An Anti-Climactic End to Therapy

When I worked for Dr. Gail the office I used had a wall of windows behind the therapist’s chair that looked onto a busy street. It was a great view for the clients, with the traffic far enough away from the building to create a perfect amount of white noise. The only problem was in the winter, when strong drafts would seep through the windows, literally sending chills up my spine. More than once I had to apologize to clients for wincing due to the rush of cold air, and not from the confession of a recent office affair with the boss.

One evening I was waiting for a client to come in for his final session. This client, whom I’ll call Kevin, and I had planned his termination from therapy for weeks after working through a depressive episode that had lasted many months. There was no overt cause to the condition and Kevin was debilitated by it. In fact he had a good job and a reasonably healthy marriage. And yet he had a terrible habit of engaging in negative self-talk: “you can’t do anything right,” “you’ll always be a loser,” “you’re worthless.” This type of inner ass-kicking messed with his sleep and concentration. Clients like this tend to benefit from Cognitive Therapy which helps clients to modify bad thought patterns. This can be especially helpful for those who use extreme or emotionally-loaded terms during their inner monologues (e.g., anything, always, worthless”). Through mental elbow grease and good support from his family he had a great outcome which buoyed his mood and self-confidence. After about six months he was ready to end therapy.

Kevin and I had gradually tapered off our sessions and agreed to have a final meeting dedicated to reviewing what has been accomplished as well as simply saying good-bye. This is common practice. Therapy can be an intense experience for some people and the final sessions can serve as a form of closure. Some clinicians argue that essentially all clients become attached to both the therapist and the therapeutic process, but that is a narcissistic and simply inaccurate viewpoint. Truthfully, any therapist who says that he doesn’t feel flattered at the idea of having clients truly value his expertise and effort is either deluded or lying, but the fact remains that not all clients connect to the therapy or therapist as much as shrinks would like.


As a general rule I allow the client to tell me how important it is to have a session dedicated to closure. For Kevin, ending therapy was a form of graduation: he was moving on from a self-basher to a more cognitively balanced person (e.g. “I may not be perfect, but I have more than my fair share of things I do well”). Thus, the final session was a sort of diploma for him. Strangely though, Kevin was about ten minutes late, a rare occurrence for him, and eventually my phone rang.

“Rob, I apologize, but I’m stuck in traffic,” he said.

“No problem. How soon do you think you’ll be here?”

“I’m…not quite sure. I’m so close, yet so far.”

“Okay,” I said with hesitation, not quite understanding what he meant. “Do you want to start the session now over the phone?” I asked. As we’ve learned, therapy done via telephone isn’t uncommon. And although the idea of beginning a session over the phone and ending it in person seemed a bit unorthodox, this seemed like a reasonable alternative given that it was our final meeting together.

“That would be great,” Kevin said.

“Fine. So today’s our last session. Are you still feeling as good as you’ve been over the past few weeks.”

“Oh definitely. Don’t I look happy?”

“Um…I don’t know if you look happy. I can’t see you.”

“Sure you can. I can see you,” Kevin said.

“I’m sorry, did you say that I can see you and vice versa?”

“Oh, most definitely!”

My God, Kevin’s turned psychotic. Why didn’t I recognize any warning signs!?

“I don’t quite get what you mean,” I said, fearful that Kevin now had a new disorder.

“Look out your window.”
I turned and glanced out the wall of windows and, sure enough, there was Kevin’s car, sitting in bumper to bumper traffic on the street, a small hand waving to me from inside.

“Hi Rob,” he screamed into the phone, the hand waving more rapidly now.

Very funny.

“Ah yes. There you are.”

“So? Do I look happy? I actually have a huge smile on my face. I’ve completed therapy!” he said.

With the phone in my left hand I cupped my eyes over the glass. “Well, it appears as though Gail hasn’t had the windows cleaned in quite some time, but you certainly sound pretty happy. How long have you been sitting there?”

“About five minutes or so. I assumed I’d be moving eventually but nothing’s changed. I was tempted to just leave the car here and come on up, but I’m sure that would land me an Abandoned Vehicle ticket.”

“Right,” I said. I began using my sleeve to clean the window in hopes of getting a better view of Kevin but ultimately just ruined the shirt and blotched the grime from the window.

At that point things felt awkward. Sort of seeing your client feels professionally unsatisfying and doing therapy with a silhouette is a little surreal, like something you’d see in a Japanese horror film. It crossed my mind to walk down the steps of the office complex and join Kevin in the car but that seemed pushy. And it was cold. Maybe he would get another call and have to put me on hold for awhile?

“Oh look,” Kevin said. “The traffic’s moving. See you soon.”

Kevin’s car only had to move about 20 feet before he could make a right turn into the complex. By the time he got into my office and sat down, though, we only had a few minutes left.

“Hi,” he said.

“Hi.”

“So…this is it.”

“Yes, I suppose so.”

We tried to review everything we had accomplished, but there just wasn’t enough time, and another client’s appointment time was approaching.

“Kevin, maybe you’d like to schedule another session so we can end more formally?”

He thought for a moment. “No, I’m good. It was nice to come in knowing I was finishing up so I don’t want to mess with that. I feel much better than I did four months ago. It would have been cool to review things, but the end result is the same, right? I’m better!”

“That’s true.” Although I was going to miss working with him, it was good to see him so much improved. That’s pretty much what the job is, no?

“If I need to come back, you’ll hear from me.”

“Sounds good, Kevin. You take care.”

And that was it. Kevin left, and I went back to the dirty windows to watch his car drive off for the last time. It was unfortunate to not have been able to see the big smile he had on his face, so I told Gail that she should have the windows cleaned. She told me that if I wanted them cleaned so badly I should either do it myself or at least split the cost with her. Fortunately she fired me not long after giving me those options, so I imagine they are still filthy to this day.

(Visited 193 times, 1 visits today)

4 Responses to “An Anti-Climactic End to Therapy”

  1. Amber says:

    I can just picture this guy waving at your window from his car with a big grin. That, at least, put a smile on my face today.

  2. Tracie says:

    “If I need to come back, you’ll here from me.”
    I think you mean “hear”, Doc Rob. 🙂
    This story is so wonderful. I’d imagine that it gives the therapist a sense of accomplishment as well when a patient improves so much. Nice entry, Rob. It made me smile during a pretty abysmal day.

  3. Closure is definitely an important aspect of therapy, which is why I like to use multiple sessions dedicated to termination. I’ve found it helps manage any lingering transference issues surrounding the realization and experience of closure, which for many is a new experience. I’m not sure if you’ve seen this in your practice, but I I figured I’d throw it out there.

    Notesfromthecouch

  4. Wayland says:

    Good stuff man.