The ending is an inevitable fact in therapy. At some point in time, the therapist and client, regardless of the nature of the alliance, will have to part ways. Endings can arouse anxiety in therapists as well as their clients. The sense of an ending evokes our awareness of painful feelings of loss.
In a reasonably ideal situation, the decision to end therapy is the patient’s, with the therapist’s support of this decision or vice versa. The therapy is then brought to the closing phase. The nature of the closing phase is unique to the therapist-client dyad. With an end in sight, the field ultimately changes. The interaction and the work changes. This, of course, does not always happen. Some clients need to leave therapy unilaterally without giving time and acknowledgement of the closing. Other times situations in the lives of therapist or clients cause abrupt end to therapy. Abrupt closures, regardless of the circumstances, leave both parties in the therapeutic relationship to deal with the emotional aspects of separation without the other.
That the therapist initiates the termination of therapy is less often the case. As a psychotherapy student under supervision in a foreign country, I had to be that therapist, very early on in my career, to initiate an ending with my 20 clients. My studies at the university had come to a close. I had completed all the supervised hours of individual therapy sessions with my clients, some with whom I have worked with for more than 30 hours. My plan was to return to my home country in Asia to start a private practice.
The realization that a decision had to be made if I stayed in Austria or if I went back to Singapore brought a mirage of feelings: anxiety of the impending move and its uncertainties, sadness of leaving an entire community of friends and colleagues. There was also a somewhat neurotic flavor of guilt for initiating an end to the work with the clients. I was engaged in a tug-of-war with myself: one end of the rope is a self feeling responsible for the feelings of the clients, and at the other end is me chiding myself for not valuing my clients’ own agency.
The most important variable in this process is time. How long a notice should I give to the clients and myself? This question also determined when I packed up the existing practice for the move. I decided to give us all three months. I figured that this is enough time for us do necessary process work while having an eye on the ending. A good time to end was also in July. Many of my clients are also expats who would have left the city (some even for good) in the Summer. So I broke the news to my clients in April.
Lest I missed out someone, I made a list. Ticking the list after having relayed the news brought me relief. With every client, I was anxious about uttering the news. As these took place during the sessions, I was conscious of myself and focussed on what emerged in the field. All had not expected the news. My experience of the field was different for each person.
The immediate reaction
Surprise, shock, surprise then shock and vice versa were the reactions. With clients who have had intended to leave town anyway, the feeling felt less heavy. With Ms. S., 57, a scientist, the shared experience is that of having to pack up furniture and returning home with a new career after more than a decade in a foreign city. With Ms. R, 24, a research student from India, the relief about going to the USA for studies and leaving a city in which the language is a cultural barrier. Ms. R, 31, an architect, feels hopeful because she too would like to return to her home country in Romania and Ms. A, a researcher, shares with me her joy of finally returning to her home in Brazil, where the beach and her favorite foods await her.
The clients of whom abandonment is a theme, was a cause of my initial concern. I felt responsible and fearful for being a potential trigger of their early traumatic experiences. I prepared myself beforehand by getting my body grounded while relating the news of my decision to end our sessions. It helped me to stay with the phenomenon in the room. Paying attention to the client’s phenomenology was a resource for me to notice the client’s difficult feelings behind smiles and kind words like “I’m happy for you.” Ms. N, 27, whose childhood experience was plagued with her mother’s repeated sudden leaving and returning, reacted with a giggle. I invited her to stay with that moment. We tracked her emerging feelings about our impending separation. She was then able to shed light on how at first instance, she lost herself in fantasy, as if viewing the present as a movie scene. As I invited her back to being in the moment, a need emerged in the field: Ms. N says, “I need to grow up”. Ms. N has lived with fragmented recollection of her development from child to adult and always felt somewhat still a teenager.
Increase in motivation. This ending phase of therapy with my clients have brought great gains in our work. The resonance in the relationship changed the moment we felt the sense of the ending. During the initial part of the ending phase most clients seemed to jump into action. This was especially evident in clients who were previously ambivalent in the therapy sessions. Those who had the habit of missing or forgetting sessions turned up more regularly, those who initially left the responsibility of the session to the therapist became more decisive about what they wanted to do in the sessions. I had a general sense that we all gave the development of the sessions more attention from this point on.
Consciously being even more present. There is an existential thread to endings like these. I was leaving to another continent. There is probably no chance for us to return as therapist and client. Having no sense of future with these individuals, I felt more at home from this point on with staying in the here-and-now.
In spite of all the pitfalls, the ending phase of therapy may bring great rewards. In making the decision to end, especially when the theoretical model gives no specific reason to end this month or this year, many of the most difficult and delicate aspects in relating to another human being may need to be negotiated. There will be experiments with leaving at the end of each session, but the choice to leave voluntarily can still feel like a very risky business. The patient will know what partings are like from past experiences and also from the inevitable breaks in therapy for holidays or illness. The final parting will be different if it is allowed to be final or at least final as far as the two participants can tell.
Parting ways is inherently painful if it is fully experienced, but it can bring strength and contentment when it is actually achieved. Much that has belonged to previous partings and deaths can be remembered in order to be set aside. This time a fair amount of sadness may be mixed with the disappointment, and the feelings may be met with a less paranoid response. All of this may involve the therapist, not only as a professional but also in strong personal feelings for what is evoked from his or her own past and also because of what this patient has come to mean. Both people will emerge from the experience changed.