‘I’m saying goodbye to my therapist and now the ending feels real’

Rae Ritchie is approaching the end of her time in therapy and this is how she's feeling about it ... 

I’ve just written a goodbye letter to my therapist.

That sounds dramatic, like the therapeutic version of a Dear John letter, but it’s actually a routine part of Cognitive Analytic Therapy (CAT), with both the client and therapist writing one to each other at the end of their work together (typically after sixteen sessions).

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For me, one of the distinguishing features of CAT is its self-conscious process. 

From the outset, my therapist explained that she would be presenting me with a letter after our first few meetings.  She also explained that we would write to one another at the end and regularly reminded me of this. 

The purpose of these letters is to look back at what has been achieved over the course of the therapy. 

'A client’s experience of mental health services is almost always a tale of comings and goings, hellos and goodbyes'

It is also intended to help with ending the relationship between client and therapist, an attempt to manage the situation as best as possible. 

This is particularly important for those of us with Borderline Personality Disorder and the acute fear of abandonment that is part of that, but I’ve come to realise that this letter writing and repeated emphasis upon endings can serve other purposes.

A professional relationship

'Some of the relationships we form can be ongoing, as with a case manager.  Others may be very short but no less significant because of that'

From the initial visit to the GP to discharge, whether passing through or involved long term, a client’s experience of mental health services is almost always a tale of comings and goings, hellos and goodbyes. 

Some of the relationships we form can be ongoing, as with a case manager.  Others may be very short but no less significant because of that. 

I spent just two hours with one psychiatrist in A&E yet he still feels like a major figure in my most recent episode.

The details he remembered when I’ve bumped into him in the hospital corridors since suggest a connection disproportionate to the time involved too.

Whatever the length of the interaction, it can be intense. 

During some of the most difficult times in our lives, we share things that we may never have told anyone else. 

It is hardly surprising that we form attachments, nor that that we feel cut adrift when that particular part of the journey comes to an end. 

Perhaps letter writing would be helpful in addressing this even if not feasible in every context. 

Managing expectations

Being more conscious about an ending can be demanding as well as useful. 

'Often my feeling was sheer panic; I didn’t need reminders that I only had so many hours left in which to explore my issues!'

I’ve resisted writing to my therapist as it’s made me anxious. 

This is partly because of uncertainty about what to say and partly because the letter makes the ending feel more real.  I’ve known about it from the outset but now it’s actually happening.

Throughout CAT, there is an open discussion about the therapy ending. 

It is very much a process, with a set number of meetings and a structure to follow.  Each session, we have checked in about how long we have left together and how that makes me feel.

Often my feeling was sheer panic; I didn’t need reminders that I only had so many hours left in which to explore my issues! 

However it has been useful in that it is realistic approach.  Therapy, at least most NHS offerings, are time limited.  We need to acknowledge this more openly.

To encourage safe client/therapist boundaries

I also wonder if our emotional projection is affected by this continual attention to the end.  We develop bonds with our therapists along with relationships with them inside our heads.  Maybe this constant reminder that the relationship will end at a particular point helps to keep that imagining in check.

At the same time, the goodbye letter provides a suitable opportunity for expressing our feelings and gratitude. 

Often we want to say thank you and speak about what an individual has done for us but may feel uncertain about how; this gives us an acceptable format.

To support dealing with difficult emotions

Facing up to and managing difficult emotions is something that many of us with mental health issues struggle with the most. 

Letter writing and repeated overt discussion of therapy ending makes us confront such difficult feelings in the safe setting of the therapy room. 

It’s a real life example to practice with, as I’m learning right now.