Anyone who has been in therapy or CBT knows that the ending can be tough – you will have (hopefully) built a relationship with your Psychologist or Psychotherapist that’s been rewarding, even life transforming, disclosing you inner most feelings and trusting a relative stranger with more than probably anyone else in your life. But all good things have to come to an end, and therapy is no different.
The ending of therapy is often as important, if not more so than the actual ‘work’ itself.
Maybe your CBT course is coming to an end, perhaps you just think it is ‘time’, or, maybe your therapist is breaking up with you because they are retiring or taking a sabbatical - whatever the reason, getting the therapy ending right is something Content Editor of Clinical Partners Emilie Head – trained therapist and someone who was in therapy herself for 5 years, thinks deserves some thought.
“Therapy of any kind, be it 6 weeks of CBT or 5 years of Psychodynamic, can be a tough process! Talking about your inner most feelings, turning up every week (even when you really don’t want to) and learning to sit through some tough feelings is no mean feat. That’s why, for me, ending therapy is something that deserves some respect – a time to honour the process you have been through, accept the highs and lows and reflect on what it all means going forward.”
You might be feeling huge relief as you approach your last few sessions – suddenly you get more time / more money / a break from having to think about those difficult things in your life. The next minute you might be quaking in your boots, wondering how you will ever cope without your therapist and if you are really ready.
“As the ending approached I seemed to oscillate between feeling confident I could ‘cope’ to thinking I had made a huge mistake and I wasn’t ready to end.” Emilie Head says of her own therapy ending. “My therapist likened it to taking away a prop – for 5 years my Wednesday 9:00 am slot had been there, through thick and thin and suddenly it was going. My advice if you are feeling like this is to remember you have internalized a lot more than you think you have of your therapy and to see it as an opportunity to try out some of your new found coping mechanisms. Many people go back to therapy later on – so bear this in mind as well.”
It is normal for ending therapy to bring up memories of other endings and losses and, as such, talking about the end of therapy offers an opportunity to process difficult endings that have gone before. Ending therapy can also enable you to examine how you experience endings, and to learn helpful ways of managing this process and the difficult emotions that often accompany it. When endings are sudden and/or unplanned they can be especially difficult, often leaving things unsaid, and this experience can leave us feeling stripped of control. In contrast, by talking about ending therapy, you are giving yourself the opportunity to do things in a planned and consensual way. Many report that this is an empowering and restorative process.
“I had one client who only found out she was moving on that day, so our ending was completely impromptu and neither of us was prepared. Just asking her “What would you have liked this ending to be like” was hugely important to her and enabled her to think of how much control she has lacked in her life.” Emilie says about one her therapy clients.
Some may find the prospect of ending therapy sad, or daunting. Others may look forward to the end of therapy, which can be an uncomfortable and demanding process. More often, these competing emotions are felt simultaneously, to differing degrees. Whatever emotions the thought of ending therapy brings up for you, it will be important to get this out in the open, to give these yourself the time and space to process them.
Which brings us on to…
Endings can be an emotive experience for both clients and therapists, and talking about ending therapy can be an uncomfortable topic. For this reason is rarely discussed as often or as early as it should be.
“I can remember feeling really awkward even bringing up the subject of ending my therapy with my therapist – I felt disloyal and somehow ungrateful. Here was a woman who I had committed to for 5 years and I was about to say ‘thanks for everything but I am off now..’ It brought up loads of stuff for me and probably took me 2 months to summon up the courage.” Emilie recounts. “But when I did, we seemed to enter a new phase of the therapy and it gave me loads of material to work on – in fact some of my biggest growth was in those last few months.”
Different therapists and therapeutic styles have different traditions surrounding when to talk about ending therapy. For instance, in some therapies, such as CBT, ending therapy may be an idea that is present from the start – particularly if you are working within a fixed time frame. Indeed, some argue that the topic of endings should be raised throughout the course of any therapy, and well in advance of the planned ending date, so as to avoid the end of therapy from coming as a shock – Beck (1995).
In other therapies endings may be more fluid and flexible – some therapists may raise the topic when they feel it to be an appropriate time; others may leave it up to you.
