Do you struggle with how to end a challenging session smoothly?
If so, you are not alone. In fact, mastering the art of closing a therapy session without leaving your client feeling cut off is a challenge for many, and a skill that is worth learning.
So we posed the question to some expert therapists who were very gracious in responding with their best advice:
What have you found to be a smooth and effective way to close an emotionally-charged session on time?
It’s obvious that these senior therapists have gems to share. They have learned through years of practice what works (and what doesn’t) to wrap up the session smoothly and on time. Don’t miss the summary at the end of this article!
“Here is what I typically do and routinely teach therapists who are having trouble ending a therapy session, especially with clients who suffer from trauma histories. Note: the “internal parts” here are Internal Family Systems constructs.
1. I always let them know that we have 5 minutes left in the session.
2. I have them check “inside” and see if there is anything that the internal parts of them want the client to know before the session is over. For example, stay connected, check-in daily, promise to follow-up next week, etc.
3. I ask the parts to take back their energy and try and go to a safe place in the client’s mind, until our next session.
4. Make sure you (the therapist) follow-up with the issue you were discussing when you see the client next. It is important to not make false promises.”
Dr. Anderson is in private practice and he expanded his professional focus in 2004 after he met Richard Schwarz, Ph.D., founder of Internal Family Systems (IFS). Dr. Anderson learned to integrate the IFS model into his passion for psychopharmacology, neurobiology and trauma therapy; He and Dr. Schwartz currently teach IFS, Trauma and Neuroscience, a five-day intensive training for therapists. In 2013, Dr. Anderson was named the chairman of the Foundation for Self Leadership (FSL)—a nonprofit organization dedicated to advancing IFS via research, scholarships and outreach. Dr. Anderson serves as FSL executive director and continues to provide consultation, individual therapy and couples therapy at his office in Concord, Mass. Additionally, he maintains an active career as a speaker, teacher, consultant, writer and researcher who travels the globe, often conducting seminars, workshops and training programs. He also remains affiliated with the Center for Self Leadership and Trauma Center at the Justice Resource Institute.
Wendy Behary specializes in cognitive and scheme therapies, as well as narcissism. Cognitive therapy is a type of psychotherapy in which negative patterns of thought about the self and the world are challenged in order to alter unwanted behavior patterns or treat mood disorders such as depression. Schema therapy addresses broad, pervasive themes regarding oneself and one’s relationship with others, developed during childhood and elaborated throughout one’s lifetime, and dysfunctional to a significant degree.
“As a therapist who is not only an educator but who works with really challenging clients like narcissists (my specialty), I know the importance of paying a lot of attention to time. We start with a very keen attentiveness to time. We work diligently to be very attentive while using emotion focused strategies, or working to illicit emotion in the client, or if the emotion is just getting activated spontaneously with more fragile clients. With a client who enters into states of vulnerability easily, it is very important to be aware of time.
Attention to time is important when working to heal old maladaptive themes in a client’s life, to meet unmet needs, and to recalibrate the way a client is holding a distorted position in the way he is thinking that sets off the emotional charge. Or if it’s something that’s happening in the therapy relationship, sometime in the transference or counter-transference (where as we would say in schema therapy, schema’s are getting activated on both sides), these are good moments for realness. So you can say something like, “Time is real, and I care about you, so let’s see if we can use some strategies before we end the session. Let’s make sure that we save some time at the end to debrief.”
Always make sure you have debriefing time where you’re making sense out of the discoveries and the emotions that have gotten activated. Make sure you have time to do some regulation work, whether it’s teaching them mindful awareness, using the breath, body scanning, or safe place imagery. There are many different skills for helping patients get grounded before they leave the session. Ending the session on time helps the client feel more grounded, feel that they can stand up, walk out and face the world again.
One sure fire way that I use in ending a session on time is to cut away at the end, pick up my phone, open up the recording app that I use, and record a message to the client. Therefore, in real time they can listen to it throughout the week. I say, “We’re coming to the end; I know there are still some painful emotions hanging in the air; I know this is upsetting for you and this is a challenging time.” Then I either give them something to practice when they’re at home as an emotion regulation strategy or I say, “I want you to listen to this and as you’re listening, please recognize that I’m going to help you; we’re going to get through this; it’s not going to feel like this all the time; you’re doing really hard work; you’re very courageous; I’m very proud of you; I’m here; I’m on your side.”
