'Endings' in therapy: a therapist's perspective.

Ending therapy can be hard. Not just for the client, but also for the therapist. This isn’t something that the ‘profession’ feels easy talking about. Indeed, when I was training I was scared of telling my clients I would miss their presence in my life, even though I meant it and prize therapeutic honesty, for fear of what the ‘counselling police’ would say if they found out. Could I be criticised for getting too attached? Worse still, might people think that ‘it’s all about me’ and that by sharing my true feelings, I might be indulging myself, and should march straight back to my own therapist before I dare take on a new client.  

This fear was active in me for a long time.

And yet, I knew it wasn’t about me in a needy or domineering way. It was about me in as much as it was my experience of the therapeutic encounter, but it was also a feeling that was being co-created with another human being. It was a product of relational depth and time spent together week on week.

For some clients (and therapy naysayers) it seems easier to imagine that counselling is, bottom line, a financial transaction. At its worst it’s ‘paying for a friendship’ and at best ‘I pay you to care, and whilst I know you probably do on some level, I know that wouldn’t be the case if I wasn’t paying to come here’. These assumptions are understandable and societally enforced in various ways, but they don’t have to be true. They don’t ring true for me in my work.

I have a private practice, and I ask for a fee. This helps me to live and pay my bills, but every time I step into the therapeutic space I am stepping into a relationship, and entering into it in a meaningful way. No amount of money can make me genuinely care. No amount of money can buy my deepest empathy. No amount of money can be enough to bring me back to the chair week after week with another soul and minister to their despair, or join with them in their triumphs and successes (however small or large).  

You do it because you are called to. I do it because I believe in the healing power of relationship. I want the best for people and to help them bring down their road blocks. I also need to eat. The nuance of what it means to be in a therapeutic relationship is a post for another day, but suffice to say I don’t ever just show up and go through the motions. Great therapy, in my eyes and approach, requires relationality, it requires trust, it requires willingness to be open to the other. It requires some of the qualities of friendship, but more than that. It is not pals. It’s not family. Yes, it’s highly one-sided. It’s a relationship all of its own despite it being about them and not you. No one feels this anxiety more than the client, but it’s OK. We go into it knowing that this is what it’s about. Nevertheless, it holds its own space and it is real. What happens isn’t magic, it isn’t the product of a highly qualified expert and a broken patient. It’s the power of connectedness between two people showing up over time. Some people will be dismayed to hear this, but I believe it to be true. It works because you do the work together not because I hold powers. And each therapy is different. Again, another post.

So, that’s a flavour. And a lead in to the point about endings.

Endings are not transactional as a given. They don’t have to be. On the contrary, if therapy is a relationship, then ending is felt at an emotion level. Hopefully, ending is felt positively – you have done good work together – but there might also be a sense of loss. On both sides. I don’t find it a small thing to sit with another person week after week (especially in long term therapy) and so when our work ends, I feel the absence of the client. This is never truer than when you have moved from near-death back to life with another person. When you have been with them in their despair over the very question of whether to stay alive.

This isn’t pathological. It’s not concerning. It’s not a cause for alarm.

It’s human. It’s life affirming. It’s reflective of the ways that human beings affect each other. It comes and it goes, and in the end you wish your client the very best. It’s OK. Further along in my practice now, I can acknowledge to myself that each ending has an impact to varying degrees. Sometimes I just hold their slot for a week or two without filling it. A nod to their leaving. Sometimes I meditate and send them on their way, privately. Sometimes I smile tearily at myself as I walk to the car knowing that’s that, and they’re going to be OK.

More importantly now, I can invite my clients to hear how I have experienced them and our work together. I can do this with appropriate boundaries. I can do this within ethical practice. I can do this without worry that I am self-indulgent and in need of prosecution. I can do this without it meaning that I am trying to hold on and not let go. I can do this as an offering that says ‘I was here, and I cared, and I will continue to care. Your presence has been felt, I have seen the world through your eyes, and I wish you well’. If my voice and experience doesn’t matter to the client then that’s OK. I don’t feel the need to tell them, and I will talk it though in supervision, but if they want to know, then I am happy to speak truthfully. Nothing is lost, only gained.  

So, how you end matters. Both client and therapist bring their own experiences, discomforts and rituals to ending, and it’s important to understand this and be aware. You need to let some people bolt out the door. Sometimes a client doesn’t want to say more than ‘Thank you for this, goodbye’ and that’s OK. But creating proper endings for people can be redemptive and transformative, for the therapist included, and we try and prepare for these in advance. The client leads and the therapist intuitively finds a way to work with that; this is the deal.

In the final analysis, perhaps the hardest thing for some clients to hear is that they mattered and will continue to matter. Perhaps it’s also the hardest thing for therapist’s to say. But I hope I will always be brave enough to say it, and I hope my clients will be able to receive my genuine warmth and care until the very end of our time together.