On Ending

by Karen Wallace

“…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, often visible when it spontaneously arises out of a client reviewing their journey of therapy at any given moment.

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 reactions 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 defences as they enter and re-enter the therapeutic space. It is a process that can be likened to weaning and maturation.

Clients are usually ending long before it is being named in the room and differs from client to client. This can be seen in there being missed sessions, a change of boundaries, change in the client’s appearance, complaining about the effort being made, displacement behaviour, existential terminations, breakthroughs and an on going sense of feeling good for the client. From a clinical perspective the counselling process reaches a stage of mutuality, there is a shift in the client’s defences towards a healthy and developed stable functioning, alongside a rebuilding of a qualitative life story, there is a reduction of symptoms, improved organisational difference, autonomous functioning, activity towards a resolution of an appropriately outlined 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 sometimes corroborated by different external changes e.g. changing employment, leaving a marriage, deciding to travel, going back to education or having a child. Towards the end of my therapy the change that I implemented was to face my deep fear of dentists and have my teeth straightened!

Clients will often report dreams that also confirm their readiness. A vivid dream that I had which verified my desire and capability to end therapy was one where I was driving a red car (although in reality, at that time I could not drive) through rough terrain where upon I reached my destination that stretched beyond a wood. The person who owned this car represented for me; strength, ability, solidness and determination, leaving me believing that I too had those traits and was ready to ‘survive’ without my therapist. For me my dream highlighted my negotiating of an obstacle that had to be overcome, from the dark forest into the light of day, my period of transition.

Patterns and textures around endings become poignant and sometimes wake up something around- ‘I have only just begun’ or ‘I am 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 between client and therapist may 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 the loss. What gets created within the dynamics of the therapeutic relationship becomes familiar territory, one of the central features of the work, so 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 fixed endings there is less of a chance of 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 accept, understand and cope with the loss and the circumstance. Mourning Proper sees the detachment and withdrawal of identifications with the object loss and a stabilizing of a harmonious emotional life in relation to the person’s psychic and physical growth.

The emotional dynamics in relation to moving on that often need attending to within the therapeutic space are reluctance, disappointment, transferential aspects, reassertion of old feelings around endings, loss; “the price of attachment is the grief of loss” (Mc Carthy, 2005), anxiety; “anxiety appears because the separation is experienced not only as loss of object but also as a loss of a part of the ego itself” (Quinodoz, 1993), anger, a cleaving back, holding on to hope, faith and belief, a celebration of achievements, emphasis on the importance of rites of passage which reflects the point in life where the client can honor their change in status, and ambivalence. When these reactions are worked through, this often brings the client to a place of understanding and internalising a realistic image of the therapist.

These emotions can arise not only for the client but also for the therapist where supervision becomes the space for the person to take these reactions. I recently came across an old telephone number of a client I once worked with. It brought me right back to the time of having to let go when he ended his therapy and it reminded me of the loss I felt. In sitting with my countertransferance I questioned what the relationship between us would have been like if it had been within another context, while acknowledging that our work together had been deeply touching for me to have experienced.

“An important limitation in any relationship is that the giving and taking can only reach a certain level” (Heuhauser, 2001). Finishing therapy can resonate with other painful endings clients have experienced and there is often a reactivation of former defence mechanisms because this triggers the reactivation of past occasions of loss and mourning. During this time there is often a fluctuation between regression, a denial and avoidance within the work of becoming aware of the sometimes painful aspects of reality concerning loss (the fundamental most human postponement is denial), a triggering of unfinished business, a return of symptoms and an inability to meet the challenge of a biologically maturational step and integration. When there is a successful resolution of these conflicts clients reach a place of empowerment.

Part of the work of this mourning may continue to get carried out even after therapy has ended. Two years after I finished therapy I found myself having to travel by train into my new place of work. This journey took me past the station that is close to where my old therapist has his practice and for the first few months of this traveling I would feel a pang of ‘missing’ every time I went by that particular station. Over time this lessened as I worked through my feelings around the experience of having moved on while honoring what I felt I once had.

The therapist’s countertransferance once processed appropriately can indicate clearly what the client may be experiencing. 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. It was during my very last session with my own therapist that I reflected my having adequately worked through the realisation of being ‘on my own’ again. It was in the form of a picture I had drawn of my adult self and of my ‘inner child’ who were smiling and holding hands together. When I pondered on this picture I had a real sense of knowing that I was able to be there for myself. In the successful termination these feelings will continue on into unknown areas of the client’s life.

Although it is an 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 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 they were used to, which were often of feeling rejected or powerless. Their getting ready for the ending was, on reflection, visible in the 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 purposeful striving” (Reber and Reber, 1985).

On a personal level 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, particularly my vulnerability, a rejoicing in being truly alive and an inner belief and trust in the outcomes of my endeavors.

“The longing for a warm cocoon recedes as new worlds beckon eager butterflies” (Grana, 1991).

Karen Wallace, MIACP, MIAHIP is a psychotherapist working in One in Four and is in private practice in Johnstown Therapy Centre.

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. Supporting Love: How love works in couple relationships. Phoenix: 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 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. (1997) ‘Cognitive Therapy’: Transforming the image. London: Sage Publications.