Endings In Therapy
By Dr Kate Owen
Clinical Family Therapist & Clinical Psychologist
When I was contemplating writing this blog post with the broad topic of “therapeutic endings” in mind, I was overwhelmed with the possibilities of what I could discuss. Would people be interested in reflecting on the many reasons why therapy ends? Would people want practical ideas on how to end well? What about ideas for ending when there has been a rupture in the therapeutic relationship?
All of these would be worthwhile topics, however, I decided to reflect on the therapist’s often unconscious preference for how to end, and how this intersects with the preference of the client(s).
Let me explain...
I once heard this metaphor for endings in therapy and it has stuck with me. Imagine that you are driving a friend or family member to the airport. Are you the person who parks in the long-term carpark, walks into the airport, sits at the café and has coffee and cake, walks your friend to the gate, waves as the plane takes off, and then texts “Let me know when you get there”? Or do you pull up in the 5-minute drop ’n’ go zone, the wheels haven’t quite stopped turning, you pop the boot open, and say “Close the boot and have a nice trip”?
When I share this metaphor in workshops and training, sometimes a participant will say “What about the option of dropping them at the train station?”. I guess a fourth option would be to leave for work and let them find their own way to the airport.
Already I can see you smiling as you reflect on your own preferences!
What is this metaphor about?
It is a reflection that professionals are people, and that we too have our preferred ways of saying goodbye. And these preferred ways to end come from a multitude of factors – our own personal life experiences, what we have learned in our training, as well as our clinical experience with clients.
But of course, we as the therapist are in a relationship with our clients, and they too will have a preference for endings. Perhaps they are the long-term parker, the drop ‘n’ go zone driver, or are willing to leave you at the train station.
One way to discover this information is to have a conversation about endings, well before the ending, so that you are able to prepare yourself and your client for therapy to finish. Ending well is a vital part of the therapy process, and has the potential to be a corrective emotional experience for those who have had abrupt and unsatisfactory endings in other relationships.
Let me share a story about a client named *Bill to illustrate this concept.
Bill was in his 40's and came to therapy to work on the relationship with his partner. Taking a Bowen Family Systems approach we explored his family of origin and significant relationships as part of this work. Bill identified that he tended to use emotional cut-off as a way of managing tensions in relationships. As our work was drawing to a close, I flagged with Bill that therapy was finishing soon and how would he like to “end”. Bill firmly responded, “No fuss please. I want my last session to be business as usual”. And so after a good piece of work Bill walked out of his last session with the predictable “See you later” and “business as usual” approach.
As Gibney (2003) writes "It is almost as if time, trust, and the previous successful engagement allow the second engagement to become a possibility. Therefore the concept of 'termination' always needs to be tempered with the concept of 'discontinuities' so that the therapist can keep both options alive in her or his thinking" pg 155.
This was the case for Bill as a year later he requested a second block of therapy. He had committed to the ongoing relational detective work inherent in Bowen Family Systems Therapy, and stated he was ready for further exploration and work on increasing differentiation (aka emotional maturity). So we embarked on another round of sessions.
Again, as the end of our sessions was drawing closer, I reminded Bill of his request for “business as usual” in our previous work together and asked how he would like to end this time. After much contemplation, Bill curiously asked “How else can we end in therapy?” This led to a discussion about different rituals, celebrations, and reflective practices that I have undertaken with other clients, as well as encouraging Bill, using a Solution Focused Therapy approach, to consider what a satisfying ending would look like to him. I normalised that the final session could be “business as usual” and that would also be a very valid option.
Bill observed his reaction to endings in relationships, evaluated what would be meaningful for him, and proposed a mixture of “business as usual” with some reflections and small celebrations in the last part of the final session.
I think of Bill often when I teach helping professionals about the importance of endings and finding the right fit for the client.
Me, I am a long-term airport parker. So understanding Bill’s preferences for endings was important, otherwise the final sessions could have been experienced as uncomfortable for him if I had not appreciated that he was more of a drop ‘ n ‘ go driver. Imagine if I was dragging Bill through the airport to have coffee and cake!
So next time you are finishing therapy with a client, be curious about their preference for ending and reflect on your own unconscious (or conscious) preferences and biases so that you can tailor the experience to the needs of your client.
*Please note: the case illustration is an amalgamation of several client examples and all identifying details have been changed for confidentiality reasons.
Please note that this article is educational in nature and does not constitute professional advice.
Gibney, P. (2003). The Pragmatics of Therapeutic Practice. Psychoz Publications: Australia.
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