Preparing and presenting the tape for them is a way of shoring up that they can exit with a sense of connection to you with a helpful transitional emotional object. These emotions are the things that make it frightening and sometimes impossible to walk out the room because they don’t feel they have resolution or they don’t feel they have sturdiness to carry themselves forth.”
Wendy Behary is the founder and director of The Cognitive Therapy Center of New Jersey and The New Jersey Institute for Schema Therapy. She has been treating clients, training professionals and supervising psychotherapists for more than 20 years. She is also on the faculty of the Cognitive Therapy Center and Schema Therapy Institute of New York, where she has trained and worked with Dr. Jeffrey Young since 1989. Wendy is a founding fellow (and supervisor) of The Academy of Cognitive Therapy (Dr. Aaron T. Beck). SHe was also the President of the International Society of Schema Therapy (ISST) from 2010-2014.
Betty Cannon specializes in providing Applied Existential Psychotherapy (AEP) at the Boulder Psychotherapy Institute. AEP integrates the concepts of contemporary existential and psychodynamic approaches with techniques inspired by Gestalt and other experiential therapies.
“I have no problem with emotionally charged sessions. In fact, I like them. They’re often just what the client needs. But closing in the middle of working with an emotionally charged issue that is far from complete can be a challenge. It depends on the situation entirely, but here is one way I might handle this. First, I would try to be aware of the time so that we have a little space for closure, which in this case would not mean tying everything up neatly, but acknowledging that we’re working with an important issue that will need to be continued at the next session or sessions. If I’m doing empty chair work and the dialogue is between parts of the self or the child-self and the internalized parent or adult self, I might have one part say to the other something like: “I know we’re not done, and I’ll be back to continue this with you next week.” If the client often works on dreams, I might suggest paying attention to dreams over the next week.
Then, I would give the client a few minutes to ground (feet on the ground, seat in the chair, and breathe) and get ready to meet the world outside. I would not express doubt or alarm since I usually feel confident that the client can handle and move forward with her own process. If the client is really charged, I might invite her to sit in my waiting area until they’re ready to drive or otherwise go out and meet the world. I would spend a bit of extra time if the client appears dissociated, having her notice objects in the room and work on grounding and coming back into the present. I would not allow the session to go over the allotted time more than five minutes since this shows lack of confidence in the client, which the client may then internalize and become afraid of their ability to work with their own deep issues and feelings.”
Betty Cannon, Ph.D., is the president of the Boulder Psychotherapy Institute. BPI trains therapists in Applied Existential Psychotherapy (AEP). Betty is its founder. She holds doctorates in both literature and psychology. She is Professor Emerita at the Colorado School of Mines and Adjunct Professor at Naropa University and Regis University. She is the author of many articles and book chapters on existential therapy. Her book, Sartre and Psychoanalysis, is considered a classic in existential psychology. She has worked with individuals, couples, and groups in Boulder for over 30 years and trained therapists for over 20 years.
Lisa Ferentz’s specialties cover a broad spectrum: trauma, attachment, affect dysregulation, shame, self-injury, depression, anxiety, dissociative disorders, and relationship issues.
“This is actually an important question. Ideally, processing emotionally charged material should be agreed upon between client and therapist prior to beginning the conversation. In this way, the therapist can do several things to decrease the likelihood of client dysregulation or flooding. Keeping one eye on the time is imperative. The first 5-10 minutes of the session should be used to remind the client of internal and external resources for grounding, self-soothing, and safety. This can include mindful breathing, using aromatherapy, a “safe place” image, an agreed upon object for grounding such as a pillow, or a smooth stone.
The actual exploration of emotionally charged material should be time-limited as well, leaving anywhere from 5-15 minutes at the end of the session to integrate the aforementioned strategies so any effect can be contained. I also believe that the therapist should invoke pacing throughout the emotional work: toggling back and forth between activation and self-soothing. This approach prevents the work from becoming a “runaway train,” and helps the client to be “forward,” and stabilized at the end of the session. If a client attempts to bring up an emotionally charged subject at the end of a session, I thank them for the courage it takes to want to go there, explain why it would be too de-stabilizing to open that door with 10 minutes left in the session, and then use that time to prepare them for our next meeting when we could safely begin to explore their issue.”
Lisa Ferentz is a recognized expert in the strengths-based, depathologized treatment of trauma and has been in private practice for 32 years. She presents workshops and keynote addresses nationally and internationally, and is a clinical consultant to practitioners and mental health agencies in the United States, Canada, and the UK.
