LIMITATIONS AND CHALLENGES OF MY STUDY, AND INDICATIONS FOR FURTHER RESEARCH

As I passionately believe the therapeutic relationship is co-created and that intersubjectivity is at the heart of our work, a more complete study on endings would clearly have explored therapists’ experience as well as clients’; and there is inevitably some sense of a ‘missing side’ in this research. However, to investigate both would have been over-ambitious in the context of this project, although the field is open for further work here.

Another, and linked, fundamental limitation I have reflected on, is the notion of looking at an individual’s experience of a preordained therapy ending with knowing little (only what has been gleaned in the interview) of their history, psychological make-up, and relationship with their therapist – with all the complexity of its transference elements. I have highlighted that ending therapy is a very individual experience, played into by these factors, but with the snapshot that one depth interview offers, I can only guess and suggest at specific processes

that there was not time to explore, or that the individual may not themselves have been aware of.

I set out to look at preordained endings in medium-term therapy; in the event, all my

participants came from a charitable service setting. This common factor cannot be ignored - as observed, there is a certain gratitude in being offered subsidised therapy at all, while the service itself is a significant ‘third’ in the picture. It may well be the case that a preordained ending in a private therapy setting (for example in cases where a therapist is known to be moving house, or going on maternity leave) could raise a different balance of issues and emotions for clients.

Seven out of the eight interviews in my study turned out to be within a month of participants’

endings, although I originally stipulated a criterion period of up to three months. While this

‘immediacy’ of the fieldwork could be seen as a limitation, in that none of my participants had had much time to experience life post therapy, it also meant the ending itself was fresh in mind, as well as giving the sample a homogeneity in this respect. Few if any other studies have captured this temporal closeness to the ending, and its lead-up, giving mine an original slant. Undoubtedly it would be interesting to do a comparable study at a greater time

distance from ending when the ‘effect’ of having ended (including the preordained aspect) may have become clearer, as well as – perhaps – the overall ‘success’ of the therapy, and how this related with having to end. Similarly, it would have been interesting to do a second, later, interview with this sample, but, as with participant checking, this would have introduced a whole complication to do with ending a more drawn-out relationship with me, the

researcher, as well as a substantial extra layer of data. In terms of scope, I judged that involving this second stage would have been too ambitious for this study.

A criterion of participation was that participants were not going straight into further therapy.

Yet all were open to the idea of further therapy at some point. The literature suggests that many in a service setting will have the option of being re-referred, especially when an ending is linked with a trainee’s placement ending. In retrospect I feel it may have been unusual that this option was apparently not discussed with any of my participants at the time of ending, and it is a point I now wish I had asked them more specifically about. Was the absence of mention of this to do with therapists’ judgements, general lack of resources – or the participants themselves, perhaps not hearing the option, or feeling such allegiance to their therapist they had no desire to move to another? It was also the case (as it happened) that all participants but one had had previous therapy, and therefore at least one previous ending; sometimes these endings were referred to, and comparisons made. For some,

having had a previous ending might have reduced the impact of the current ending, although perhaps less so if the therapeutic relationship being researched was considered more meaningful. A further study might either compare different endings more specifically, or stipulate that participants had had no previous therapy experience.

My sample, as mentioned, was self-selected, and as such, as Kantrowitz (2015) notes, consisted of individuals who ‘want to tell their story’. I tried to counteract this bias a little by offering a small expenses payment, but in the event the payment was considered incidental by most and certainly not the main prompt to volunteer. My participants may have felt a particular desire to talk about their ending for a number of reasons, including: valuing their therapy especially highly, feeling the loss acutely, and/or wanting implicitly to please their therapists through whom the invitation had usually come. All my participants seem to have had basically good relationships with their therapists; I suspect clients who have more negative relationships with their therapists might not have volunteered, not least because most perceived a link between me and their therapists, as, at minimum, part of a common community. Participants’ therapists themselves may have opted to help me recruit because of their own difficulties with client endings, or may have selected particular clients to give my flyer to, because they had a concern about these clients’ endings, or thought the research might be specially beneficial to these clients. Alternatively, therapists may simply have wanted to do their bit towards research in the field. Further research with therapists, exploring their feelings around client endings, would be interesting to shed light here.

My interview with Bianca, with her psychiatric diagnosis and history of psychiatric care, prompted me to consider whether I should have restricted my sample in terms of

psychological health or history. As it stands, this interview (along with Hilda’s) was useful in suggesting more vulnerable clients may have more difficulty with a preordained ending, albeit a qualitative indication from a tiny base; it flags up the need for further research.

I experienced my interviews as delivering rich and thought-provoking material. Jason, a wheelchair-bound young man, reported treasuring his therapist’s words that he had been an inspiration to him, an able-bodied man. However, in the main I was disappointed that there was not more about the intersubjective experience from participants: most offered limited if any perceptions about what their therapists were or might have been experiencing. And perhaps it is the built-in ‘limited’ nature of the therapy that affected this; some did note that their therapists would be experiencing endings all the time, given the prescribed limits of the service, implying the whole experience could be seen as inevitably a bigger deal for client than for therapist. This in itself might have been a slightly painful realisation for participants,

and therefore not one to dwell on. I believe this area of clients’ perceptions of therapists’

experience of ending would be an interesting one to research more specifically.

I found myself intrigued by the gift-giving in some of my participants’ endings, and have speculated on the various functions of this. In this study there was not time to explore it in depth, but I think the subject of therapy ending gifts might be an interesting focus of future research.

Given that this study indicates the interview itself had therapeutic potential, it would be fruitful to research this very issue, perhaps using a matched (as far as possible) sample: half given a ‘post therapy’ interview, and half not; with a comparison made some time later. Other aspects of a post-ending session would also be interesting to research – for example, should it be (/be presented as) more of an enquiry or a therapy session; is prior contact between the client’s therapist and the interviewer/therapist useful or detrimental, and so forth.