Techniques And Rituals For The Conclusion Of Therapy

Any pain, detachment or end in our life generates uncertainty and fear of what awaits us – especially if in the phase we are closing we have a support that we will no longer have; fears that also arise when the conclusion of a therapeutic process is approaching.

At this point, when the initial objectives have been achieved, we must face the conclusion of the therapy and, with it, the fear of relapses and of not being able to go out into the world without the security that psychological support can give us.

These fears are very common, therefore to guarantee a good ending to the therapeutic process, they must be treated during the therapy itself, before it ends. To do this, various techniques are generally used designed for different objectives, but all related to the fears we refer to:

• Help the patient to take credit for the changes that have taken place during the therapeutic process.
• Create “safety mechanisms” that help to deal with any relapses or crises.
• Facilitate the transition from a life with therapy to one without it.

As simple as it may seem,  each patient and each therapeutic process are different from each other, so each case must be analyzed as a stand-alone. With this in mind, below we will see in a generic way how to help our patients to successfully deal with the termination of therapy.

A good conclusion of therapy is achieved when the patient recognizes the merit of the change as his or her own

When a patient begins to receive psychological assistance, he usually begins the journey with the expectation that the psychologist will solve his problems.  Usually this is because we are used to the medical model, in which a professional prescribes an external solution that does not generally involve any particular change in our life. Or at least not beyond taking a medicine at set times.

Many don’t know this, but a good psychologist doesn’t work that way. Conversely, he will try  to make the patient who undertakes the process in a position of inferiority and expectations with respect to the psychologist, the best therapist of himself. He will master and effectively use the tools that the psychologist has provided him.

However, this does not mean that a person who has successfully overcome a psychological disorder will be able to follow and advise others on their own. It just means that, as an expert on himself and his problems, once therapy is over, he is able to use everything he has learned on himself without the need for continuous psychological support or supervision.

It is very important that this message is clearly conveyed by psychologists to their patients, who must understand themselves as  participants and main supporters of changes in their own life. We, as psychologists, have only helped them to achieve well-being by trying to enhance their abilities with precise tools. On top of that, it was the patients who put the theory into practice and reaped the results: they are the ones who have changed until they get to where they are.

Regarding the conclusion of the therapy, it is usually good to ask the patient to reflect on what he has learned, or even to write a letter to his past ego, the one who went in search of psychological help to deal with a problem that he has now solved. or has learned to manage. This will allow him to acquire or internalize a distinct perspective on what he is capable of doing. This awareness exercise will be of great help in case of any relapses.

The essential “safety mechanisms” in case of relapses

The “safety mechanisms” are those resources that the patient must have within his reach to be able to deal with possible relapses. These mechanisms range from explaining your problem at the beginning of therapy, to normalizing the “falls” as a phase of the problem.

At the beginning of the therapeutic process, it is necessary to explore the antecedents and consequences of the problem for which therapy has been used. This analysis must include the situations or people that facilitate or provoke the appearance of the problem, but also the emotions that make it appear.

These data are very important to achieve a personalized and successful treatment, but they are also very important in the conclusion of the therapy: they are very important aids linked to possible relapses.

Do you think that a relapse always occurs within a meaningful context, and the objective readings of this context are as important as personal ones in order to treat and predict behaviors. If we identify the situations in which the problem can arise, then, we will be more ready to face it.

However, the deep knowledge of the problem is not only useful for predicting relapses, it also provides us with the necessary suggestions to deal with them. For this reason, by analyzing the problem in a global and personalized way, we know when it can arise and which resource to use in each situation, being able to teach our patients these “safety mechanisms” that will help them overcome any obstacle in their path.

It is also necessary to make it clear to the patient that he himself is in control of his problem, so if a relapse occurs, he himself would be able to redefine it as a simple fall. The difference between the two terms is marked by the control we give to the problem that brought us to therapy and to the thoughts that arise when faced with the revitalization of the problem.

To explain it better, let’s take a simple example: interrupting the diet for a day does not mean having wasted the effort invested on it and all the progress, so we can decide to continue or to return to our old habits.

In a psychological treatment, when faced with a relapse, we can do the same thing. We can decide to give up or we can think about the progress and let it be just a small hitch along the way.

The transition to a life without therapy, when it has been long

Finally, another factor that makes the conclusion of therapy difficult concerns the malaise, fears and difficulties of patients who have gone through a long-lasting therapeutic process. In this case, their fear is not that of facing a possible relapse, but of facing a life without psychological supervision, without someone to check or approve their strategies.

This can happen because feelings of affection, friendship or even dependence have been created on the part of the patient towards his psychologist.  If a therapeutic process becomes long, therefore, adequate distances must be maintained with the patient: we are not friends and we will not be by his side forever.

This process can get complicated when our patient does not have a good social support network and we, as psychologists, have played this significant role in his or her relational world. In this case, one of the therapeutic goals – before facing the end of the therapy – will be to make him enrich his social network as much as possible or to make him create a new network of friends with whom he can let off steam or share his problems.

It is therefore in the interest of every psychologist that the conclusion of the therapy also receives the consent of the patient and that it is the result of a satisfactory therapeutic process. For this to happen, the patient and the psychologist must agree on the goals achieved; furthermore, the patient must be clear that he can successfully cope with life outside of therapy.