 One of the things I do on my contracts is that I always have an emergency contact number whether that's a partner or a parent or somebody, so I would probably use that. And I always ask, am I OK to contact this person in case of an emergency? So I would probably contact the emergency contact number and just make sure that everything was open. Well, that's a really good tip for people listening. We demystify what goes on behind the therapy room door. Join us on this voyage of discovery and co-creative conversations. This is The Therapy Show behind closed doors podcast with Bob Cook and Jackie Jones. Welcome back to episode 83 of The Therapy Show behind closed doors with the wonderful Mr Bob Cook and myself Jackie Jones. And in this session, I think we briefly mentioned it on the previous podcast, we're going to be looking at unstructured endings in the therapy sessions or when a client leaves abruptly. Yes, yes, yes, that's right. And I'm in my office. I'm just thinking, I think the last podcast I was in my conservatory. I'm not quite sure about that, but I'm in the office this time and behind me is a wonderful Doctor Who picture with a dialogue. Because my daughter is now 23, but when she lived with us, she was into Doctor Who. So I know the people who are listening won't be able to see that, but you could imagine it. The ones that are listening can always jump over to your YouTube channel Bob and watch it over there and see the picture of the Dalek. So there we are. Yeah, I've just come in actually, it's pouring rain outside, so I'm very happy to be here talking about my favourite subjects and talking to you, of course. Thank you. So, unstructured endings in the therapy room. Yeah, it's an interesting title because really what it's about is that I think most therapists need to think about how they end with clients. Yeah. And endings need to be planned for. Now, of course, you know, that's with all the best will in the world. Exactly. And the clients might just leave or they might turn up one evening and say, OK, well, I don't know if I'm going to leave tonight or I want to break or I've achieved what I want to do. And they give you no time for planned ending. So they end up just coming and then 50 minutes later, you don't see them again. So you can't really legislate for that. But I don't know what you do Jackie, but when I, well, when I did, I'm sorry because I don't take individual clients anymore. I always, you know, in the contracting stage said, say it's, you know, when you leave and work all this through and everything else, we need at least a couple of weeks, or even three, hopefully, but at least a couple to actually review what, what you've come for, you know, where we've come and say goodbyes. And I really don't want you to just turn up on the night and then go. So I have that conversation is built in that usually it's at least two sessions. Yeah, we can have a review and they can have a healthy ending myself. And of course, if it's in a group, a healthy ending with a lot more people, you know, usually in the state, but let's just, well, it's individual and group therapy. I need to give more than two sessions. And I used to like three really, but I would accept to. And that gives us time for a structured review and a time to have a healthy endings. I don't know what you did. Well, yeah, I see he's contracted, you know, the sessions don't end abruptly, so to speak. It is contracted in there, but there are always those clients that don't do that. And I can understand in a group why maybe it would take longer because, you know, it will impact the rest of the group. If suddenly somebody doesn't turn up. Well, yeah, or if somebody turns up and says they want to end and there's not been time for structured ending, or somebody might have been away that particular evening when the person comes in as I want to do. So they end up with uncompleted a good buys, which is a never good thing. Yeah, I've only had one client in the whole of my time that just didn't turn up. But the previous session, she'd asked if her husband could join in the session. And I declined. Yeah, and I think that was the reason, but there was just no contact whatsoever. I, you know, obviously I took it to supervision. I tried to send a message and an email and probably for a couple of weeks. But then there was just no contact. That was it. I never heard from her or so again. Yeah, two points there. You know, usually if something like that happens and it did happen to me more than once, by the way. So that's why I said, wow, that's not a bad record where just that's only happened once. And there's usually a clue in the session before or the session before that. There's usually a clue if you reflect on where the therapy had been going and where the person was in therapy and their transactions in their last session. Yeah. Usually a hidden clue, even if it hadn't been reflected on. Yeah. It was, it was difficult. It was a difficult time. I think I took it to supervision more than once because not knowing what happened to the client, you know, that they were okay and everything kind of was hovering over me for quite a while. Yeah. And I think that's how it is. Had you been with this car? Had this car been with you a long time? Not a long time. No, it was probably about four or five weeks. Yeah, sessions. Yes. Yeah. Four or five sessions. So it wasn't, you know, a long standing client. But yeah, it took me a while to get over it purely simply because I didn't know whether they were okay or not. I think, you know, it's okay to end if you, you know, they're saying I feel okay now when I want to end. That's absolutely fine. But it was just not knowing they just didn't turn up one session and that was that. Well, you're on the land of the knowing that aren't you? Yeah, yeah. You're in the land of