After The Last Session…Now What???!!

October 7th, 2019
By Annélie Anestin, PhD, Psychologist

Now what? In my opinion, that is one of the most important and emotionally charged question to be explored in psychotherapy. Before discussing the end of a therapeutic relationship, allow me to backtrack a little. When psychotherapy is started, my role is to assist clients in fostering their autonomy to identify the nature of their struggles, learn coping strategies to alleviate their distress and raise their awareness of self-efficacy. As my colleague Andrea described in her blog post about life therapy: “we believe that psychotherapy is not for life and we strive to help clients identify what can make them feel their best and build a life from which they don’t need to escape from”. 

Throughout the therapeutic process, progress is monitored and at some point, an agreement is reached to end therapy. To me, that is always a special moment to witness…seeing clients feel better and believing in themselves that they can enjoy life and cope with its challenges is so uplifting! That last part, … coping with life’s struggles… is what the “Now what?” refers to. I have been asked that question by almost every client during the last session. Despite feeling better, clients are often concerned with a fear of relapse. What if my depression comes back, what if I have another panic attack? What if I get in another fight with my husband or son? These fears are very common and important to acknowledge. The answer is Now you live, Now you enjoy what you worked so hard to build for yourself, Now you focus on your priorities and values. Trust yourself that you have the coping skills to face these challenges. Not convinced? Here are a few tips to help you navigate the fear of relapse

• Differentiate between experiencing a lapse and a relapse. The former is very common and happens when you go back to your unhelpful habits for a short period of time. For example, avoiding making a business phone call for 1 day or 2 because you are too nervous. The latter refers to resuming all your previous coping mechanisms and thinking patterns. For example, coming up with an excuse or delegating to others all business phone calls to avoid feeling anxious and telling yourself you will make a fool of yourself.  
• Identify possible triggers that can lead to a lapse or relapse. For example, lack of sleep, interpersonal conflict, stressful life situation, lack of self-care routine, etc.
• Remind yourself what was helpful during the therapeutic process to deal with these triggers. For example, challenging your thoughts, deep breathing, emotional processing strategies, problem solving strategies, etc.
• Be compassionate towards yourself. Being self-critical for falling in your old ways will make you fall in them that much more. Instead, adopt a self-compassion stance: be kind and patient with yourself and recognize that you are in a challenging situation, which happens to the best of us, and that you have the coping skills to deal with it even if at this very moment, you don’t feel like you do.
• Have a look at this link providing detailed information and tips regarding fear of relapse: https://anxietycanada.com/sites/default/files/RelapsePrevention.pdf

In a nutshell, that is it after the last session. Acknowledge the fear of relapse but remember what you learned about yourself throughout the therapeutic process that led to your progress. Lastly, know that your psychologist is always available for a booster session!