The Unforgettable Closure: my journey with Therese (76 y)

A little nervous, I entered Thereses house.

I was late because I left her address at my private practice, and needed to make a detour.

When I apologized, Therese reassured me, saying she was just happy I had come.

​​Therese had never been late for our therapy sessions, always arriving at least 15 minutes early.

A few months ago, we decided to end the therapy.

Little sunshine

Therese had been suffering from Empty Nose Syndrome (ENS) due to a medical error. Five years ago, a doctor had removed too much of her turbinate during a procedure, leaving her with a constant sensation of breathing in too much air. This had caused her to feel tired, dizzy, and unwell, leading to severe depression. Unfortunately the doctor who operated never owned up to his mistake, making her feel frustrated and unseen. Because of the worsening depression, her general practitioner referred her to the private practice where I worked at the time.

During our initial session, Therese told her life story, gradually moving her chair closer to me while continually adjusting the volume of her hearing aid. She had been born with Turner Syndrome, a genetic disorder causing various medical and developmental challenges throughout her life. As she spoke about her life's challenges and how she had overcome them, I couldn't help but feel a deep sense of sympathy and admiration for her. Her mother used to call her 'little sunshine' and I could see why.

I felt hopeful that therapy could help her through this difficult time. Toward the end of that first session, Therese stood up, looked at me with an expression of desperation, as if a little girl was pleading with me not to leave her alone.

She silently begged for help, saying, "Please, help me. I can't go on like this. No one should have to. No one has been taken me seriously. They say it's all in my head. Please, do you think you can help me?"

In that moment, I felt an enormous weight on my shoulders. My heart sank, leaving me speechless. It wasn't solely due to the question itself, but rather the manner in which it was posed. I witnessed a vulnerability I hadn't encountered before. This small yet resilient individual was entrusting me with all her hope, instilling in me a profound sense of responsibility. I quickly composed myself and assured her that I would do everything in my power as a therapist to help her feel better. While I couldn't provide a medical cure, I promised to never give up on her.

And yet, I had to.

Or, at least, that's how it felt. Her journey became one of the most challenging ones I would embark on as a therapist. Not due to Therese as a person, but because we struggled to align our therapy objectives. My approach involved grieving over the event and its consequences, accepting her new reality, enhancing her coping mechanisms and increasing her social support since she felt alone in this. However, she was resistant to the idea of grieving or accepting.

Each session was marked by her pleas for help, inquiries about other doctors or medications, crying that the suffering was abnormal, no one should have to endure it, no one was helping her, and the unfairness of it all. I started to feel stuck, and losing a little bit of hope as time went by.

Being honest with myself

Although I tried everything within my capabilities—working toward acceptance in 101 different ways (from creative therapy, to cgt, act, embodied work,...), addressing her anger and frustration toward the doctor, being a listening ear, or involving her family in a more systematic approach—we didn't make the progress we both hoped for. While her depression improved, we struggled to find a way for her to cope with ENS.

Deep down, I knew I couldn't provide her with the healing she sought. I had always promised myself to be transparent with clients when I felt that I couldn't help them effectively or lacked the necessary hope for therapy to succeed. I felt that I couldn't provide Therese with the support she truly needed, and she wasn't making the progress she had hoped for.

Her depression improved, but we couldn't find a way to cope with the psychological suffering due to the ENS.

Emotionally, I felt as if I failed her. But rationally, I know Therese simply wasn't ready for therapy.

She refused to accept her new reality, holding onto the hope that someone would discover a solution. She continued to consult every available doctor all over the country, sharing her story with anyone who would listen. While I deeply admired her perseverance, it created significant challenges for her in this situation.

The end of therapy

I found a therapist specializing in chronic pain to take over her care. I hoped she would be able to help Therese in a way I couldn't. Therese attended one session with the new therapist but returned to me, explaining that she had decided to stop therapy entirely. While she acknowledged that the session with the other therapist had been helpful and made her feel understood, it wasn't what she wanted. She remained determined to seek a doctor who could provide a cure. And that's the one thing we as therapists can't do... no matter how much we would love to.

We discussed the pros and cons of ending therapy, and I assured her that my door would always be open should she change her mind. I didn’t feel ready to let her go, knowing she wouldn’t continue to receive psychological support, but I had no choice.

An unexpected request

At the end of our last session, I informed her that I would prepare all the necessary paperwork and asked her when she could come to pick them up. She surprised me by suggesting to end our sessions with a cup of coffee at her house, telling me how much it would mean to her.

I knew it was the most beautiful closure I could give her.

Therese had often mentioned how she enjoyed having people over for coffee and a chat at her home. It created a moment for her to look forward to, where she could momentarily forget about her illness.

Therapy is built on human connection. It’s not about becoming friends, but I firmly believe that vulnerability should be a two-way street.

Clients share their most intimate thoughts and experiences—the things they’re afraid to tell anyone else, their deepest shames, their guilt, their sleepless night's anxieties, and more.

Of course we don’t need to share our own life stories, but we must create a safe space for clients to open up fully, and this often requires a degree of vulnerability. In this situation, it was being open to the idea of having a cup of coffee together at her house.

A Heartfelt Farewell

So, here we are now, sipping coffee on Thereses porch. The walls are decorated with beautiful, colorful paintings from her deceased mother. She loves the one with the sunflowers because it reminds her of the happy person she used to be. We discuss her ongoing search for medical help, her new medications, the unfairness of her situation, and her unwavering determination to find a cure.

I learn about the meaning behind her mother's paintings, which are created in support of children's cancer funds, she tells me about the vegetables and nuts her beautiful garden provides, about all the pictures in her house of her loved ones, and shows me with a lot of pride the mug she made with a picture of her mother and her sisters.

While her husband in still snoring on the couch behind us, her 12-year-old cat jumps onto my lap and begins to purr. I smile at Therese thinking she's one of the bravest women I have ever met.