fantasy. Yeah. And usually when people come to me, therapists, you know, come to me and I'm their supervisor with similar clinical issues like you've just mentioned. I encourage them to complete if possible for themselves because the other person's gone. Yeah. That would be, I think you said you did. Sending a text and email. There's no reply. Then to say a final email or text saying I've had no reply from you. I assume that you left therapy and I wish you all the while. Yeah. Whereas you complete an ending for yourself. Yeah. Which is what I did. And I did take it to supervision and discuss it and we did kind of reflect over the session before. And I think I think me refusing to do something that she wanted made her quite angry. Well, it did. She was angry in the session. But I just thought it was it wasn't appropriate to bring a third person into the therapist sessions after four to five weeks. So you had your boundary and what you're saying is that they reacted to that boundary in a way which was perhaps. You may not be unfeasible by you and then you're in a situation of unknowing. Yeah. And it was a boundary. We did discuss it and you know I wasn't prepared to change that for her which I think made her quite angry. Well, I think it's quite remarkable in your career. I'm not sure how long your clinical career is or has been. But to just have one person you know terminating in that sort of ways is I think it's quite rare because you know I probably could go my career but of course it was 30 odd years. And I'm sure there's many more than one. And for many reasons. What you've just said of course where there's something which you said, especially when they've just seen you four or five sessions because you have to start thinking I think clinically. I don't know what your supervisor said but you have to start thinking clinically well, you know four or five sessions how you know it takes quite a long time really clinically to achieve a robust working relationship to be able to handle those sort of ruptures maybe. And usually actually, I think it takes more than four or five sessions to have a robust working relationship to be able to hold in inverted commas ruptures. Yes. Yeah. And that's how it felt. Yeah. So if the person being with you three months or six months I think you'd have a different story. Yeah. And that's not to say I haven't had you know clients that have been for a short term, you know that all my clients don't you know it's not years and years, but it's more of a planned thing. You know in my contract I have that they'll come for a minimum of four weeks and then we reassess they might reassess after that four weeks and decided they don't want to continue so you know it's not like clients never end with me but not abruptly like that with no, no contact whatsoever. But certainly not unusual. I would imagine all the listeners of this YouTube that are perhaps seasoned therapists or counsellors. They will have experienced what we're talking about here. Yeah. Even those that are listening are going to be therapists or counsellors. I think it's really important information because it will happen. Yeah. And I do think it's, we can write into our contracts that we want planned endings, all the things I just talked about earlier. And in our essence, we aren't in control of that. True. Yeah. And you know, I think also what I've just said is, oh it's a second, I'm saying the same point, but I think it's very true. If the relationship hasn't been successfully built, if you like, in terms of robustness, then I think these ruptures can happen. And also they can happen. They're more likely to happen in the first six, seven sessions of therapy. Yeah. That's been my experience. And again, another thing that I think was really useful in my training and in my practice was training at the Institute. We got low cost clients. That was part of our training that was only for a set amount of time. So we were both aware that there was going to be an ending in eight weeks time, I think it was. And once we got past weeks sort of five-ish, I was doing a countdown with them every week just to reiterate that we were ending in two, three weeks time. Yeah, I think that's a different story. I mean, you know, it's interesting, but if I took 10 people off the street who had nothing to do with therapy and I asked them about endings, I'd probably find out that nine out of 10 people would have a history of challenges over endings. Yeah, me too. I don't like endings. I always like to leave the door open. So even in the contracting phase, if you put in a structured ending of the way we're talking about and have at least three or two sessions before that you have to tell the therapist. You know, if they're script, that's a TA word, but if their early history had been about challenging about endings, then they may have to have their script and leave in a way which isn't healthy. What's their script, but they haven't been in therapy long enough really to deal with, you know, a new type of script, if you like. Yeah, which I think is really important, do you know what I mean? Because that is coming into the fairy-poomer with us though we feel about endings. And it's something that I don't think we often get the opportunity in the outside world to discuss or become aware of. No, and it's in therapy where it's most reflected on. And endings ending a relationship, ending a relationship with somebody significant, loss, someone's left you, all these sorts of endings, people have challenges. So, you know, it's an area where people may act out on familiar script. Yeah, because for me, I think it comes up a lot in the therapy room that there's always endings associated with making a change, whatever that changes, we've got to let something go, which is an ending of, you know, one form. So it does come up quite