendy to be given at the last group. Members called both
therapists and alerted them to their violation of group norms.
Members sought to create a ritual (in other words, giving a transi-
tional object), to manage the unexpressed feelings of sadness, re-
gret, and anger.
When Anne actively began to anticipate her own leaving, the
group reviewed how it had incompletely worked through Wendy’s
departure. Anne specifically requested a ritual from the group. She
asked that a pouch be used to contain concrete and/or imaginary

gifts and wishes from the other group members. In doing so, she
gave explicit voice to her wish for transitional objects from the
group. Furthermore, she indicated she had something to give to
group members as well. Anne’s self-conscious and thoughtful ap-
proach to leaving group was consistent with her therapy goal of ex-
pressing her own wishes in relationships.
Over a period of many months, group members readily accepted
her request while discussing fears of inadequacy (their choice of
gifts), the meaning of a gift exchange, and feelings of competition.
Anne brought in her gifts on her second to last group meeting, pro-
viding additional time for processing feelings. Anne laid out small
stones she had collected from a river in a circle. She read each
member a paragraph she had written about why she had selected
each stone and some essential feelings about each person. This poi-
gnant ritual was generated completely by the patient’s drive for clo-
sure and connection. The ritual structured aspects of the good-bye
while also giving members freedom to explore feelings. This indi-
vidual managed to leave group in a way that uniquely honored and
celebrated what she had accomplished there—the strengthening of
her ability to give and receive in relationships, to love and be loved.
At the final group meeting, group members and the cotherapists
gave Anne the treasures they had collected for her. The gifts in-
cluded a rock, a single earring (Anne did not wear matched pairs), a
book of poems, a CD, a heart-shaped ornament, and a group mem-
ber’s father’s recipes for soup for the cold New England winter. One
cotherapist gave a compass and the other, a miniature hand—both
concrete items that symbolized the metaphors of finding direction
and taking an outstretched hand, themes that had been explored in
treatment.
Discussion of Anne
Transitional objects are primarily understood as inanimate ob-

jects that facilitate separation and individuation, and in particular,
ease separation anxiety (Davidson, 1976). Interestingly, Davidson
relegates gifts in psychotherapy (patient to therapist and vice
versa) as “expressions of social ritual and talisman in the transfer-
ence-countertransference interaction” (p. 482). While it is essen-
tial to consider the transferential meaning of any gift-giving, the
above vignette suggests that the clinical implications of gifts may

not always be limited to transference. Certainly Anne was leaving a
part of herself with each of the group members and therapist, and,
reciprocally, she was taking parts of the group members with her.
However, we believe that the creation of this termination ritual
was also meaningful in that it strengthened a process of individua-
tion. Anne’s gift-giving ritual helped to consolidate the gains she
had made in individual and group treatment. Consistent with
Hahn (1998), we found that the group’s flexible and attuned re-
sponse to Anne’s gifts fostered her self-understanding, intimacy,
and sense of connection.

In the initial phase of treatment Anne talked at length about her
difficulty with choosing and sending presents (and the childhood
deprivation, both emotional and concrete, that had preceded it).
In her third year of treatment, she recognized the increased ease
and pleasure associated with giving and receiving. When a boy-
friend met her at the airport with a cold soda it became a metaphor
for his capacity for attunement as well as love. In crafting a
planned termination ritual, Anne allowed herself a personal, tan-
gible communication that grew from her work in therapy. She
took charge and was able to explore the range of sadness, disap-
pointment, regret, as well as joy that characterized her group ther-
apy relationships. Anne’s ability to act with courage clearly re-
paired an early wound but also provided a foundation for
reciprocity in future relationships. Anne’s use of ritual is consis-
tent with Maar’s position (1989) as cited in Peternel (1991) that,
“properly handled, the ending may enable patients to attain
greater autonomy and more articulated self-definition” (pp.
160-161).
It is also important to note that in Anne’s case, the departing
member involved the entire group in her creation of a meaningful
goodbye. In addition, the ritual began at the second to last group
meeting. Thus, the departing member and the rest of the group
had the opportunity to process any remaining thoughts and feel-
ings engendered by the previous week’s termination ritual. There
were marked consequences to Anne’s termination for the group
as a whole, and they continue to emerge, as demonstrated in the

