Endings are an inevitable part of therapy. It is usual, particularly for time limited work, to be clear about endings from the start of therapy. This offers clear boundaries and clarifies timescales but doesn’t mean endings are easy. Thankfully, the majority feel right and come about organically but there are some that set a different tone. These may reflect tensions or highlight unresolved dynamics present in the therapeutic relationship. Or sometimes, the ending just doesn’t feel right.
When Ending Therapy Doesn’t Come Easy.
It’s never ideal for therapy to end prematurely, as sometimes happens when services change or maternity leave beckons. As a clinician, I like to reflect on endings and think about why they may have stirred up some powerful feelings, and how this fits with my formulation of the presenting difficulty. I have experienced disappointing endings when a young person or family poignantly fail to attend their last appointment, possibly finding goodbyes too hard to do. There have been tantrum-like protests from an older child, who showed such strength and admirable resilience at other times, and there has been the parent who refused to let me go nicely, knowing I was about to start mat leave. I have wondered if she was unable to think of me with my own baby, knowing that she found her own child’s needs intolerable and uncontainable.
I remember other goodbyes too: the ones that went well and seemed positive and right. It’s those that trigger certain feelings in me that stay that seem to stay though. I am not sure if anything could have been done differently to prevent such reactions (certainly in some cases), but each one reflects how hard endings can be.
Is It Really The End?
I sometimes wonder if the relationships formed in the therapy room has really come to an end. Does separation mean the end of a relationship?
I remember part of my doctorate focussed on attachment and bereavement, and how relationships continue with those who have died. There are times when I think therapeutic endings are a bit like this. I often wonder what some children and families are doing now. Are they well? Did they become the adult or young person I envisaged? Are they working? Are they in prison? Are they a parent? Do they continue to experience emotional difficulties?
It’s About The Relationship.
Regardless of what was worked through in sessions or what our ending meant or looked like, I recall families and children with fondness and wish them healthy and positive lives . I have learnt so much about myself over the years because I have met these people. Professionally, they have helped shape my practice. They have furthered my understanding of their individual experiences of emotional difficulties and trauma that you just can’t get from a book. In the early days, they rapidly gave me confidence and the assertion to manage complex and worrying situations. Personally, I have learnt about my emotional reactions to different comments, incidents, and dynamics. This in turn has helped my practice.
Even though we’ve said our goodbyes, it doesn’t always feel like it’s the end. I still hold many families and children in mind and think about them relatively often. As Ernest Hemingway said, “It is good to have an end to journey toward; but it is the journey that matters in the end.” I have travelled many journeys with children, young people, and families, some bumpier than others. They have shaped the clinician I am today; they are part of my journey as well as me being part of theirs, and for that, I am thankful.