Facilitate Memorable Terminations with Awareness, Courage and Love

Functional Analytic Psychotherapy (FAP), a contemporary contextual behavioral therapy grounded in empirically supported principles, harnesses the power of the therapeutic relationship and maximizes the therapist’s genuineness, compassion and effectiveness. FAP focuses on how therapists can notice and respond effectively to client daily-life problems when they also occur in session in order to directly shape behaviors that help clients live more meaningful lives (Kohlenberg & Tsai, 1991; Tsai et al., 2009; Tsai, Callaghan & Kohlenberg, 2013; Tsai, Kohlenberg, Kanter, Holman & Plummer Loudon 2012; Holman, Kanter, Tsai & Kohlenberg, 2017).

Contrary to notions that behaviorism is a relatively impersonal approach to treating simple problems, it is through this concise conceptual framework that FAP facilitates an intensive, emotional, and in-depth therapy experience. Specifically, the concepts of awareness, courage and love (ACL), behaviorally defined, are at the heart of FAP. ACL represent middle level terms that are important in creating a science more adequate to the challenges of the human condition (Kanter, Holman & Wilson, 2014).

Therapist cultivation of ACL involves in-depth training in which clinicians develop self-knowledge and the ability to take strategic risks in being vulnerable, genuine, and emotionally close in the service of client growth (Maitland et al., 2016). Because FAP therapists form authentic connections with their clients that serve to help them engage in healthier relationships outside of therapy, termination is seen as an opportunity for clients to develop more adaptive ways to process daily life relationship endings which can be a painful part of the human experience (Tsai, Gustafsson, Kanter, Plummer Loudon & Kohlenberg, 2016).

While this article focuses on how to create a good termination, we believe co-creating a deep, authentic, open-hearted relationship throughout the course of therapy facilitates a memorable ending. Although ACL interventions are inextricably intertwined, we will provide examples of FAP interventions that highlight each category in an intentional termination process.

Awareness

Awareness involves an open-hearted presence in which you notice with compassion the feelings both you and your clients are having, and understanding the history which may have shaped these reactions.

In the termination phase, awareness interventions involve helping your clients explore the feelings and memories of previous transitions and losses and how termination may be bringing those up. Specific questions to address include: 1) Since the end of therapy often brings up feelings and memories of previous transitions and losses, what is coming up for you from the past as we prepare for our goodbye? 2) How do you usually handle loss, endings, and grief? 3) How can we say goodbye in a way that would be healing and memorable?

Courage

Saying goodbye to clients with courage means stepping outside of your comfort zone and expressing that which is unique to you and tailored to your client. This can be done either verbally, or preferably, in writing, so that clients have a letter or card they can treasure. Questions such as these can serve as prompts to the therapist: “What feels most vulnerable for you to express as you say goodbye to your client? How has this person deeply touched you, healed something inside you, inspired or motivated you? What will you never forget about this client?”

Taking into account those questions for therapists, the following is an example of a powerful goodbye letter the first author wrote to a client:

Dear T,

I have witnessed such courage and vulnerability in our time together. I have seen you reach for your highest self which has inspired me to reach for my highest self.

When you were in the throes of your bulimia, your willingness to reach out to me despite your shame affected me deeply. Your courage in going to your darkest places with me made me feel incredibly privileged and honored. It affirmed that our work together meant as much to you as to me. Every week that you went without purging felt like a win for both of us. I will miss your smile, your willingness to dive into the work the moment you walk through the door. I’ll miss the fun we had even through the pain. We laughed, joked about the men you chose, and how you were so much better than them. I will miss witnessing you continue to develop into a person who doesn’t settle for less than you deserve. I’ve allowed myself to be really open to the depth of your caring, which has made me more open to others’ caring in general. In letting me cry with you as you cried, it touched my deeper vulnerabilities and my courage as well. I feel moved and tearful and I’m writing this. I know now you are at a place where you can navigate your own path. You have worked hard to create an environment in which you are able to be honest and open, and you now allow yourself to be taken care of by those close to you. I’m grateful that you let me walk this walk with you–it has been a long and rewarding journey. I will never forget you.”

Love

An intervention that focuses on being loving acknowledges and validates clients’ experiences, recognizes their improvements, and sees and communicates to them their best selves to help them generalize their progress moving forward.

The second author specializes in a creative method in which she writes an inspiring personal narrative for clients in the form of a fairytale, a short story, a metaphor or poem that highlights both the essence of their struggles and communicates the growth and hope developed in therapy. These writings can include: the striking points and hallmarks of their life history, the challenges they endured, their talents and strengths, their dreams and goals, and key interactions and observations in sessions.

As an example of such an intervention, the following is a poem the second author wrote as a parting gift for her client after a year of therapy for depression stemming from her second divorce. The client cried when she received this prose because she felt so seen, understood and cared about. The lines in the poem (altered to maintain client privacy) are unique to her life situation and capture what she has said in therapy. The “kick” refers to her stating that she was “kicked” out of her house to live with her grandparents when her sister was born.

The kick

Teased as a bastard child

Hot cheeks of embarrassment

A bleeding heart

Intense pangs of anger

Tasteless saltiness of the sea

Deafening quietness of loneliness

The first divorce; the second one

“Where is the manual for relationships?”

The adult says to the child self within:

“I am here for you. I will never leave you. I will always take care of you.”

The child says back:

“Play with me! Be naughty!”

Promising experiences coming soon:

Living according to your values

Meaningful connections

Yoga retreats

Cherishing your emotions

Taking care of yourself without waiting for another to meet your needs

A new love

The best is yet to be.

Summary and Conclusion

By providing an evocative structure for terminating therapy with awareness, courage and love, therapists create the opportunity for clients to develop more adaptive behaviors in the context of relationship endings in daily life as well. Awareness interventions involve noticing with compassion the feelings both you and your clients are having, understanding the history which may have shaped these reactions, and exploring how to say goodbye in a way that would be most healing and memorable. Courage interventions involve stepping outside of your comfort zone and expressing with vulnerability how this client has deeply touched or inspired you, what you will never forget. Love interventions focus on validating clients’ best selves to help them generalize their progress, and can include writing an inspiring personal narrative for clients in the form of a fairytale, short story, metaphor or poem that highlights both the essence of their struggles and the growth and hope developed in therapy. Having experienced open-hearted communication developed from an authentic relationship with their therapist, clients can leave therapy equipped with skills that can be generalized to their daily lives to foster deeper interpersonal connections. We hope this article inspires therapists to be creatively and authentically present for their clients in the psychotherapy termination process.

Recommended Websites for Further Reading

http://functionalanalyticpsychotherapy.com/

http://socialconnection.uw.edu/

www.LivewithACL.org

http://contextualscience.org/acbs

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Holly Yates, M.S., LPC