Our time is up.
Both parties knew that on this particular day, this moment was coming. And now having arrived, it is all about a goodbye that requires the fullness and reverence of a sacred process.
Traditionally viewed as the ultimate goal of treatment, termination of psychotherapy remains complex. It often brings bittersweet emotions and perhaps some pain, despite the decision to terminate typically made by mutual agreement of therapist and patient.
The separation may be seen as exciting or concerning, depending where on the spectrum the goodbye falls, whether desired or premature.
In the best cases, developmental milestones have been reached. Goals met. Mission accomplished.
In any case, the time has come for the patient to venture forward in possession of enhanced coping skills and increased self-awareness. Armed with greater emotional control (affect tolerance) and other positive, balanced ways of being in the world. With these new powers, the patient sets off to explore the next frontier.
Perhaps platitudes flow from the therapist, such as “You know the door is always open” or “If you want to return for a check-up or a check-in … ” or “If a crisis happens, I’m here.”
Yet leaving an open-ended potential for return denies the importance of the finality. Endings in the here and now require experiencing the moment.
The future is uncertain; promises of what may be around the corner are illusions. There are no guarantees, for life is uncertain.
Tricky mental states
For the therapist, a separation requires a delicacy of affect awareness and sensitivity to subtle nuances, which speak to understandable ambivalence by the patient. Waves of tricky emotional and mental states may present themselves, perhaps subtly, perhaps with intensity. Even when a termination is mutually agreed upon, ending a deeply forged alliance proves difficult to navigate.
A mutual exploration of original goals set and goals met are often focused on the outward aspects of treatment. This serves to highlight and validate the complex work involved in reaching positive conclusions and hopeful outcomes for the patient.
Leaving therapy is a risky, courageous step. There is no reason to assume that terminations follow a path of positive movement in every situation. There may be feelings of fear, regret, uncertainty and trepidation. There may also be feelings of relief, happiness, healthy pride and excitement.
Even if circumstances change and the patient demonstrates second thoughts about termination, this becomes additional grist for the mill. Sometimes a patient decides just one more session is necessary, maybe two — then decides there may not be a need for extra sessions after all. This movement back and forth, known in contemporary circles as the leading edge and the trailing edge, is not uncommon. Two steps forward, one step back. It’s all there to be experienced and expected during the termination phase.
Therapist and patient
Essential to termination, if all is to go relatively smoothly, are focused conversations about the relationship between therapist and patient. It is here in the moment of termination that the relationship requires focused attention, close attunement to all feelings, including joy and grief and perhaps unaddressed transferential guilt experienced for “leaving.”
This crucial aspect of treatment in the final hours, one that arguably supersedes traditional goals met, is that of the developmental dynamics that have existed all along, interpersonally, between therapist and patient.
The subtle developing, deepening and intimate space, which has been created by two people together, over an extended period of time: one that has manifested and grown with a kind of unspoken goal, and one that speaks to the successful experience of creating and sharing of a “relational home.” A place where fears, shame, loss, sadness, joy, terror, even dread or happiness have converged, been explored and met with contextual understanding.
The relationship has impacted both parties, and both have been presented a valuable opportunity that comes with a responsibility to address the significance of the experience that occurred. An integrative experience.
The capacity to expand and express greater authenticity in the therapeutic setting during the termination process is a testament to the efficacy of treatment.
Termination speaks powerfully to the impact two people have had in one another’s lives. The sacred space of a small room has contained the lives of two individuals. Here is a key component of successful treatment.