‘Endings are only a necessity, a necessity for new beginnings…’ (Grana, 1991)
Just as all living things must at some point reach a natural ending, so must psychotherapy. From the outset all the work that clients undertake propels them towards an occasion when therapy will no longer be needed or wished for. Therefore moving on and letting go starts at the very beginning of the therapeutic encounter. The notion of ending is always there from the beginning either consciously or unconsciously, most visible when it spontaneously arises out of a client reviewing their journey of therapy at any given moment.
Termination
Termination is one of the major events in the therapeutic process. It is full of symbolic meaning and an important and integral phase in psychotherapy, not just a place to finish.
It is probably one of the greatest challenges facing both client and therapist. Although some contracts end by default rather than execution, the ideal is an ending in which there is a mutual agreement by each to finish, where there is an effectively implemented termination phase. Enough time will need to be given so that responses to the idea and process of finishing are assessed and the essential meaning and features fully discovered. This phase of the therapeutic relationship starts the work of mourning with the therapist and is characterised by action; the action being the outcome of different important developments around ending which requires identification and working through, a transitional experience that can be an occasion of great opportunity.
The working through takes place in the interval between the time the ending has been put in place and the moment the client accepts its certainty, i.e. there is an uncovering of internal conflicts, unconscious impulses, unrecognised fantasies and hidden defenses as they enter and re-enter the therapeutic space. It is a process that can be likened to weaning and maturation.
The Ending as a Process
Clients are usually ending long before it is named in the room and differs from person to person. This can be seen in there being missed sessions, a change in boundaries, change in the client’s appearance, complaining about the effort being made and commitment required, displacement behaviour, existential terminations, breakthroughs and an ongoing sense of feeling good for the client. From a clinical perspective the counselling process reaches a stage of mutuality, a shift in the client’s defenses towards a healthy and developed stable functioning, alongside a rebuilding of a qualitative life story, a reduction in symptoms, improved organisational difference, autonomous functioning, activity towards a resolution of an appropriately transference neurosis, a lessening of anxiety and guilt and suitable developmental object relationships. In essence there is a moving from the paranoid-schizoid position to the depressive position and from oedipal to genital relationships.
The client’s resolutions within the analytical process are at times corroborated by different external changes, e.g. change in employment, leaving a relationship, deciding to travel, going back to education or having a child.
Also, clients will often report dreams that also confirm their readiness to finish their therapy.
The Experience of Ending
Patterns and textures around endings become poignant and sometimes give rise to a person thinking ‘I’ve only just begun’ or ‘I’m right back where I started from’. ‘Any removal of a certainty causes us to feel a loss’ (McCarthy, 2005), eliciting internal schemata and unresolved past gestalts around abandonment and dependence. The termination of therapy can often be experienced as another separation where the work of mourning will be given relevant significance in the transference/countertransference dynamic. Clients regularly develop an attachment to the therapist and/or therapy, so grief, ‘essential to life, not a problem to be overcome or even to finish’ (Clarkson, 1999) and mourning are appropriate attendant affective responses to loss.
What gets created within the remit of the therapeutic relationship becomes familiar territory; one of the central features of the work, therefore, inevitably leaving and moving on can bring with it some loss of security. This is more so in long-term work because in short term therapy with a fixed ending there is less of a dependency and of clients feeling angry, sad, anxious or abandoned around the finishing. ‘Mourning has ultimately to do with letting go’ (Casement, 2004). It is a transitional progression of spiral mobility which consists of being able to understand, accept and cope with the loss of circumstance. Mourning Proper encompasses the detachment and withdrawal of identification with the object loss and a stabilising of an harmonious emotional life in relation to the person’s psychic and physical growth.
The Emotions of Ending
The emotional dynamics in relation to moving on that often need attending to within the therapeutic dynamic are reluctance, disappointment, transference, the reassertion of old feelings around endings, loss; ‘the price of attachment is the grief of the loss’
(Mc McCarthy, 2005), anxiety which ‘appears because the separation is experienced not only as a loss of object but also as part of the ego itself’ (Quinodoz, 1993), anger, a cleaving back, holding on to hope, faith and belief, a celebration of achievements, ambivalence and emphasis on the importance of rites of passage which reflects the point in life where the client can honour their change in status. When these responses are worked through, this allows for the client to reach a place of understanding and a realistic image of their therapist.
