The co​lour of autumn and the other side of resolve: seeking closure in therapy

A.

A therapist attending a social party event is having a casual conversation/small talk with some person nearby:

_ the person asks the therapist:

“So, what do you do?”

- The therapist is slightly tentative and responds:

- “ I am working in healthcare, I am a psychotherapist”

The person looks somehow interested and then replies:

“Ah, yes it must be a very demanding job. I am working in construction, I am an engineer”.

The therapist response 1:

“Construction”? “I wonder what made you decide on “construction” as a career path…?

Could you tell me a little more about it?”

Or

The therapist response 2:

“ .. That must be an interesting job! How long have you been working in construction?”

B.

A client attends therapy for an initial session/assessment and asks the therapist if the therapist is aware of terms “trolling” and “ghosting”?

The therapist responds in asking several questions about such experiences and guiding the client to find deeper meanings to such situations and how such situations are affecting the client.

When the client asked the therapist if she or he understands meaning of specific words i.e. ghosting – the therapist started making psychological links as to why such a question had been asked: is such a question representative of a client’s  (cognitive) motivation (emotional, process thinking (thoughts) for attending therapy and an aspect of relatedness that needs confirmation or clarification). 

The therapist is assessing levels of client’s ways of relating in therapy and type of motivation for attending therapy.

The therapist is completely  and empathically attuned to client’s narrative and intervenes (guiding) the client with specific questions: most times reiterating or paraphrasing what client is telling her/him, employing active listening and a genuine level of interest that can better assist the client.

The therapist’s understanding of “ghosting” has various degrees of analysis on psychological knowledge based constructs that then are applied and assessed under what is known as need for cognitive closure (NCCF) (investigated by Kruglanski, A. W (1989), interpersonal relations, types of attachment, rejection/abandonment issues who can shatter one’s sense of self and shift perception on one’s sense of self or various aspects of client’s self-esteem, trauma therapy, individual differences, abnormal psychology, gestalt psychology, psychoanalytic understandings of group dynamics, social psychological constructs and developmental psychology – to name but a few. 

The therapist is making no such preliminary distinct determinations at the time of assessment, but it is all there, all that knowledge ground is brought to mind because what it is assessed in that moment are:

a) Why is the client asking the question?

b) Why the client asks the question at that particular point in time?

c) What is the client’s motivation to attend therapy and why now? (at that particular point in time?)

d) What are client’s wishes for therapy and what are perceived as “wants” from the therapeutic process?

e) Can the client identify his problems or perceived difficulties?

f) Can the client recognise his felt difficulties?

g) How emotionally distressed is the client? And so on.

Such preliminary analysis forms part of an (initial) assessment and ways of working in therapy but it is also part of therapist’s method of assessing client’s need for (cognitive) closure.

If the client is asking specific questions during the therapeutic process, a whole new analysis is pertinent to the case with all client’s questions being integrate into client’s work, enabling a better understanding of the case.

An accepted and basic definition of “closure” refers to a desire to conclude on a matter/find resolve and such an understanding can extend to both practical issues and psychological terrains. 

From above examples,  should leave no doubt that seeking closure in therapy is about seeking a different side to resolve, a need of closure, a personal account that cannot be formulated in universal terms and the starting point of such formulation may be reviewed as and when the clients are proposing specifics (ghosting, trolling etc) during a therapeutic journey. 

The therapeutic relationship is relevant at all points in time - but only and if/ when your therapist is trained into a school of thought/therapeutic modality that accounts for therapeutic relationship as being of consequence to the therapeutic process.

Endings and closure in brief therapeutic work

Cases/clients/patients come and go and this is a fact - a therapeutic journey and reasoning for attending therapy are also focussed on clients/patients' learning how to work through endings and or closure and or termination - all such terms forming important facets of a therapeutic encounter and collapsed in their conceptual meaning. In psychotherapy, ending or termination of a therapeutic course are majorly agreed as synonymous terms and are conceptualised as a rather complex matter for client/patient engaged in the therapeutic process. 

There are clear theoretical and practical distinctions as to how an ending to the therapeutic course is processed between long term therapy and brief therapeutic work. Here we discuss brief therapeutic work.