a lot in therapy. And it's surprising. That's why I said, wow, at the beginning, when you said that had only happened to you once. That's quite remarkable. Well, I'll take that as a compliment though. Oh, yeah, I would definitely take it as a compliment because I think people have a lot of challenges about endings. And I think what clients, well, there's two parts of this, I was going to say, what clients forget is the impact of them suddenly leaving is on the therapist. And then I thought, is that right? Yeah, that's true. But also sometimes people in the consciously or unconsciously to punish the therapist. Yeah. I think that's the way I felt with the one that left me abruptly, that it was a punishment. Not so much the ending, but the no contact after they decided not to. That felt personal. Persecutory. Yeah, yeah, yeah. Because I hadn't, I hadn't, you know, flexed my boundaries to allow her to do what she wanted in the therapy room. And I'm not sure that she was used to that people saying no. Again, you know, when it's happened to me for different sort of reasons. I think it's different again. If people do this in the early stages and the relationship is not being formed between the therapist and the client. Then I understand it perhaps more clinically, even though the impact can be quite perhaps hurtful or whatever, but I can rationalise it clinically. But if there's been a relationship which has been formulated and quite robust and the client's been with me quite a while and that happens. Then we have a different story. Yeah. In terms of level of perhaps hurtness or level of a knowing or wondering how the client is. Yeah. So it's an interesting one. And here's another sort of query to you we could talk about is. And I'd like your thoughts. I mean, I certainly took my thoughts. What happens and it may have happened during clinical practice. I don't know. If a client leaves abruptly. And you've been working in therapy on their escape patches, or you've been working on suicidal ideation, or you have some clinical concerns about what they might actually act out. What do you do? That's a really good question. What do you do, especially if there's no contact? What's your thoughts on that? Well, it's never really happened to me and I've never had to do it, but I would imagine there needs to be one of the things I do on my contract is that I always have an emergency contact number, whether that's a partner or a parent or somebody. So I would probably use that. And I always ask, am I okay to contact this person in case of an emergency? So I would probably contact the emergency contact number and just make sure that everything was okay. Well, that's a really good tip for people listening. Because no therapist have that in their contract. Right. And I think that's a really good piece of advice for people listening. First up is, outside that, the first step is to talk to supervisor, I think. Secondly, I can tell you what I do anyway, besides talking to the supervisor, is I would phone, email, text, and I've still didn't get, oh sorry, and in the email or the text, I would say, you know, I'm not sure quite why you left. However, I am concerned about you given what you're talking about therapy. And it was specifically sensitive things we were talking about. And, you know, even if you are going to leave therapy, I'd like you to reply. So at least I know you're okay. Yeah. Yeah, I definitely. So I would continue the dialogue. Yes. Yeah. Because I think that in itself letting the client know that you are concerned about them. Do you know what I mean? That it's, you need to know that they're okay because you care. You know, and that in itself can be quite helpful. Yeah, the times that this happened, I'm thinking of a couple of times now, they have replied. Yeah. I'm just thinking, have I had a client where they're dealing with suicidal ideation or I was concerned with them, or they'd had a psychotic plate or whatever it is. And I replied in that way. Have I been in a situation where they haven't applied back to me? I don't think I have, you know, Jack. I think I'm thinking of the clients that I'm thinking about, they've all applied back and said things like, I really appreciate your concern and carried on in some justification for believing or whatever. But I don't think I've had someone who hasn't replied back to my concern. Yeah. Because ultimately, at the end of the day, we can't enforce, you know, our contract really, and we can't make people come back to end therapy appropriately. If they choose not to come back, you know, that's their choice and their priority. I think it is difficult, particularly if it happens in the early days. You know, and it's important that we take care of ourselves as therapies and take it to supervision and work through it ourselves. Yes, because I think it will happen. Yeah. Okay, you only had it once, but I'm thinking of it in my experience. Yeah, obviously established, but also in the light of how many therapies come to me in my title as a supervisor where this has happened. Yeah. It's quite common, but it usually happens more in the beginning of therapy. Yeah. Now, it happens in early clinical life, like in placements, then usually the placement takes it over and sends emails and you can also post this in text. But when you start working out clinically privately yourself, it will happen. And I do sort of advise people to at least send an email or text, find a way to end themselves. And in your situation, if you still didn't get any answer, which does sound persecutory by the way to me, then you have to find a way you can end the best you can end. Yeah. That's how I'm talking about. Yeah. You know, going back to what I mentioned previously about in the contract, I always felt more comfortable having an emergency contact number four, each