Therapy Closure - How to Face it And Deal with Possible Future Relapses

Every bereavement, farewell or closure in our lives fills us with uncertainty and fear for what will happen in the future. This is especially true if we have been relying greatly on the person or situation involved in the situation. We can no longer count on the support that they gave us. Fears can often appear when we reach the end of therapy.

In cases like these, when the objectives that were initially proposed in the therapy have been achieved, then we face the closure of the therapy. With this can come the fear of relapse and not being able to face the world without the security that psychological support can provide.

These fears are very common, and to guarantee a successful end to the therapeutic process the patient must deal with them before the therapy finishes. There are different techniques and purposes for this, and they are all designed to deal with these fears. These are the main objectives:

• Helping the patient to take credit for the changes that have happened in the therapeutic process.
• Creating “security mechanisms” that can facilitate the confrontation of possible relapses or crises.
• To facilitate the transition from a life with therapy to a life without it.

Although this may seem simple, each patient and each therapeutic process are different. You have to analyze each case individually. In this article we will deal, in a general way, with how to help the patients face the closure of the therapy successfully.

The patient will be his own best therapist

When a patient has a session with a psychologist, they usually do so with the expectation that it is the psychologist who will solve their problems. This usually happens because we are used to a medical scenario. The doctor will prescribe an external solution that doesn’t usually imply any particular change in our lives. At least not beyond taking a pill at certain times.

But many people don’t realise that a good psychologist doesn’t work like that. In psychological therapy, the goal is that the patient becomes their own therapist. They start off in an inferior and expectant role towards the psychologist. The hope, however, is that in the end the patient will be able to master and and effectively use the tools that the psychologist has provided them with.

This doesn’t mean that when a person has had a psychological problem which has been successfully treated, that he or she is now able to care for others or give advice. They have, though, become an expert about themselves and their own problems. After finishing the treatment, they are able to apply to their own life everything they have learned, without the need for continuous psychological supervision or accompaniment.

Reflect on what you have learnt

It is very important that psychologists transmit this message very clearly to their patients. We must let them know that the patients themselves are the participants and main stewards of the changes established in their lives.

We, as psychologists, have only helped them to achieve their well-being by trying to enhance their abilities with very specific tools. Beyond this point, it is the patients who have put the tools into practice and reaped the results. They are the ones who have got themselves to where they are now.

When facing the closure of some therapy, it is usually a very positive thing to ask the patient to reflect on what they have learned. Sometimes it is very helpful to write a letter to one’s previous self – to the person who went looking for psychological help to face a problem that they have now either overcome or learned to deal with. This will help them to acquire and internalize a different perspective on what they are capable of doing. And it will equip them to face any possible relapses that may happen.

The “security mechanisms” that are essential for possible relapses

The “security mechanisms” are resources that the patient must have at their disposal to be able to face possible relapses. These mechanisms include the explanation of their problem at the beginning of the therapy and the normalization of the “falls” as just one more phase of the whole process.

At the beginning of any therapeutic process the psychologist should explore the background and consequences of any problem that the patient goes to therapy for. This analysis should include the situations or people that cause the appearance of the problem. It should also include the emotions that cause it to surface.

This information is very important in order to carry out a personalized and successful treatment. However, it is also very important in the closure of the therapy. It can contain vital clues related to possible future relapses. Let’s consider the fact that relapse always occurs in a significant context. The keys to that context are as important as personal keys when it comes to being able to treat and predict behaviors. And so, if we identify situations in which the problem may arise, we will be more empowered to face it.

Being prepared for a possible relapse

In depth knowledge of the problem is not only important to being able to predict a potential relapse. It also provides us with the necessary clues to cope. Therefore, by analyzing the problem in a global and personalized way, we know when it may arise. We will also know what resources we can use in each situation. In this way, psychologists will be able to teach their patients the “safety mechanisms” that will help them overcome every bump in the road. We must make it clear to the patient that they are the one who has control over their problem. If there is any relapse, then they are the one who will redefine it as a simple fall.

The difference between both terms is decided by how much control we assume regarding the problem that led us to seek therapy. Another influence is the thoughts that arise when the problem resurfaces. Let’s look at a simple example to explain this further.

Simply skipping one day of our diet doesn’t mean we have lost the effort we have invested in it and all the progress we have made. It is up to us to decide whether to continue or whether or go back to our old habits. During therapy about possible future relapses, we can do the same. We can decide whether we are going to give up, or whether we will treat it as a small stumble along the way.

How to prepare ourselves after extended therapy

Finally, something else that can hinder the closure of a therapeutic process is the length of the therapy.  The longer the process, the greater the unease, fears and difficulties a patient can feel. In these cases it is not so much the fear of a possible relapse. The fear is more to do with how to face  life without psychological supervision. Without someone to adjust, supervise or validate the progress. This may be because of the relationship with the psychologist, and any affection, friendship or dependency that may have developed. If this is the case, and the therapeutic process is going to be extended, then the psychologist will need to keep their distance from the patient. They are not their friend and won’t always be at their side.

This process can be complicated when the patient doesn’t have a good social support network. Sometimes the psychologist starts to take that place in their lives, even though he doesn’t set out to do so. In this case, one of the therapeutic objectives, before finalising the closure of the therapy, will be for the patient to enrich their social network as much as possible. If they don’t have one then they will have to generate a new one, in order to be able to vent or share their problems.

In the end, what we want to do when facing closure of the therapy is have an agreement between the psychologist and the patient. Both the patient and the psychologist must agree with what has been achieved in the sessions. The patient must also know that they are able to face a life outside of therapy successfully.