How do clients experience a preordained ending in medium-term psychotherapy? A phenomenological enquiry

This qualitative study explored eight client-participants’ experience of a preordained ending in medium-term psychotherapy (average length 12 months) in charitable service settings. The aim was to investigate the experience of ending therapy, in particular when the ending was a ‘given’. Interviews were conducted shortly after therapy had ended. Interpretative phenomenological analysis was used, and four domains emerged: Individual Experience, Acceptance, Resistance, and Managing the Ambivalence. Eight sub-themes clustered under these domains. Individual experience had one sub-theme: ‘ending therapy is a highly individual experience’. Acceptance had two sub-themes: ‘a basic human acceptance of preordained endings’, and ‘the transformative impact of therapy endings - and the particular ‘carpe diem’ of preordained endings’. Resistance had one sub-theme: ‘fear of loss, and resistance to finality’. Managing the ambivalence had four sub-themes: ‘the painful loss of the relationship can be in part counterbalanced by internalising the therapist’; ‘ending therapy as a transition: looking back and looking forward’; ‘therapy ending prompting a paradoxical confronting of both strengths and vulnerabilities’; and ‘the post-ending therapeutic function of the interview itself’. Accordingly, against a backdrop of the experience of ending as highly individual, there was often a basic acceptance of the therapy limitation, and the preordained ending in itself had the potential to galvanise psychological change, though counterbalancing this was a resistance to ‘finality’, linked with fear of loss. Managing the ambivalence around these tendencies was the challenge participants faced. Participants typically experienced ending as a transition, with something of the ‘before’ being taken into the ‘after’; this potentially included the internalising of the therapist. Participants often had a heightened awareness of both their potency and their vulnerability. Importantly, participants valued the research interview itself as an opportunity to process their feelings both in relation to ending, and to their therapy as a whole. The study recommends future research into the possibility of services offering clients a post-ending ‘process’ session with a third party therapist, as a potential means of deepening, consolidating and validating their experience of ending therapy.