one of my clients. I don't know whether that's me, you know, preempting anything, but yeah, I just felt more comfortable and specifically for me having the client's permission to contact them if I needed to. So that obviously I wasn't making confidentiality or anything. See, I think that's not the norm necessarily. And I think it's a really good piece of advice. Yeah. Did you do that with this one? Yes. Yeah. Well, no, not contact them. No, I didn't on this one because it was early days, do you know what I mean? And because of the previous session where she did kind of leave under a cloud. I think I half expected it to be honest. But because I do have issues or I did have issues with endings, I just wanted her to know that it was okay and that she could come back, which like I said, for me, I always leave the door open whenever a client finishes. The other thing I wanted to ask Bob is, do you have a length of time that you keep like I've said it on previous podcasts, I keep notes on my clients. Do you have a length of time where you should keep those notes on clients before you dispose of them or? Well, here we go. Again, people listening here will have to have different regulating bodies. So for example, I'm part of the UK CP world and therefore the UK CP world will say, if I remember correctly, seven years. Yeah. The TA world, so seven years. The British Association, BACP, I think might say seven years or maybe it's five. British psychological society, I don't know. And there's other different regulating bodies. So according to your regulating body is what people tend to follow. The TA world, because they were part of the UK CP, so I understand where they got that from. It's seven years. I certainly think it's important to think about that, especially in terms of insurances. Yeah. I mean, I think most insurance companies will follow the regulating bodies procedures. So I don't know what you remember, which regulating body you remember often. Well, to be perfectly honest, I'm not now because I'm not practising. When you were going through this BACP. Well, I think BACP is in line with the UK CP. Yeah. Seven years. Yeah. Now, I may be incorrect and people listening are on the BACP. But I'm not in the UK CP world, but I think it follows the UK CP recommendations of seven years. Yeah. Which is a long time, you know, for us to be hanging on to it. But I think it is important that the listeners understand that it's, you know, it is an important part of being a therapist is that we do need to hold on to certain information for quite a long period of time after they've stopped coming. I don't know if you've done a podcast on this, but it's very important. Yeah. In terms of protect, protecting yourself. Yeah. Yeah. I think we did a podcast way back 10 months ago, I think. So it was on notes, but maybe it was on note taking from a different angle. Yeah. Yeah. Yeah. So, yeah, that's, yeah. Okay. I was going to say something, since you've asked me that, I've completely forgotten what I was going to say. I apologise. I thought it might be useful for people to have a little reminder of it or to, you know, understand that. Yeah, we do need to keep information first for quite a while after. Yeah. After the client stop coming, even if they've only been to see us for, you know, four or five weeks. See where you're coming from. Yes. And you'll have many, many clients you'll only see for three or four sessions of perhaps, I'm not talking about, you know, ending abruptly here, but they might only come for outcome, you know, short outcomes. Yeah. Yeah. For example. Yeah. So it's an example. You know, there's some people have come to me for that and the understanding was that it was one issue and they were coming for, you know, a certain period of time and that was it. But again, we both knew that that ending was coming. You know, it was kind of booked in beforehand, if that makes sense. Absolutely. So another interesting sort of dimension of this is, as I said, I have a structured ending. I'm thinking back now, it was three sessions. Yeah. It was individually adding groups in groups. I wanted three, three. It was planned for if we possibly could do this. And in the structured ending. Besides saying goodbye to me, of course, we looked at what people had actually accomplished or not. Yeah. So we did a review. Which I think is really helpful. Yeah. No, I do. Yeah. I'd encourage people or therapists not just to sort of like end it with a goodbye and nothing else. I think there needs to be a review. And I also think there needs to be a conversation around how does endings fit into your script. And what's bought about this ending now. Yeah. You know, a much longer detailed. I'm saying quarry might be the right word, but certainly a sense of curiosity about why now what's, you know, because quite often people. You know, clients may want to leave because of their history. Yeah. Or even something they've received the therapist has done. Yeah. Yeah. What if. What if it's not the client that ends the sessions? Have you ever ended sessions with a client? Yeah. Yeah. I think of a client at his slight. Which I ended the session. On that. What are you disliking anybody, Bob? I think it was the second session. Or might be in the third. And it was in my earlier days. I don't think as we, as I've got more experience than I, I think I worked out what the counter-transference was. And I was, I was able to see the child in the, or the vulnerable younger self in the client. But I was thinking when, in my very early days, I think, even after taking into supervision. I'm not sure whether I actually explored my own counter-transference. But a lot of the reasons, you know, disliking clients and things like that is often from a counter-transferential position. So thinking about the reasons on my end with