Eric Gentry’s work is rooted in the belief that we all have the innate drive urging us toward our health and maturation. Because of difficult experiences from our past and present, he believes that this drive becomes thwarted and we become stuck in our problems, negativity, and symptoms. His work is about helping individuals confront these obstructions, navigate successfully through them, and realign with their natural maturational processes. He has a wide range of both experience and training in a variety of psychotherapy styles and techniques. He has actually created a process for session closure and trauma containment.
“When a client is either overwhelmed by a trauma memory or has accessed some difficult material in the last 1/3 of a session you can use this technique to contain the traumatic material or safely bring a session to a close.
Eric Gentry is a board certified expert in traumatic stress. He is the current vice-president at the Arizona Trauma Institute. He is slow to view problematic behaviors and beliefs as pathological and, instead, helps individuals identify the utility of these “problems” so that they can adopt more healthy and useful behaviors and beliefs.
Dr. Stanley Hibbs’ specialties are anxiety treatment, productivity coaching, wellness coaching, and marriage counseling. Even with the variety of specialties, Dr. Hibbs has a simple prescription for closing a session: it’s his job to watch the time, not the client, and he will let them know when that time is approaching.
“During my first session, I tell my clients that they may sometimes notice my glancing at the clock. I don’t do this because I’m bored or eager to end the session. I do it because it’s my responsibility to keep track of the time to make sure we cover everything we wanted to in the time allotted. It’s my job to worry about the time; not theirs. Clients usually appreciate this, so I rarely have a problem with ending sessions on time.”
Stanley Hibbs is a licensed clinical psychologist, certified life coach, seminar leader, and published author who has helped thousands of individuals and couples over his 30 + year career. His books include Consider It Done!: Ten Prescriptions for Finishing What You Start, Anxiety Gone: The Three C’s of Anxiety Recovery, and Anxiety – Treatment Techniques That Really Work: A Practical Guide for Therapists. He says, “Perhaps the highlight of my career was traveling the country leading my seminar “Anxiety: Treatments That Really Work” for thousands of mental health professionals.”
Dr. Harriet Lerner is best known for her scholarly work on the psychology of women and family relationships. She has many best-selling books on anger, intimacy, marriage, connection, deception, and more. Feminism and family systems theory are the central themes of her work. Dr. Lerner’s private practice is the heart of her work, but she also tours nationally to speak and consult.
“Although a therapist may be tempted to be apologetic about ending an emotionally charged session on time, the people we work with are ultimately assured when we can maintain time boundaries and end sessions in a calm, confident, and professional manner.
One can say warmly, “Our time is up. We’re in the middle of something important and I look forward to continuing this conversation when we meet again.”
Obviously, as when a patient is suicidal or in unmanageable distress, more is required. No position should be rigidly held. But, as a general rule, it’s important to keep to the time limits and relate to the client’s competence to manage the strong emotions that a session may evoke.”
Harriet Lerner is a clinical psychologist and a contributor to feminist theory and therapy. From 1972 to 2001 she was a staff psychologist at the Menninger Clinic in Topeka, Kansas and a faculty member and supervisor in the Karl Menninger School of Psychiatry. During this time she published extensively on the psychology of women and family relationships, revising traditional psychoanalytic concepts to reflect feminist and family systems perspectives.
Lynn Lyons focuses on anxiety disorders in adults and children in practice. She has written several books on the subject and identifies the role of anxiety in families and the need for a preventive approach, both at home and at school.
I am a big proponent of homework assignments between appointments and of working toward goals. When a session is emotionally difficult, I want to connect what we did in the session to how and what the client will work on between sessions. I have a stack of index cards in my office and I routinely write things down and hand the cards to clients. About 10 minutes before the session comes to a close (I do 60 minute, 90 minute, or 2 hour sessions), I reach for an index card, and say something like, “Let’s write down what we’re working on.” Maybe it’s a mantra, like “It’s normal for me to feel uncomfortable as I step into new situations,” or “Just because I think it, it doesn’t make it so,” or “Every time my heart pounds, I will remember what we talked about and keep moving.” Sometimes I write down the homework to be worked on between sessions: “When I am in situation X, I will change my pattern by doing Y.” This helps both end the session, makes a connection between sessions, and helps my clients move concretely toward their goals in therapy.
