Recently, a couple of cases got me thinking about what made a good outcome of therapy and how when not careful, what seems like a good therapeutic alliance can be impeding progression.
There had been two particular cases which shared similar
themes for the past months. I had worked with them for a couple of months and
it had come to a point in time that I thought it was time to end the therapy.
However, I noted that the clients involved were resistant towards the ending
and started to bring in new materials for our sessions. It took me a couple of
sessions before noting that they did not seemed to have real difficulties
managing those situations. Upon exploration with them, it came through that
they did not think they were quite ready to deal with life without therapy. The
sessions had somewhat both directly and indirectly created some sense of safety
for these young people at a time that they were scared of themselves. They were
afraid that without therapy, they might slip back into hurting themselves again
and possibly taking it further.
On one hand, I have to admit that it felt good that the young person thought therapy had been helpful or at least they saw it as a critical bit of their lives. However, this just did not sound right; both professionally and personally. If therapy was to be effective, I should be seeing my young person not only being able to move away from self-harm behaviour but to better coping mechanism when they are faced with future issues. I read recently about the original Milan's team's differentiation between psychiatric problems and life problems. It resonated with me. We all face problems in life, but not all of them require therapy. It dawned upon me that my young clients were afraid of facing problems in life. And as they are on their road to recovery, their run-ins with situations in their daily lives made them uncertain if they were ready to deal with life without therapy.
I shared this thought with the two clients and they agreed that no amount of therapy was going to take away all the problems in life. They recognised that they had made progression and while they think they might be able to handle things to come, they thought having a therapist with them just made things a lot more secure. We agreed to have a couple more sessions to consolidate their achievements, strengths and resources so that they feel more confident as they embark on lives without therapy.
[July 2016] Note to self: If only I read Glenda Fredman and Caroline's paper on Ending earlier!]