clients. Well, it's an interesting question. Another reason I may, but usually I haven't taken a person on in the first place. But if there's a psychotic break, or if the person's had a breakdown, or if we think psychotherapy isn't useful for the client. Yeah. It would be another one. Usually in the initial sessions, they will talk about whether they've got a psychiatric history. Or if they've got a psychotic process going on. And then I probably wouldn't take them on because I'm not sure psychotherapy is useful for people who are fluidly psychotic. In other words, the main sort of critique I have of that is if they aren't able to maintain adult enough to do psychotherapy. In other words, I might get stuck in their younger self and I'll just be inviting them into their own health. So I'm not sure the psychotherapy is useful for people in that level I'm talking about. But I usually wouldn't take them on. But then that begs the question, like you take somebody on, start doing the work and then they have a psychotic break. In other words, the psychotherapy triggers some hidden psychosis. Yeah. Now, there begs the question what you're talking about. Well, there I might, and I was thinking of somebody, I might say, right, is this useful? Or we'd be talking about this or we'll spend more time building up and strengthening their adult or stroke. I might say, you know, I was thinking of a client who had a psychiatrist. And the psychiatrist is the person that said be useful for this person to do therapy. And then the person was more vulnerable than actually thought. So there may be reasons that you may say terminate therapy, or at least might end it for a while while they do medication or see their psychiatrist and then come back. But there needs to be a lot of thoughts about whether psychotherapy is useful for a client who's obviously got a diagnosis, perhaps a fluid psychosis. And as I said, you can take somebody on and actually, as you're working in a regressive developmental way, you may trigger some psychosis, which you may be trying to work with or not. Yeah. See, that's it. I wouldn't take if I had prior knowledge of it, I wouldn't take on a client like that because I don't think I've got enough experience or, you know, I would feel like I needed more training. Even though we did it in our training, it's not specific enough for me. I like to feel confident. And then I was thinking in my younger days, before I'd worked through quite significant issues of my own, I was thinking of when I'm, and I have done this, when I might say to a client, you know, And usually I would know with the two or three sessions, so this isn't going to happen when I've been working the six months. But the count of transfers is too intense. Yeah. Though in other words, say, you know, I was thinking I was adopted and I work through a lot of the loss and stuff to do with that. But if we go back to my earlier days, say somebody came in with a similar sort of issues. Or if I've been sexually abused, for example. And I decided to work with them. You see, I think the contract is really important here. But anyway, if the counter transfers are so intense that I'm not able to work through it, though, putically enough of the time I was working with the person, then I would pass them on. Yeah, I've done that in the past when some things come up a few weeks in and I've not felt experienced enough in that. We've had the discussion and they've been referred on to somebody that does specialise in that, like eating disorders. I don't have much experience with that. And, you know, the other thing that's come up is that they've been on the waiting list for, you know, therapy through the NHS, whether it's CBT. Oh, yes. And then, you know, they've said, oh, I've got my first appointment or I've got my six weeks doing whatever. Then we have the discussion that it's not appropriate to be seen to people at the same time. Yes, there's another. As we're talking, there's quite a lot of coming for therapists to end them. And of course, as you know, illness. Yes, yeah. You know only too well. Very well aware of that, yes. There was lots of appropriate endings. Yeah, it might be forced on you. Yeah, yeah. I think quite a lot of areas where therapists may, you know, end with clients, even if it's only for a while. Yes. Yeah. Yeah. Which goes back to my earlier statement. The door is always open, you know, to me. And it's, it's, you know, if they finish, it's not like, well, you're finished once, you can't come back again. I don't have that attitude with them. But if they finish in contact 12 months, two years later, then that's absolutely fine. It's an industry. I enjoyed this one, Bob. Yeah, it's an industry. I could talk more, but I know we're running out of time. But I think that's, I think it is. I think your tip, which I didn't have, by the way, where you have emergency numbers is a really good one. Thank you. I think it's for myself and as a supervisor, I didn't stipulate that the trainee should, but on retroflexion, I think it's excellent advice. I think it's from being a foster carer. We always had emergency contact numbers for everybody. It was like the dumb thing. Yeah. I suspect social workers do as well and things like that. Yeah. So I understand why it's useful in the therapeutic arena. Yeah. Okay. Thank you. I enjoyed that. So talking about next time is another topic that we kind of brought up in the past, which is transitional objects in the psychotherapy process. Yes. So I've gone to put the fire on. So yes, that's what it is. And I look forward to talking next time we meet. Okey-dokey. Til next time, Bob. Goodbye. Bye. You've been listening to The Therapy Show. Behind closed doors podcast. We hope you enjoyed the show. Don't forget to subscribe and leave us a review. We'll be back next week with another episode.