In therapy, the work in each phase is different and significant. The beginning, middle, and ending phases all have great importance.

The greatest part of the work is done in the middle phase. Here, the effect of the patient’s past on their current functioning and relationships is worked through, over and over again, with many old conflicts being unconsciously played out with the therapist, who offers her understanding of these matters to the patient in gradually deepening ways.

As a result of such understanding, we start to see many shifts in the functioning of the patient. During the latter part of the middle phase of treatment, patients will often report they caught themselves doing something (deemed “the same old stuff”), but they were able to understand why they were reacting the way they were and able to remind themselves this was neither helpful nor beneficial for them. Typically, patients then begin to talk about how things are improving.

Understanding and Functioning

I work actively with patients from time to time to ask where they were when they started their work with me, where they feel they are now, and where they would like to be. I ask about what they feel has improved, and why. Improvement in itself is not always an indicator that things have been fully worked through. The patient’s understanding of why things have improved for them is a better indicator that the patient may be ready to move gradually towards ending therapy. Also, I ask about what the patient is still feeling limited by and how we could collaborate together on helping with those important remaining issues.

All good therapists understand that no matter how intensive or how long a therapy has been, no person is going to walk out of a treatment without any conflicts, struggles, or issues for the rest of their lives. To be alive and to be human means we will forever struggle with our emotional issues. What good therapy should accomplish is a better understanding of what is inside us and how to keep dealing with it usefully so that it does not interfere with functioning well in our current lives.

Patients get to a point where they start feeling “good enough” even though their lives are not perfect and they will always have a certain amount of difficulty and struggle. This opens up the way for what is called the “ending” or “termination” phase of therapy. Depending upon the length of the therapy, the termination phase could be a few weeks, a few months, or several months. The common wisdom is that the longer the therapy, the longer we should give ourselves in the ending phase of treatment to say goodbye to one’s therapist in a way that will allow for most effective functioning after the end of the treatment.

Reflection and Letting Go

Some of the work for patients to do in this last phase of treatment is to reflect upon what they have been able to accomplish. It is important to mourn what they did not have or may never have in their lives. The past cannot be changed; it can only be understood and mourned. It is also important to be able to see the therapist as a realistic figure, neither idealized nor devalued.

Most important, in this last phase, is the process of mourning the loss of the therapist as a person who has cared deeply and listened attentively. The therapist had been there through thick and thin to help the patient understand their past and understand the long shadow of the past upon their present, thus opening up the way for improved functioning in the present, greater happiness, and the ability for the patient to achieve their full potential. When ending therapy, patients often get to say goodbye to a person important to them, done in a manner they may have never had the chance to do with other important people in their lives.

To start therapy takes courage, to continue it and go deeper and deeper into one’s mind and one’s struggles takes even greater courage, and to plan a good and healthy ending of one’s treatment takes the greatest courage of all.

Wishing all of you a good beginning, a good middle, and a good ending in your therapy!