Lynn Lyons is a licensed clinical social worker and psychotherapist in Concord, New Hampshire. She has been in private practice for 28 years and specializes in the treatment of anxiety disorders in adults and children. She travels globally as a speaker and trainer. With a special interest in breaking the generational cycle of worry in families, she is the co-author of two books on anxiety: Anxious Kids, Anxious Parents: 7 Ways to Stop the Worry Cycle and Raise Courageous & Independent Children, and the companion book for kids, Playing with Anxiety: Casey’s Guide for Teens and Kids. Lyons’ latest book, Using Hypnosis with Children: Creating and Delivering Effective Interventions is a how-to guide for helping professionals looking to incorporate hypnotic strategies for the treatment of depression, anxiety, medical procedures, pain, and sleep.
Tammy Nelson is a well-known sex and relationship expert. She manages a balance between physical and emotional obstacles and growth when digging through years of unhelpful patterns and helps her clients find love, healing, and passion.
“Many times I see couples in sessions where the emotions run high, and an hour or two is not enough to process years of relationship stress. It can be challenging to process intense feelings in the treatment room, opening up delicate memories, and pent up resentments. At the end of a session, when the clock reaches a few moments before the next couple will arrive, the clients need to be wrapped up enough to not only go back out into the world, but to go back into their world together. Many times they are in the same car, they have to drive home, resume their lives, pick up where they left off.
One way I help them to come to a safe conclusion in an emotionally charged session is to remind them of where they started in the beginning of our time together, and then ask them to share with each other one thing they are taking with them from today.
They review what they have learned, and then share with their partner something they will take into their week. And then I close with one thing they appreciated about their partner in the session. Usually, they can find at least one thing they appreciated, even if it is as simple as, “Thank you for showing up today.”
Most couples look forward to this ritual and find it is helpful in many areas of their life outside of the therapy. I remind them to be “light and polite” on the ride home and not to over process everything that happened in our time together.”
Tammy Nelson, Ph.D., is a sex and relationship expert, an international speaker, an author and a licensed psychotherapist with almost 30 years of experience working with individuals and couples. In private practice she focuses on helping people of all ages, orientations and genders find love, healing and passion. Tammy is a Board Certified Sexologist, an AASECT Certified Sex Therapist, a Licensed Professional Counselor, a Certified Imago Relationship therapist, and a Licensed Alcohol and Drug Abuse Counselor. She is the author of The New Monogamy; Redefining Your Relationship After Infidelity and Getting the Sex You Want; Shed Your Inhibitions and Reach New Heights of Passion Together as well as What’s Eating You: A Workbook for Teens with Anorexia, Bulimia, and other Eating Disorders.
Elana Rosenbaum’s love is practicing and teaching mindful living through meditation and focus. Due to her personal experience, she finds fulfillment in working with cancer patients. Mindfulness as a practice is
described as “Paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally” and “Bringing one’s complete attention to the present experience on a moment-to-moment basis.”
“My approach is simple. I say, “We’ve got to stop now,” in a calm tone and I physically begin moving up from my chair and will walk toward the door and open it. My client follows my example and I tell them we’ll take up where we left off next time.”
Elana Rosenbaum, MS, LICSW, is a leader in the clinical application of mindfulness meditation to cancer care. She has authored Here for Now: Living Well with Cancer through Mindfulness and Being Well (even when you’re sick). In 1995 she was diagnosed with Non-Hodgkin’s lymphoma and subsequently underwent stem-cell transplantation. Her ability to thrive and embody mindfulness in the face of adversity led to the development of a mindfulness-based intervention for bone marrow transplant patients at the University of Massachusetts Medical Center, Emery University and Dana Farber Cancer Institute. She is adjunct faculty at the renowned Stress Reduction Clinic at the University of Massachusetts Medical School where she worked directly with Jon Kabat-Zinn as one of the founding teachers. She’s been teaching and educating patients and healthcare professionals in mindfulness, including leading cancer centers, for over 25 years. Elana has a private practice in psychotherapy in Worcester, Massachusetts and is a sought after teacher, speaker, workshop leader and research consultant.
Dr. Richard Schwartz founded Internal Family Systems (IFS), a model that combines systems thinking and multiplicity of the mind to address client descriptions of various parts–many extreme–they experience within themselves. When these parts feel safe and clients concerns are addressed, they are less disruptive and more likely to accede to the wise leadership of what Dr. Schwartz came to call the “Self.” In developing IFS, he recognized that, as in systemic family theory, parts take on characteristic roles that help define the inner world of the client. The coordinating Self, which embodies qualities of confidence, openness, and compassion, acts as a center around which the various parts revolve. Because IFS locates the source of healing within the client, the therapist is freed to focus on guiding the client’s access to his or her true Self and supporting the client in harnessing its wisdom.