These emotions can arises not only for the client but also for the therapist where supervision becomes the space for the person to take these feelings.
‘An important limitation in any relationship is that the giving and taking can only reach a certain level’ (Heushauser, 2001). Finishing therapy can resonate with other painful endings clients have experienced and there is often a reactivation of former defense mechanisms because of there being a reactivation of earlier memories of loss. During this time there can be a fluctuation between regression, denial and avoidance within the work of becoming aware of the sometimes painful aspects of reality concerning the loss (the fundamental most human postponement is denial), an activation of unfinished business, a return of presenting symptoms and an inability to meet the challenge of a biologically maturational step and integration. When there is an acceptable resolution of these conflicts clients reach a place of empowerment.
Part of the work of this mourning may continue and get carried out even after therapy has ended.
Ending for the Therapist
The therapist’s countertransference once processed appropriately can indicate clearly what the client may be experiencing, a parallel process that is common within the therapeutic dynamics. Throughout therapy the therapist acts as a container of the client’s emotional responses and when the client internalises and integrates these ‘functions of containment’, where the container is embodied by the client, an adequate separation takes place. In the successful termination these feelings will continue on into unknown areas of the client’s life.
Although it is the end of the therapeutic relationship hopefully it is not the end of therapy for the client. Ideally, I believe the aim is that the client becomes his/her own therapist where there is a sustaining from within and for me as therapist it is to trust that my clients have the internal self-awareness and strength to negotiate future life difficulties.
In hindsight, some of my clients’ ending of therapy seemed to be unconsciously prepared for months before their finishing. As working through and moving on got closer it became important for them to have an ending that they played a part in, one that they could see as a liberating process as opposed to the type of endings that they were used to, which were often of feeling rejected or powerless. Their getting ready for the ending was, on reflection visible in their concerns and questions that they brought into the space: ‘I wonder will I cope without you?’, Have I changed enough to move on?’ Will I be able to create and sustain the intimate emotional connection I had with you with other people in my life?’ ‘Am I going to be missed?’ and will I be able to be with my pain without the safety net of therapy?’
An end is more than a mere terminus, it is that which is aimed at or desired, the result of a personal striving’ (Reber and Reber, 1985).
On a personal note, I can relate to these questions as I consciously live my own life which I had been aspiring to during and after my therapy; connectedness, congruence, an appreciation of my feelings and emotions, particularly my vulnerability, a rejoicing in being truly alive and an inner belief and trust in the outcome of my endeavors.
‘The longing of a warm cocoon receded as new worlds beckon eager butterflies’ (Grana, 1991).
References:
Clarkson, P. (1999) Gestalt Counselling in Action (2nd edition). London: Sage Publications.
Feltham, C. and Horton, I (ed) (2000) Handbook of Counselling and Psychotherapy. London: Sage Publications.
Grana, J. (1991) Images of Women in Transition. USA: Saint Mary Press.
Hellinger, B. (2001) Ed. Heuhauser, J. Supporeting Love: How love works in couple relationships. Phoneix: Zeig. Tucker & Theisen Inc.
Mc Carthy, L. Personal Lecture. April 2005
Nolan, I.S. and Nolan, P. Ed. (2002) ‘Object Relations and Integrative Psychotherapy’: Tradition and and Innovation in Theory and Practice. London: Whurr Publishers Ltd.
Quinodoz, J-M. (1993) The Taming of Solitude. USA: Routledge.
Reber, A.S. and Reber, E. (1985) The Penguin Dictionary of Psychology (3rd edition). London: Penguin Group.
Web site-http://psychematters.com/papers/casement.htm.
Wills, F. and Saunders, D. (19997) ‘Cognitive Therapy’: Transforming the image. London: Sage Publications
