not talking about death
“I just wanted it to end better this time” they say …
They hold their last piece of artwork tightly, a piece that seems in it’s contained and folded way to have encompassed all of the materials used in the months of work. Little bits of it drop to the floor; a small pile of colourful residue that I will soon be brushing away.
For many therapists the last few weeks or months can be the most fruitful and hardest in treatment. The end-point of a therapeutic alliance is a moment of unavoidable death in which the client may integrate their wider internal concept of loss into something tolerable.
When clients request to end treatment it can take a while to convince their care teams that this is appropriate. Partly as caring people we all want to be so sure that the client is safe and that ending treatment is timely, but I’ve also noticed how in these last moments that other people want to ‘get in on the act’ of therapy. Having spent much time being aware of the suspicions of family and care teams about the purpose and efficacy of art therapy, I then spend much time carefully extracting them from the process at the end of their client’s treatment. It’s as though by this final stage they (carers and families) all want a bit of the therapeutic action.
One client made solid, blocky structures out of all sorts of materials. I spent my time with them wondering whether the room or even I could contain the increasing volume and size of the structures, sensing that we may never shift into a different gear. Then they seemed to loosen the process, letting go, playing with mess and allowing the structures to almost dissolve into puddles of fluid emotion.
Support staff appeared to view our work as ‘activity’ and little else … a nice way for the client to spend their time, whilst their medics prescribed medication to the job I clearly wasn’t doing. After a while the client started talking about the length of time they had been in treatment, talking about how much more normal life was for them now. Their work became quite solid again, but with space and fluidity built in. They appeared settled. I felt as though they had instigated an ending, and yet now I found myself being cajoled by those around the client into keeping treatment going -
“it’s the only thing they engage with; they love coming”
“Are you sure? I don’t think they’re ready … we’re not ready to end”.
It’s inevitable that in thinking about endings with clients we are thinking about our own death and mortality. This hopefully isn’t news to any therapist, and yet for families that have spent their adult lives trying to stay alive amidst the challenges and potential confusion of a child with cognitive disabilities then thinking about what has always been in the background, their own mortality and that impact on care for their child appears overwhelming; an ending understandably to be avoided at all costs.
I have raised the issue during reviews with families of ‘succession of care’; a polite and slightly kinder way into the conversation about who cares for your disabled child when you die and the impact that might have on your current relationship. One time the mother became quite tearful and talked about her own mother dying. The death sounded distant, silent; with no exchange of words. It didn’t sound like a good ending. In speaking about this the room became silent. The client appeared calmer as though for a long time they had been anxious about this obvious loss - the loss of their parent. We left with a sense of something having shifted, the mother shaking my hand as though I were there just for her. I was touched by my own sense of loss, of my own mother, of her mother and others before. There was nothing new here, but that didn’t stop this moment feeling like the most profound in months of treatment. I felt extraordinary, useful and full of meaning, if only for a while.
