Therapy Beginnings and Endings

handA universal tendency, found in every culture on earth, is to develop carefully prescribed rituals for coming and going. Why? Because beginnings and endings are extremely important to relationships. The way we are greeted sets the tone for everything else that will follow during a limited period of interaction. And it is the words and gestures a person chooses, just before departure, that consolidate our feelings about the interaction and about that person.

Most every profession, in which persuasion plays a significant role, devotes time and attention to beginnings and endings. It has been so since 1925, when Lund formulated the law of primacy in persuasion (i.e., the side of an issue presented first will have greater effectiveness than the side presented subsequently). This was generally held to be true, until 1950, when Cromwell conducted experiments illustrating the power of the recency effect (i.e., the side of an issue presented last is more easily recalled). Now it is generally accepted that both the beginning and the end have special significance.

This is why trial attorneys learn to make compelling opening statements and decisive closing arguments. An experienced attorney knows that, in a close case, a trial can be won or lost in the opening statement. This is because the opening statement shapes the way jurors perceive the evidence. Once jurors reach a preliminary conclusion about which side they support, it can be difficult for them to change their preference, even in the face of contradictory evidence. Whereas the opening statement is a persuasive presentation about what the evidence will show, the closing argument is an argument about what the evidence has shown.

I like to do the same in therapy. My opening line is designed to communicate the idea that help is available and that there is reason to hope for progress. When it is time for the session to end, my final statements are designed to communicate the idea that some type of significant progress has been achieved and that there is reason for increased self-confidence.

Another profession that pays close attention to beginnings and endings is negotiators. Regardless of whether he or she works on Wall Street or for the FBI, a skillful negotiator knows how to start a conversation in such a way that the other party feels comfortable sharing his needs. According to the FBI’s former top negotiations expert, Constantine von Hoffman, “Your job as a negotiator is to help them feel safe enough to tell you what the problem truly is, to really expose themselves.” Those trained by Hoffman learn to accomplish this by starting with open-ended questions. This allows the other party to begin with a feeling of control. This illusion of control is eventually turned to a position of advantage as the expert negotiator employs the information he has collected.

Although in therapy we are not seeking the release of hostages, the use of open-ended questions, at the start of therapy, allows the therapist to quickly find the core issue. A simple but important question is, “What has happened since I saw you last?” In most cases, clients feel duty-bound to answer only the questions asked by the therapist. So if you do not think to ask, “Did your teenage son attempt to kill himself over the weekend?” or “Did your husband tell you that he no longer loves you and plans to leave?” some very significant events may not get addressed until near the end of the session, when the client finally apologizes for being so distracted during therapy. Another open-ended question, I like to use with established clients is, “Were you thinking of something that you wanted to discuss, as you drove over here?” The typical response is, “It’s funny that you should ask, I was telling myself on the way over that it is time for me to…” I start the session with topics that are currently pressing for attention because this is where motivation and energy for change are located. If the end of the session arrives, and the client does not have much to say, then it is time to once again employ the open-ended question. Ending questions which I have found to be very useful include, “What was the most difficult part of the session?” and “What was the most helpful part of the session?” or, “How do you feel after doing your therapy today?” These all communicate concern. But even more importantly, these questions allow the therapist to assess whether the client’s needs have been met, and whether or not they are satisfied with your work.

I do not believe there is one “right” way to begin or end a therapy session. It depends on the situation and the person. However, I am confident that those who pay close attention to beginnings and endings are in a better position to help the client benefit from the therapy relationship and consolidate his or her feelings about the experience.

Woman extending hand image available from Shutterstock.

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3 Responses to “Therapy Beginnings and Endings”
  1. Yes, this does happen in real life, although not as often as anyone would hope. Yet even when it’s the patient who chooses to end therapy, and the two parties “agree to disagree,” it is still very beneficial to plan ahead and allow for a termination phase — the length being roughly proportional to the length of the therapy, from a couple of sessions to several weeks — to discuss the ending. Unexpected feelings can arise when time is short. By exploring these feelings, therapy can be therapeutic until the very end.

  2. Psychodynamic therapy, on the other hand, grew out of the theories and practices of Freudian psychoanalysis. Psychoanalysis is based on the idea that a person’s behavior is affected by the unconscious mind and by past experiences. Psychoanalysis involves an intense, open-ended exploration of a patient’s feelings, often with multiple sessions in a week. The sessions include an examination of the feelings the patient is aware of and those the patient is unaware of before therapy begins.

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