case that follows.
Case Example: Nancy
When the next group member, Nancy, prepared to leave a year

later, feelings were aroused for all group members that included an
intensification of missing Anne and questions about how to say
goodbye this time. Nancy’s anxiety increased until she was able to
explore her wishes to create her own personally meaningful good-
bye. In her last session, Nancy addressed comments to the whole
group and then to individual members and therapists. Nancy dis-

cussed her feelings about what the group meant to her. Her good-
bye to the group included a gift of a small ceramic cat to place on a
bookshelf to remind us of her. She had spoken frequently in group
about her pet cat. In addition, she gave each group member a copy
of a book of poems. Finally, she took photographs of the empty
room.
Discussion of Nancy
In contrast to Anne’s termination, which was focused on the

unique relationships she cultivated with each group member,
Nancy’s termination was more focused on the group as a whole. By
giving each member the same gift she addressed the group as a
whole rather than the individuals. In the weeks leading up to
Anne’s last session, Nancy distanced herself and enacted her feel-
ings by missing some group sessions and arriving late to others.
Nancy was not able to acknowledge her feelings or behavior until it
surfaced in another group member as Nancy was leaving group.
This repetition facilitated the group’s awareness of one member’s
expressing feelings for the whole group.
Case Example: Ethan
Ethan, a successful artist, was terminating after seven years in group

therapy. Both the group and he agreed it was time for him to end af-
ter having met his goals of understanding and managing his anger
and creating a satisfying intimate relationship with a woman. None-
theless, he was reluctant to leave the group as he had not yet devel-
oped deep friendships outside of group and felt pained to have to
let go of these important relationships. In fact, in the months lead-
ing up to his departure, there was much discussion in the group of
the yearning to see each other outside of group time. In part, this
yearning seemed to reflect the group’s sadness about having such a
valued group member leave the group, one whose own anger had
enabled the other members to face heretofore denied rage and
greed. Five weeks before terminating, Ethan brought in copies of a
painted card he had drawn of the group represented as animals.
Discussion of Ethan
Although he did not plan his ritual with the group, Ethan left the
group plenty of time to process the meaning of his chosen ritual.
Ethan expressed his heartfelt wish that each member would hang
his picture on the wall of his or her office. The ritual turned out to
be a fascinating compromise between the group members’ wish
for extra-group contact and their somber respect of the bound-
aries of the group. Indeed, Ethan was speaking to the group id, us-
ing primitive, symbolic images of wild animals that were portrayed
as more domesticated creatures. In addition, the choice of animal
for each group member provided for an enlivened and touching
discussion among the group members.
SUMMARY
Feelings that are evoked when an individual announces his or her

intention to leave are powerful for both therapist and group mem-
bers. Unless they are channeled into constructive expression, they
may undermine potentially valuable group experiences. A success-
ful termination is really a gift to the departing member as well as to
all remaining members of the group. A termination ritual styled by
a particular patient according to his or her own need, therapy
goals, and personality may help the patient achieve a more clearly
defined sense of self.
At the same time, we recognize that any departure from the set
of group norms previously established should be executed with
caution and thoughtfulness and, when possible, the whole group’s

agreement. The termination process is likely to be most meaning-
ful when members have sufficient opportunity to explore all
thoughts and feelings evoked by this transition. The use of rituals
during the termination process should not be immediately dis-
missed nor assumed to be a good use of the group’s time. There
may not always be a way to know beforehand if the ritual will in fact
be useful to the departing member or the remaining members. A
ritual has the most meaning when it is crafted by the whole group
and with the group therapist’s careful attunement to and thor-
ough exploration of the intra- and interpersonal significance of

the ritual.
REFERENCES
Appelbaum, A. H. (1994). Psychotherapeutic routes to structural

