Whether you are a cognitive behavioural therapist or a psychodynamic counsellor, whether you offer fixed-term or open-ended sessions, the ending is present in the work from the beginning.
I remember learning about endings as a trainee counsellor. I was taught the importance of planning and managing the ending, where possible. I was also taught – and have since learnt from my own practice – that the ending is integrative to the therapeutic process. If we can explore and understand the ending with the client, it can lead to insight and even change.
Of course, it’s not just about the client’s experience of endings. Therapists also have to reflect on their own feelings around endings – and those feelings can vary with each client. Some endings have filled me with sadness; others have filled me with hope.
But of all the endings I have experienced in my work, none has involved the death of a client. And when I think back, nothing in my training addressed the possibility of working with a client who is dying, even though it surely gives a different meaning to the ending.
Perhaps we can’t talk about death or dying. Maybe we can’t even think about death or dying. Ironic, isn’t it, for the counselling professions? And perhaps not helpful to our clients. How can we support our clients to explore their feelings about death if we cannot tolerate our own?
On p14, Uma Thomas encourages us to think about death, particularly if we work with people at the end of life. Uma also reflects on her work in a hospice, which can be complex but also liberating. How do you find the hope, manage powerful feelings and hold the frame? And, yes, she talks about endings.
If Uma considers death competence, you could say that Dr Asma Shahin Khan considers religious, racial and cultural competence in her article on p8. Asma is a Research Associate at the Centre for the Study of Islam in the UK, which has developed a free online course, Understanding Mental Health in Muslim Communities.
Asma explores how religious identity affects the way Muslims in Britain seek and receive support for mental health problems. She also considers the impact of socioeconomic disadvantage, racial and religious discrimination on Muslim experiences of mental health.
I urge you all to read Asma’s article, whether or not you are Muslim or have a Muslim client. It not only gave me access to a greater understanding of the complexities and nuances of the experiences of Muslims in Britain but also prompted me to reflect on my own religious identity and cultural context. Who knows, maybe the two are linked?
Obsessive-compulsive disorder (OCD) can be difficult to treat. So, Dr Daren Lee’s article on p20 could prove to be a welcome and valuable resource. Daren explains how the metaphor of a kidnapper can be used if the OCD is characterised by intrusive thoughts about harm befalling a loved one. With compassion and care, the therapist can offer the client the opportunity to challenge the kidnapper, exposing the intrusive thoughts as empty threats and rendering the compulsive behaviours redundant.
Working with psychosis also calls for care and compassion, as Conor McCormack writes on p24. A delusion, Conor explains, can help to stabilise reality, to secure a person’s identity. It should therefore be treated with respect. The therapist’s task is to allow the client to speak – and to listen.
Janet Toulson Sayers has worked in the NHS for more than 50 years. So, she has listened to a lot of clients. In a personal piece on p28, Janet looks back on her career, starting with her days as a trainee clinical psychologist at the Tavistock Clinic in London. It’s about endings, but it’s also about change – in therapy and the therapist, not just the client.