In all therapeutic traditions it is important to acknowledge that therapy will be drawing to a close, so as to summarise the themes of your work, to consolidate learning, to think about ways of maintaining your progress, and to discuss any emotions this brings up.
“The ending is far more than just saying ‘Thanks and bye’. The ending is time to really reflect on how far you have come (or what has held you back), to think about how things have changed and about what’s next. I can clearly remember thinking how weird it was going to be having Wednesday mornings free again, about how I was suddenly not going to see my therapist again – it felt surreal and many of my clients have said the same thing to me.”
Don’t forget, your therapy is for you: if you feel like it is the right time to start talking about endings, no matter what stage of therapy you are at, bring it up with your therapist. . This will be particularly important if you tend to find endings difficult. There really is no right or wrong time.
“I think some clients find bringing up the theme of ending difficult because they worry their therapist will feel rejected or hurt. In my experience, these feelings tend to be displaced rejection feelings of the client themselves. I had one client who was really concerned I would feel hurt when she brought up the topic of ending therapy. We talked about it, and over the course of a few weeks, she realized what was actually worrying her was that I wouldn’t be affected by the end of the therapeutic relationship with her. This was a useful way for us to talk about the importance she places in what others think of her.” Says Emilie.
It’s normal to wonder what your therapist will be thinking as you draw to a close – will they miss you? Will they draw a sigh of a relief? Do they feel it is too early for you?
Emilie Head: “I think people often feel worried about their therapist’s feelings and spend too much time thinking about this and not enough time worrying about themselves - a great coping mechanism! But you really don’t need to worry - good therapists know how to do endings well and will absolutely respect your reasons for wanting to end therapy. They will also see the ending as tough, but will want to celebrate all the work you have done and the relationship you have.”
Again, different therapists and therapies will have different traditions surrounding how to end therapy. Some may offer you the opportunity to phase out sessions towards the end, for instance, reducing the intensity of sessions from weekly to fortnightly. Others may prefer to continue therapy as before, but include a thorough discussion around the topic to prepare you for the transition.
Some therapists like to write clients an end of therapy letter. In this letter they may summarise the work that you have completed together, and some may also share their thoughts with you regarding your progress and their hopes for you going forward. This can be a helpful way to tie together the work that you completed, and to remember it once therapy has ended. It can also offer the opportunity to prepare for set-backs, should they occur.
“End of therapy letters can work the other way round as well and form a nice part of a ‘ritual’ – as a society we tend to have rituals for leaving events, handshakes, bidding farewell, a thank you note etc. Maybe consider a letter to your therapist or even yourself, that you share in your last sessions. It can feel like a nice way of drawing that full stop.” Emilie says.
The core of all psychological therapy rests on having a strong relationship with your therapist, and it’s not uncommon to worry about losing this regular source of support. If this is the case for you it’s important to think about what you can do to meet this need in other ways – drawing upon support from others and/or using skills and insights you have developed in therapy to soothe yourself through this transition period.
It can be tempting to seek further therapy at this time, but many therapists would discourage this. The period following the end of therapy offers an important opportunity to practice the skills you have learnt and to put new learning into place - an important extension of the work. If you are worried about going it alone, it will be important to discuss this in your sessions in good time, so that you can think together with your therapist about how you can best manage this transition period. For instance, you might decide to access a peer-support group where you can maintain your self-development in a supportive environment or use a journal as a way of continuing that dialogue with yourself.
Ending therapy is an important part of the therapeutic process - sometimes likened to the last chapter of a book, or the final installment of a TV show, where loose ends are brought together, and some sort of conclusion is reached. As with finishing a good book or favourite show, this can be a sad process, but also a fulfilling one – enabling you to move on to the next phase of your life.
“My advice on ending therapy? Go for it – really ‘do’ and experience the ending. It can feel like a bereavement, it can feel uncomfortable or unsettling. Hopefully you are leaving therapy better equipped to deal with these types of feelings and the ending of therapy can be a great first opportunity to give your coping mechanisms a trial run!”
Clinical Partners is the UK’s largest private mental health partnership, helping children, adults, families and organisations nationwide.
Beck, J. S. (1995). Cognitive therapy: Basics and beyond. New York, NY: The Guilford Press.