Thread by @BrightonPsych

On endings in psychotherapy:
Endings are an important part of the treatment in psychotherapy. Critically important. So how do we (psychotherapist and patient) know when an ending is right? 🧵:
Just as the start of therapy is mutually agreed, so should the ending be.

Patients will often raise endings when their primary concern is something else: dependency, feeling trapped, a power play, resistance and avoidance, anxiety, control and many more reasons.
This does not mean that the topic should be dismissed or avoided in the room, however.

My experience of endings is that when the time is right, it is mutually felt between myself and the patient.
Endings are often spoken about for many months before they come to fruition. And talking about an ending does not mean that it needs to be acted upon.

For many patients, feeling free to talk about leaving, ending or stopping can be an important part of the work where they experience the therapist as listening to this as non-judgementally as anything else. Sometimes imagining leaving a relationship brings the freedom to stay.

How long should a planned ending take? As every patient is different and therefore every 'therapy' different, every ending will differ. Healthy relationships can hold ambivalence - the desire to stay and the desire to leave. This is normal.

And sometimes, it is incumbent on the psychotherapist to challenge an ending when the work is not done. This can be hard and conflictual but our job is to hold the patient's best interests in mind, rather than their self interests. We are not there to collude.

Endings that are relationally held, are felt to be 'right' by both parties - patient and psychotherapist.
And lastly, endings mean endings - they are not breaks. They need to be mourned and accepted as final by both parties. This is another important aspect of the work.