Service users’ first accounts of experiencing endings from a psychological service or therapy: A systematic review and meta‐ethnographic synthesis

Abstract

Purpose. To review and synthesize the qualitative literature on service users' experiences of endings from a psychological service or therapy. Methods.A systematic search of the peer-reviewed literature identified qualitative studies meeting specific inclusion criteria. A modified CASP tool was used to critically appraise their quality, and a meta-ethnographic approach was used to synthesize their findings.Results. Twelve papers met the inclusion criteria. The interpretation of findings suggested three key themes: anticipation of ending, service user control, and sense of responsibility. Although studies varied in geographical location and type of service, they were consistently of high quality.Conclusions. The review highlights the importance of service users' perspectives in understanding the experiences of endings. The findings complement existing literature and provide new interpretations. Considerations for practice were limited; however, the review provides useful directions for future research. Practitioner pointsWhen ending therapy, clinicians should consider the dyadic nature of the therapeutic relationship and the emotional impact this may have upon both service users and staff. Further consideration should be given to how staff manage their responses to the ending. The time-limited structure of therapy may aid the ending process by relieving staff and service users of responsibility.'Ending' in therapy is the process whereby a service user concludes their therapy or treatment. The end point in therapy is influenced by two or three distinct parties: the client, the therapist, andwhere applicable, the service in which the therapy is delivered.

A survey of therapists’ experience of ending therapy with people with intellectual disabilities

“…The importance of a planned ending echoes findings from the general population literature. In their systematic review, Webb et al (2019) found that by experiencing a planned and well-prepared ending, clients felt more in control, which subsequently alleviated feelings of anxiety in relation to the impending end. Webb et al (2019) also reported that, as part of endings that go well, collaborative decisionmaking regarding the end of therapy alleviated associated feelings of anxiety.…”

“…In their systematic review, Webb et al (2019) found that by experiencing a planned and well-prepared ending, clients felt more in control, which subsequently alleviated feelings of anxiety in relation to the impending end. Webb et al (2019) also reported that, as part of endings that go well, collaborative decisionmaking regarding the end of therapy alleviated associated feelings of anxiety. Mangione et al (2007) found a similar result with therapists working in the general population: 36% of therapists surveyed suggested that endings should be jointly decided; however, in practice, this was less likely to occur.…”

“…There is a consensus within the literature and in clinical practice that psychological therapy has three phases: an initial phase, middle phase and an ending phase (Webb et al , 2019). Gelso and Woodhouse (2002) state that the ending phase is when “the therapist and client consciously or unconsciously work toward bringing the treatment to an end”.…”

Grounding clinical guidelines in service users’ experiences of endings

“…A deductive coding framework was developed as a template to guide the deductive process (Crabtree and Miller, 1999). Codes were derived from the literature, namely, the National Institute of Health and Care Excellence (2009) guidelines and a systematic literature review on service users’ subjective experiences on endings (Webb et al , 2018). A refutational stage (step 4) was added as a process to ensure that the researchers considered contrasting data.…”

“…Within mental health-care services, endings are widely considered to be an important phase of therapy for both service users (Webb et al , 2008) and therapists (Råbu et al , 2013) across a wide range of clinical areas and therapy modalities and often elicit a complex emotive response (Wachtel, 2002).…”