How to finish ACT therapy
Many articles describe how to start therapy, how to establish contact and build therapeutic alliance in ACT therapy. Usually final sessions are underlooked in literature and courses. While ACT has limited number of sessions, so it can be useful to understand how to finish therapy.
This article does not have an ideal way of final session. Instead of that, we try to structure information that we already have to show more options that can be adapted to different cases.
Final session in ACT
This idea comes from Darra's Westrup book called “Advanced ACT”. During the final session, therapist and patient follow the same pass as in other sessions: train awareness, defusion, working with values, so they devote time to processes. According to the author, ideas from ACT are claimed to be atypical for culture and society, what is why they should be sustained before going back to reality.
Final session as a plan in case of relapse
Learning new behavioral strategies involves thinking through various strategies in case of relapse (returning to the old behavior). If a client who struggled with anxiety began to understand ideas of acceptance and values, trying a new behavior and reinforcing would be a good result. However, as we know from Relational Frame Theories, old ideas do not disappear, and previous behavioral strategies can be activated during periods of severe stress. Focusing on these difficulties, some therapists take the time to assess the risks and develop a plan, which can help a client to continue using new skills. For example:
T: Your anxiety does not look like something you want to get rid of. You started to walk a lot, met new people. You also went to couple of dates. This was done with your anxiety. C: Yes, it sounds great! I didn’t think it was possible. I’m grateful for our work. T: Due to the peculiarities of our language and the way we think, the old behavior may return. Your mind starts to tell you that anxiety is unbearable and that it is better to stay at home instead of meeting people. What if the old behavior will come back? Have you ever thought of that? We could have some time to think about it and come up with solution. C: Yes, sure.
Later you can discuss ways of self-help: the practice of defusion and awareness, the ACT matrix, the use of acceptance instead of avoidance, as well as not so obvious things like books, interest groups and something that can be useful to this particular client.
Final session as ending a relationship
Some patients can be worried before ending relationships with therapist. Together with the therapist, the client goes a certain way, and the specialist can become a significant person in the client's life. Maybe, patient hasn’t had an experience of parting with someone close in real life. Such an experience can be the end of therapy.
In this case there is no one right option as well. You can reduce the number of sessions, for instance instead of once a week, meet once every two, or even once a month. Or you can try to work with the experience of parting with the help of flexibility. You can specify which of the options will be more suitable:
T: We have done a great job, and judging by the results of the last few weeks, we can say that your depression has receded. It's great. It seems that our path may end here.
T: Before we end, I’d like to say something: during this time, we really learned a lot about each other, and perhaps became close. And the end of therapy can cause many different feelings. If they exist and you are ready to discuss them, then there is a place and time for this.
By offering space for complex feelings and thoughts, we touch flexibility again. The therapist shows that if there are feelings, he or she is ready to stay with them and accept them.
Final session as a practice of gratitude and compassion
Therapy is process. During this time, you and your patient worked as a team and really made progress. You can dedicate time to discuss what patient takes from therapy and what was most useful for him in therapy. This does not mean that you should avoid subjects that are connected to discomfort and mistakes. Our mind loves criticism and it can’t really be grateful, what is why the last session is a terrific opportunity to practice gratitude and compassion. This practice should be done in both directions: not only does the client say what was useful for him or her, but the therapist also emphasizes some points for which he or she is grateful to the client.
In order to practice self-compassion you can use this exercise (author Ilya Rozov). Here is the text:
"Sit down most comfortably. Focus your attention on your breathing for a while, and then gently translate it into imagination. Remember how you came to the first session. Try to imagine it as if you see yourself from the outside. What did your face look like? What was your facial expression like? You can see a person who faced very strong discomfort and difficulties. What could you send to this person from your current situation, when you have already gone through therapy? There may be some kind of message, signal, smile, word or look. Imagine taking this step, guiding yourself in that state with something compassionate and warm. Gently complete this exercise."
The end of therapy is not the end
Not all patients come with a specific request. Sometimes problems from other areas of the patient's life are raised during sessions. Summing up, the therapist can gently touch these points:
T: We have achieved certain results on the problem that you came with some time ago. While we were working, you also raised the topic of your relationship with your mother. Is it relevant to you now or not?
Remember that the point of this step is not to leave the client in therapy, but to give space for painful topics and show willingness to work with them, as well as emphasize the client's choice: to work on this topic or not.
Finishing therapy for therapists
For us, as therapists, the end of therapy is also an important part of the process. At this state, we may meet a lot more monsters from the ship than we would like. For example, we can think that haven’t done enough or thought through. We can experience feeling of sadness because of the separation. Please, do not avoid these thoughts and feelings! Treat them with acceptance and awareness, allowing them to be in the office.
Text: Ilya Rozov. Editorial board: Olga Kravchenko, Anastasya Pevneva
The material was prepared by the Pure Cognitions media project. Copying without a link to the source is prohibited. Support the project by subscribing to our Patreon.
- Website
- Telegram