The beginning of the end

Process , Psychology Jul 05, 2016 No Comments

Endings are an inevitable part of clinical work. It is usual, particularly for time limited work, to initiate conversations about endings from the outset. This offers clear boundaries and clarifies timescales. That doesn’t mean endings are always plain sailing and easy, for me or the client. Thankfully, the majority feel right and come about organically as the therapeutic work comes to its natural close but there are some that set a different tone and may reflect tensions or the dynamics of our relationship that may have been left unresolved or unprocessed.

It is never ideal or my wish for therapeutic work to end awkwardly or for it to come to a close prematurely as sometimes happens when services change or maternity leave beckons. It’s important as a clinician to reflect on endings and attempt to have insight into why they may leave us feeling as they do. Examples include the disappointment experienced when a young person poignantly fails to attend their last appointment, the tantrum-like, protestations of the older adolescent who has shown such strength and admirable resilience at other times, or the parent who refuses to let go nicely knowing i am about to start mat leave, possibly unable to think of me with my own baby. I remember other goodbyes: the ones that went well and seemed positive and right, but it’s those that prove difficult and trigger certain feelings in me that stay. I am not sure if anything could have been done differently to prevent such reactions, but each one reflects, in it’s own way, how hard endings can be.

I sometimes wonder if things (our relationship) have really come to an end. I remember part of my doctorate focussed on attachment and bereavement, looking at how we continue relationships with those who have died. There are times when I think therapeutic endings are a bit like this. It is fair to say that I don’t remember every family I met over the last decade or so, but there are many I do. Some more than others. I often wonder what they are doing now. Are they well? Did they become the adult or young person I envisaged? Are they working? In prison? Continuing to experience emotional difficulties? Are they parents? What about their parents, how are they?

Regardless of what was worked through, what came up in the sessions, or what our ending meant or looked like, I recall families and children with fondness and wish them to have healthy and positive life experiences, and overcome any hurdles that will test them. I have learnt so much about myself over the years because I have met these people. Obviously on a professional level they have helped me shape my practice and 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. I think it’s more about knowing why I respond the way I do, rather than the emotion itself. Even though we said our goodbyes, it doesn’t feel like it’s the end which may sound strange. I am unlikely to bump into many of the families I have worked with. I live and work in a completely different part of the country now but somehow (without wanting to sound proper cheesy) I carry these families with me. 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 are part of what has made me 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.



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