Felix and Sage Psychology Last Session

The Last Session

Having written about a first session before, it makes sense to fast forward to a musing on the last session. (Many of the future writings will focus on the bit in between!) A last session is, in many respects, quite the opposite from a first session. It is an ending rather than a beginning, the client and therapist have come to know each other, recapping, reminiscing, and looking ahead are far more important than information-taking. One thing that is similar in both the first and last session, is that must be therapeutic, in other words, both must hold an element of growth, strength and deepening.

The funny thing about a last session, is that, there sometimes really isn’t such a thing! Every single last session I have had with a client, ends with the words: “My door is always open. Any time when you want to, you can come again.” As a client, I put this into practice last September when I was visiting my family in South Africa (where I grew up). After 15 years of not seeing the therapist I saw for one whole year of weekly therapy in 2002, and a few infrequent subsequent sessions after that, I made an appointment to pop in and say hello. To be quite honest, the biggest part of the therapy was to see that he is actually still alive and well! Why did I feel this need to see him again? The answer is easy. If we form a strong bond, a connection, a sense of knowing, and being known by our therapist, the relationship never really ends. In that sense, it really did not matter that my psychologist’s office was flooded a few years ago and my file had to be discarded due to damages. Even though he had no notes to read prior to my 2019 session, he still knew me. That in itself is a therapeutic act.

Last sessions can come in many different forms.

 

    • There is the “text book last session” where the client and I have worked together for some time, the “presenting complaint” has been addressed satisfactorily and we have reached a logical end of the road. In such a session there would usually be a bit of re-cap of the things we had discussed previously, and a hopeful look into the future. This type of last session happens fairly often, and is probably the most straightforward way to end therapy.

 

    • Then there is the last session when I do not know it is my last session with the client! I might happily book in a next appointment, and then the client cancels, or fails to turn up, and never reschedules. Numerous reasons can explain this early dropping out. Maybe payment is a problem. Maybe they felt enough relief from the sessions and prefer not to plunge into deeper therapy. Maybe it is really a question of “life happens” – and for people who have difficulty prioritising or acting proactively, everyday business distracts them from coming back. Or the reason for the no-return is that the client did not feel there was a good connection with me, and found another therapist that suited their needs better. I invariably find that clients are incredibly diplomatic and kind when they didn’t like the therapist’s style: very few will say “I did not like the session, therefore I am running for the hills”! Much more likely is just a simple phone cancellation of the next session, and the words “I will ring later to reschedule”.  

 

  • Then there are the clients who will never really have a formal last session. These are the people who have come for a long time and who finds the joy in the therapy journey not in the solving of presenting complaints, but in a deep sense of shared humanity and having a therapeutic witness to their lives. This sense of being known is phenomenally beneficial to our mental health. Known – not in a superficial social-media type of way, but really known, deeply and authentically. These are the clients who might come more infrequently as time passes, often leaving months between their sessions (or in my case – 15 years!). The relationship never really stops.

If I reflect on my own feelings in a last session, I see a couple of things. Often a sense of satisfaction that the job has been done well, that the client is actually feeling much better than when he or she first arrived. There is often a bit of a celebratory note – especially if significant improvements have been achieved in mood or ability to do things that were previously hard. With young kids, I would often measure them at some points during the therapy and then celebrate a real growing up at the end of therapy when they measure a few (magical) centimetres taller than at our starting point! They turn into the therapist or teacher in their last session when I write down their recommendations and helpful tips for other kids who might find themselves in similar situations. This is an incredibly empowering exercise for youngsters. Not only do they know they are helping others, but they also know I will not forget them, because I will cheekily keep using their ideas!

Sometimes, in a last session, there is a part of me that feels hesitant only to celebrate. Life is not plain sailing, and future suffering and troubles will most certainly come. We should not set our clients (children or adults) for failure by creating an expectation that from now on, all will be just fine.  And that to me is the essence of therapy: not to try and eliminate “bad feelings” (e.g. anxiety, sadness, guilt), not to be so strong that nothing ever phases us, not to be so independent that we need no one, not to be so happy that we have little capacity to hold our own shadows. No – the point is that we can feel all of it, weather all the storms, not because the problems are smaller, but because we are deeper, fuller, more mature and more balanced human beings. We can feel the fear, but still push through. We can feel the darkness, but still take that next step, and do the “next right thing” (to quote Anna from Frozen II). We learn to grow around the shadows, even befriend the shadows. We learn to rejoice in the “dappled things” of Gerard Manley Hopkins’ poem “Pied Beauty”, and we find our meaning in the world we live in, even though it is far from perfect.  

And sometimes, within the joy and the realistic hopefulness of a last session, there is a tiny sense of sadness and loss for me too. Even though the roles are well-demarcated, and even though the two chairs (the client’s and the therapist’s) are so different, and even though the professional boundaries of the therapeutic relation are strong and well-contained, I know that I have also attached part of me to this connection with this person. Therefore, the letting go is dappled – the bits of sunshine and shadow keep dancing in patterns in the wind.

Maybe it is for both the client and for myself that I always end those last sessions with the words: “My door is open. Come back any time you want to.”

 

 

Lindie Oppermann
Psychologist
Felix & Sage Psychology

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