Alternative Mental Health Community

Until We Meet Again

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Ending therapy can evoke many feelings for both the therapist and client. Dr. Tammy Fowles shares poignant stories on ending counseling...for now.

In the past, termination of therapy sessions held more of a finality then it does for me now. It indicated that our work was completed and our relationship had come to an end. Today, while it still marks the completion of the work we have contracted to do together, the door remains clearly open. The client is invited to return to do another piece of work should the need arise.

Every seasoned therapist is aware of the powerful feelings that termination of therapy can evoke. Feelings of accomplishment and pride can often be overshadowed by feelings of anger, fear, abandonment, grief, and loss. This critical event requires great skill, empathy, and the careful attention of the therapist. The therapist must assist the client in moving towards the future with confidence and hope. The client must possess the skills to maintain the gains that have been made, master the separation, and what it may uniquely represent to the client, and be able to reach out for assistance in the future should the need occur.

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We have all witnessed the rather sudden regression of some clients as termination approached. While it is important that we honor the client's present experience, it is also necessary to recognize that the regression will probably be resolved as the client successfully works through his or her concerns around terminating treatment.

Therapists must prepare clients for termination from the beginning. Approximately three sessions prior to termination, I ask the client to begin to think about how they wish to mark the occasion, and a date is set.

RITUALS

I am a firm believer in the power of rituals, and more often than not incorporate them into the final session. I encourage my client to create a ritual that will mark the completion of his/her present piece of work. I welcome him/her to invite others to participate if he/she chooses. Sometimes the ritual is as simple as lighting candles and incense, while the client reads what he/she has written for the occasion. Then, I might read what I have written and, at times, then sip sparkling cider out of champagne glasses. Other rituals are more elaborate. One woman wrote a brief play representing her therapy journey and had members of her support system act it out. We then sang songs, testimonials were delivered, and we feasted on food that participants brought in. It was a powerful and empowering closing. A man with whom I worked was a lover of music. I had asked him earlier to produce a tape containing on one side those songs which represented his pain and struggle and on the other to record music which inspired him and represented his achievements, strengths, and growth. He played this tape during our final session. Another women with whom I worked had shared with me that her parents had never once acknowledged her birthday. They had never baked her a cake or offered presents. On our last session, I presented her with a cake and a gift-wrapped journal.

What To Take Along

I almost always request that my client bring in a letter of support written to him/herself from the nurturing, supportive part of themselves to our last session. I request that he or she read it out loud, and I then read my own letter of support written specifically to this particular individual. Generally, this includes reminders, observations of how he/she has grown, and strengths which I have appreciated along with encouragement for further development. I try and always mention something about the individual that I have found to be unique and wonderful. At no time have I worked with someone where such a quality could not be found. The client is instructed to keep these letters and read them whenever he/she is in need of reassurance. It's a reminder of his/her strengths, the lessons that have been learned, future goals, self-care commitments, etc.

Life Stories

Erving Polster, in his book, Every Person's Life is Worth a Novel, acknowledges the healing involved in an individual discovering how "remarkably interesting" he or she is. In part, it is the recognition of this truth that prompts me to suggest to each client that they write their own story. Often when the client is sharing his or her story with me, I make observations, comment on the significance of a certain event, the beauty of another, etc. I make suggestions such as that a client may want to explore a particular aspect of the story to a greater degree, or acknowledge the pain, strength, etc. of the main character (him or herself) more fully. I often find myself pointing out that the writer has demonstrated no empathy or compassion for themselves in the telling of their story and recommend that they go back and attempt to do so. Very often it is a review of the finished product that becomes the focus of our final sessions.

A client with whom I had worked for some time (I will call her Anne), and whom had suffered extraordinary sexual and emotional abuse at the hands of her father, brought in her story. The story was written not from the perspective of the adult, but from that of the little girl. As she read it, for the first time, she began to cry from some deeper place. While she had shared her story before, it was much more akin to a recital with minimal expression of her pain. Now she was truly grieving, as she allowed her child to speak directly versus controlling the child within her by speaking for her from the intellectual stance of the adult. Since this time, I frequently ask that when a client's issue stems from childhood pain, that the story be told by the child, not revised and edited by the adult. I have found the child's story to be far more powerful and empowering, and I am grateful to Anne for this and many other lessons which I have learned from her.

I have kept a notebook for several years, although it has been misplaced on more than one occasion. While I started it in around 1985, the book's contents are few and far between. The purpose was for purely personal growth, and so very often I do not identify the particular source or even the date in which I entered it. I ran across an entry the other day that I would like very much to include here, although I confess that I have no idea from whence it came. It is part of a story I either read or had told to me. Somehow it feels like a very appropriate way to finish this piece on termination.

A woman shares with her therapist that she feels her life is over. Her therapist responds by sharing a dream he had with her. In the dream, the therapist hears, "You never finish anything." This troubled the therapist greatly for a very long time. Seven years later while listening to a tape, he had an insight, "Who says you have to finish anything? Nothing is ever really finished as long as we are alive." He then suggested to the client that perhaps she could conceive of her life as a continuation of her parents, and her children's life a continuation of hers, and that the process will continue as long as there is human life.

next: A Room with a View