change. Bulletin of the Menninger Clinic, 58, 37-54.
Balint, M. (1950). On the termination of analysis. International Journal of
Psychoanalysis, 31, 196-199.
Davidson, L. (1976). Inanimate objects in psychoanalysis and their rela-
tion to transitional objects. Contemporary Psychoanalysis, 12, 479-489.
Dies, R. R. (1994). The therapist’s role. In H. Bernard & K. R. MacKenzie
(Eds.), Basics of group psychotherapy (pp. 60-99). New York: Guilford.
Ettin, M. F. (1994). Symbolic representation and the components of a
group-as-a-whole model. International Journal of Group Psychotherapy,
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Flapan, D., & Fenchel, G. H. (1987). Terminations. Group, 11, 131-143.
Gabbard, G. O. (2000). On gratitude and gratification. Journal of the Amer-
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Hahn, W. K. (1998). Gifts in psychotherapy: An intersubjective approach
to patient gifts. Psychotherapy: Theory, Research & Practice, 35, 78-86.
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Kritzberg, N. I. (1980). On patients’ giving. Contemporary Psychoanalysis,
16, 98-118.
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phase of group-analytic psychotherapy. Group Analysis, 22, 99-104.
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well. American Journal of Psychotherapy, 33, 583-591.
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Orgel, S. (2000). Letting go: Some thoughts on termination. Journal of the
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Elizabeth L. Shapiro, Ph.D. Received: April 5, 2001

Department of Psychiatry Revision Received: July 25, 2001
Massachusetts General Hospital, A.C.C. 805 Accepted: July 30, 2001
15 Parkman Street
Boston, MA 02114

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International Journal of Group Psychotherapy

ISSN: 0020-7284 (Print) 1943-2836 (Online) Journal homepage: http://www.tandfonline.com/loi/ujgp20

Parting Gifts: Termination Rituals In Group

Elizabeth L. Shapiro Ph.D. & Rachel Ginzberg Psy.D.

To link to this article: http://dx.doi.org/10.1521/ijgp.52.3.319.45507

Published online: 21 Aug 2015.

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SHAPIRO AND GINzbERG

Parting Gifts: Termination Rituals In

ELIZABETH L. SHAPIRO, PH.D.

Termination of one’s membership in group therapy is an impor-

Elizabeth L. Shapiro is Assistant Clinical Professor of Psychology, Department of Psychi-

Is the ritual suggested by the group leader or the patient?

In order to appreciate the potential value of rituals in group ther-

understand the impact of rituals and therapists’ complex reactions

REVIEW OF THE LITERATURE

dresses just a few of the parameters surrounding termination; for

made. Kauff (1977) developed the notion that disturbances in the

kinds of general guidelines, there are few instances in the litera-

The therapist is faced with a challenge and opportunity when a pa-

One of the unusual aspects of psychotherapy is the relative lack

We wish to emphasize the importance of understanding the pa-

If a neurotic patient brings me a present I tend to refuse it because I

Winnicott’s position suggests that our higher functioning patients

cannot sustain an additional narcissistic injury. For example, a col-

THERAPISTS’ RESPONSES TO TERMINATION RITUALS

Perhaps one of the reasons that therapists write relatively little on

our unconscious choice of profession, and yet “some analysts feel

on this dictum without taking the time to understand the mean-

As with so many events in group therapy, termination provides a

Case Example: Edward

lege roommate’s excitement about showing him around in a new

and the remainder of the work left to be done in future therapy.

Lack of planning increases the likelihood that the ritual is serv-

cess and spontaneous rituals may emerge from individuals or the

Case Example: Anne

Anne, a member of one long-term outpatient group, announced

asked that a pouch be used to contain concrete and/or imaginary

Transitional objects are primarily understood as inanimate ob-

above vignette suggests that the clinical implications of gifts may

and sense of connection.

as a whole, and they continue to emerge, as demonstrated in the

Case Example: Nancy

When the next group member, Nancy, prepared to leave a year

group and then to individual members and therapists. Nancy dis-

In contrast to Anne’s termination, which was focused on the

Case Example: Ethan

Ethan, a successful artist, was terminating after seven years in group

Feelings that are evoked when an individual announces his or her

caution and thoughtfulness and, when possible, the whole group’s

ough exploration of the intra- and interpersonal significance of

Appelbaum, A. H. (1994). Psychotherapeutic routes to structural

Maar, V. (1989). Attempts at grasping the self during the termination

(2nd ed.). New York: Guilford.

Elizabeth L. Shapiro, Ph.D. Received: April 5, 2001