Endings in therapeutic process and brief or short-term therapy

If brief psychodynamic therapeutic model is assessed and agreed as a therapeutic modality for a client, the ending of therapy becomes an integral part of a therapeutic focus. For a psychotherapeutic programme to be considered brief work some of the factors that are accounted for are:

a) Number of sessions decided through an initial assessment and offered to a prospective client (maximum 24);

b) Course of therapy follows a specific therapeutic model developed for brief therapeutic interventions in a modality assessed as being best suited for client's identified difficulties/challenges (National Institute for Health and Care Excellence/NICE has clear guidance on how such clinical aspects are assessed);

c) Client and therapist are developing aims/ focus for therapeutic work whereas all sessions are planned and structured around such a formulation - your therapist is going to formulate your difficulties in a meaningful emotional constructs/phrases;

d) Therapist and client are working strictly with concerns identified and formulated as a focus and if further events or challenges are presenting themselves during the course of therapy, such aspects are than considered whether or not require further work/sessions;

e) If the therapist is part of a specialist service and or organisation and the organisation is responsible for clinical work, the therapist and the service are responsible for re/assessing client's needs at any given point;

All above mentioned criteria are some of the many considerations as to what constitutes brief work in therapeutic terms. Brief therapeutic work and short term therapy are interchangeable terms.

Endings and Cognitive Behavioural Therapy

Cognitive Behavioural Therapy or CBT is conceived as a short term model of therapy known as brief work or short-term therapeutic work – most CBT protocols are designed interventions structured for a set number of sessions. CBT is an evidence-based (scientific) model of therapy with interventions/protocols that in their majority do not exceed a recommended 28 sessions course of treatment.

In Cognitive Behavioural Therapy (CBT), the ending of a therapeutic process is an essential aspect of the therapeutic work and it's reviewed in collaboration with client/patient towards the end of a therapeutic process - being considered as a blueprint for the client to apply and examine in her/his future life events. Such a blueprint and review are usually assigned as last (could be more than one) sessions in a therapeutic course. If the therapeutic process is conceptualised in four parts – creating a blueprint for the work would commence during the third part of this process continuing to the end of the therapy.

Client’s wish for seeking closure through a therapeutic process 

Seeking closure could be identified as a focus at assessment session or earlier on during the course of therapy, however sometimes such aspects of the therapeutic process are elaborated on towards the end of therapy and sometimes prompted by elicited emotions and or thoughts in client's understanding that therapy is coming to an end.

Brief therapeutic work, even when based on psychodynamic models, is highly unlikely to be preoccupied by unconscious interpretations i.e. transference and countertransference processes.

Client/patient’s wishes of seeking closure through a therapeutic process can take many forms and if not identified as part of an agreed initial focus of the work can sometimes manifest in clients/patients’ resistance/defences to the therapeutic process.

It is highly probable that in seeking a resolve in therapy from past experiences, client may (unconsciously) recreate or enact similar experiences in the therapeutic work. Interpretations on such “acts” or “events”, in brief work, could then be examined throughout the therapeutic process and shared with the client for client’s better growth and engagement - ultimately the client is gaining a wealth of information about self, readjusting (if need be) a sense of self and perceptions of her/his world all around and client’s relationship with others.

The concept of closure is powerful and is part of a psychological terrain of practice with unlimited ways of approach and applicability; it has its components of tolerance of uncertainty/ resilience towards ambiguity/unclear forms of knowledge, a clear insight in personal tolerance to events and situations classified as need to know /resolved and released of ambiguity or assessing levels of tolerance to not knowing/understanding something for certain etc. But more importantly, through gaining such an understanding of self, the client is simultaneously trained*, reminded* or equipped* with coping strategies and or different ways of perceiving a situation.

It is all about understanding behaviour in different situations and applying a type of knowledge and response pertinent to that situation. Need for closure or seeking closure as a cognitive motivation and if examined in therapy, can tell/inform about tolerance of uncertainty, coping strategies, interpersonal relationships with significant others and group dynamics, it can be applied to understandings on ways and likely degrees of  responsiveness to specific situations etc. 

In more general terms such a need for closure or degree of seeking closure from an individual holds information on personal attitudes and attributions to the world (knowledge) at large including perceptions of “difference”, electoral vote, consumer behaviour, values and engagement in social group responsiveness - as there are clear links between adherence to centralised views, a desire to know and resolve ambiguity and a sense of belonging.

Need for closure is a cognitive motivation as powerful as it can exist and its links (if not resolved) are as dangerous as ever.