“In Internal Family Systems (IFS), we can have the client tell the part that is so emotional that we have to stop but will pick up with it in the next session right where we left off. So, if it could separate now a little, then we can finish helping it next time. This usually works well, but it means the therapist must remember to bring it up next time.”
Richard C. Schwartz, Ph.D., is on the faculty of the Family Institute at Northwestern University. He is the coeditor of the Handbook of Family Therapy Training and Supervision, the coauthor of three books, and author of over 40 articles on a variety of topics in psychotherapy. He serves on the editorial boards of five professional journals and is a fellow of the American Association of Marital and Family Therapists.
Dr. Ronald Siegel is a teacher, speaker, author, and practitioner of mindfulness, psychotherapy, and mind-body treatment. Dr Siegel’s approach to mindfulness provides step-by-step action plans to help clients become more focused and efficient in daily life.
“This is very challenging for seasoned clinicians as well as beginners, since we need to strike a balance between holding the therapeutic framework and being a decent, caring human being. If we see this coming (it’s 10 minutes before the end of a session and a person is working with difficult material), it’s usually best to say something in advance indicating that you want to help them think through what they need right now, given the end of the session coming soon. That can help your client or patient be a collaborator in managing your time together.”
Ronald D. Siegel, PsyD, is Assistant Professor of Psychology, part time at Harvard Medical School, where he has taught for over 30 years. He is a long-time student of mindfulness meditation and serves on the board of directors and faculty of the Institute for Meditation and Psychotherapy. Dr. Siegel teaches internationally about mindfulness and psychotherapy and mind–body treatment. He has worked for many years in community mental health with inner-city children and families, and maintains a private practice in Lincoln, Massachusetts. He is the coauthor of Back Sense: A Revolutionary Approach to Halting the Cycle of Chronic Back Pain, which integrates Western and Eastern approaches for treating chronic back pain. He was also coeditor of the acclaimed book for professionals, Mindfulness and Psychotherapy and Wisdom and Compassion in Psychotherapy: Deepening Mindfulness in Clinical Practice, and coauthor of the new professional text, Sitting Together: Essential Skills for Mindfulness-based Psychotherapy.
Jim Thomas is an active life coach, trainer and psychology therapist. His specialty is emotionally focused therapy (EFT). EFT is a structured approach to couples therapy formulated in the 1980s and has been developed to expand understanding of the dynamics in couple relationships.
“When I see the time winding down on the clock as a couple is winding up or remains wound tight, I know it is time for me to breathe. Taking a few deep breaths, my heart opens up. Look to the couple and what brought them to the session, to this work. Ask, how can this highly emotional reactive process be seen in a meaningful, positive light? What positive intent drives this behavior and the underlying emotion? As a fellow therapist taught me, how does this reflect the intensity of their bond? Then find a way to reflect this back to them, meeting them where they are. ‘I see how upset and troubled you both are. The train picked up speed today and you might leave here feeling frustrated, lost or hopeless. Yet, there is something important about all this. I see how much you care, how important this is to you both, wanting to be heard and to change things. How might we all take a moment to slow down and reconnect before you leave today?’”
Jim Thomas is a licensed Marriage and Family Therapist, EFT Therapist, Clinical Fellow and an AAMFT Approved Supervisor as well as an ICEEFT EFT Supervisor. His work focuses on helping people to be more fully aware and engaged in their lives. He accentuates their wholeness and strengths while dealing with real issues. He says, “When people connect more deeply with themselves, they can step beyond self-imposed limitations.” Jim is now a Director Emeritus of the Denver Children’s Home. After stepping down as Director of DFI, Jim became the Director of the Colorado Center for Emotionally Focused Therapy. He is active as an EFT Therapist, Trainer and Supervisor. He also enjoys providing life coaching and positive psychology therapy support to individuals in his private practice.
How to End a Challenging Session Smoothly
There you have it: 13 secrets to closing a challenging therapy session based on personal and professional experience of expert therapists. Here are some important points to remember:
We want to thank all of the experts that contributed their wisdom to this post. And all other therapists, please let us know in the comments below what you found most helpful for how to end a challenging session smoothly and on time.