ABSTRACT
The final stage of therapy is as important as any other stage, but it is often neglected by therapists. The significance of treatment ending, particularly in the treatment of those with personality disorder, is likely to depend on two factors: the quality of the therapeutic relationship and the patient’s specific beliefs about loss and how they have coped with this in the past. The end of therapy is implicit at the beginning of treatment, as cognitive therapy is not open-ended and involves separate phases of assessment and treatment with regular reviews of progress, thereby emphasizing a limited number of sessions and progress towards the end goals of therapy. Patients who are afraid of abandonment, or who have experienced loss in the past are likely to be particularly sensitive to the finite nature of therapy and for them, this may even have implications for engagement in therapy. For the patient, being in therapy involves trusting the therapist and feeling safe enough to be open about problems and showing vulnerability. If someone has not been able to trust others to do this in previous relationships, particularly in childhood, engagement in therapy will be slower and the finite nature of therapy may be regarded as anxiety-provoking for the patient, as the therapist will not be able to meet the patient’s emotional needs in the longer term. Some patients may protect themselves against the threat of being vulnerable and the loss of a therapist by simply not engaging in therapy. For these patients, the beliefs about loss and abandonment need to be addressed at the beginning of therapy as little progress will otherwise be made (i.e. the end of therapy begins at the beginning).
