Termination and endings in Psychotherapy

We have just celebrated the ending of the year, welcoming in a New Year. It provides a shared / collective opportunity to reflect on the past, think ahead to the future. Likewise, psychotherapy invites us to think about the past, how it contributes to who we are, what is important to us, how the past can provide an understanding of previously unconscious material that has been repressed in order for us to reconcile the past and choose what is taken into the future.

This segmentation of time helps to contain a complex worldview. I suggest the break or holiday from psychotherapy offers us a chance to reflect on how we manage our internal world in the absence of the secure base represented by the clinical setting. The break provides an opportunity to see how we feel without the weekly hour or hour and a half in the session or group.

How important are endings in psychotherapy?

The therapeutic alliance between the therapist and the client provides a safe, secure and consistent base for attachment to a reliable figure for working through trauma. Childhood experiences of adult caregivers, depicted most vividly in fairytales of giants and powerful forces that impact on our emotional security; in adulthood leave traces of emotional trauma that can distort our judgment of reality haunting us as adults. Trauma inhibits the development of neurological pathways that lead to self-regulation of emotional states. Attachment styles will influence how we react to stresses in the environment, the challenge of psychotherapy is to find a way of reaching our fears and understanding how these shape our lives. The biological changes in the brain required to establish new pathways takes time and can leave us feeling confused and bewildered.

Neuroscience has given us a greater understanding of the effects of child hood trauma’s and a method of working that bring about changes in how we process feelings and thoughts.

Through our interactions in the therapeutic setting, either individual or group, enables us to experience /observe our defenses at work in a safe and containing space/ in the individual session or through the group matrix of interactions. This results in a re-working of the internal working model originally created to cope with trauma to enable change to occur. We begin to integrate more adaptive responses to our emotions and feelings. To gain mastery over long held ways of relating, the internalized working model that shaped our attachment style is revised.

What part then do breaks and endings play in this process? Jeremy Holmes suggests that different attachment styles require different approaches to endings. (See paper European Psychotherapy on termination of psychotherapy /psychoanalysis)

I suggest that some knowledge of the theory is useful to clients like a comforting diagnosis helps people feel more in control. It is what mindfulness can do for all of us used in the service of our need for regulation during times of heightened arousal / stress.

Whenever we make an attachment be it to a therapist, a working environment or an intimate relationship we are faced with separation. This is why falling is love is so disorientating; the object of our love leaves us fearing loss, jealousy, envy etc. etc. If our love is reciprocated then we are both preoccupied with one another. It becomes a joke when the love struck people are in a group of friends and only have eyes for each other.

So attachment and separation are present and unavoidable; we are social beings who seek closeness and intimacy throughout our lives. (The exception is when we are preparing for the end of life.)

Ending a relationship or needing to adjust to changes in others in our lives such as our children going from being a child to an adult requires an ability to face the often painful and difficult process of change.

Breaks in therapy offer an opportunity to try out our internalized therapeutic capacity for self-regulation. Ending therapy or a good ending requires work on understanding the capacity we have to deal with life outside of the safety and security of the therapeutic alliance.

 

Thea Beech is a UKCP registered Group Analyst, full member of the Institute of Group Analysis and a Training Group Analyst.  Her work in psychodynamic psychotherapy spans 20 years in the NHS and for the last 10 years overseas in South Africa.  Thea is available at our Brighton and Hove Practice.

 

Further reading by Thea Beech

What is Social Unconsciousness?

Crossing Borders – Group Analytic Society Symposium, Berlin 2017

What is a Psychotherapy Group?

Group Psychotherapy: The Octopus and the Group – what do they have in common?