Closure and Endings

Hazan and Shaver (1987) were two of the first researchers to explore Bowlby's ideas in the context of romantic relationships. According to Hazan and Shaver, the emotional bond that develops between adult romantic partners is partly a function of the same motivational system--the attachment behavioural system--that gives rise to the emotional bond between infants and their caregivers. Hazan and Shaver noted that the relationship between infants and caregivers and the relationship between adult romantic partners share the following features:

• both feel safe when the other is nearby and responsive
• both engage in close, intimate, bodily contact
• both feel insecure when the other is inaccessible
• both share discoveries with one another
• both play with one another's facial features and exhibit a mutual fascination and preoccupation with one another
• both engage in "baby talk"

On the basis of these parallels, Hazan and Shaver argued that adult romantic relationships, like infant-caregiver relationships, are attachments, and that romantic love is a property of the attachment behavioural system, as well as the motivational systems that give rise to caregiving and sexuality.

Brennan, Clark, & Shaver, (1998)  suggested that there are two fundamental dimensions with respect to adult attachment patterns. One critical variable has been labelled attachment-related anxiety. People who score high on this variable tend to worry whether their partner is available, responsive, attentive, etc. People who score on the low end of this variable are more secure in the perceived responsiveness of their partners. The other critical variable is called attachment-related avoidance. People on the high end of this dimension prefer not to rely on others or open up to others. People on the low end of this dimension are more comfortable being intimate with others and are more secure depending upon and having others depend upon them. A prototypical secure adult is low on both of these dimensions.

 

How does attachment avoidance, or attachment anxiety help you understand Carol Price’s reactions and responses?

 

 

Clinical/professional interventions, as seen in the story of Carol Price, were helpful in supporting Carol to find alternative ways of dealing with and coping with dysfunction in her life. Clinicians not only need to focus on changing maladaptive coping strategies, but also need to understand the underlying unmet needs as well as help individuals learn alternative ways to satisfy their psychological or emotional needs.

 

From the different sessions Carol has with: the liaison nurse; the consultant psychiatrist, and the therapist. Which one did you think was most able to help Carol in her recovery? What role did the other clinicians have?

 

Endings

Ending a therapeutic relationship is important for many reasons. To allow the person to separate from their attachment and reliance on the therapist. To mourn the end of a relationship and experience a good, good bye. To prepare the person for new relationships they will encounter in their lives with renewed confidence, competence and resilience. Who decides to end (therapeutic discharge: when ready for love & work or when the negative transference is worked through)? 

 

What are some of the meanings attached to the end of each session?  Would you expect the end of each session to become easier or more difficult? How can you prepare for endings well and learn from previous ways in which sessions have ended? How did the Psychiatrist respond to Carols question – why is this happening to me?

 

WORKING THROUGH

Ending is a process, as important as forming relationships. Resolutions and changes are recognised and appreciated. Allow for consideration of previous loss/separations/mourning/grief/sadness.

Loss and grief

According to analytical theorists,  a normal reaction to loss is grief, but if experience of loss has previously not been satisfactorily navigated, loss and or grief can lead depression. Depression has been seen as a state of psychic pain. In the presence of an accepting figure (therapist), the person can learn to better face loss and restore hope. Normal grief and mourning must be one of the best known examples of internalization of the lost object (Pedder, 1982). If all goes well, and especially if a good prior relationship with the lost person was enjoyed, one is left with a good internal object, with memories and experiences of the lost person which are sustaining.

Graduation not termination

Jonathan Peddar explores and writes about ending therapy, and sees endings as more about celebration, than a finality. Ernest Jones writes about endings marking the persons achieving increasing personal strength, confidence, and wellbeing, a capacity for enjoyment and happiness.Freud (1936) wrote that: what analysis achieves for neurotics is nothing other than what normal people bring about for themselves without its help. The business of the analysis is to secure the best possible psychological conditions for the functions of the ego, with that it has discharged its task.

Your own learning journey

Similar to ending a therapeutic relationship, ending this MOOC is about reviewing progress made, new learning and new ways of understanding the world of mental health.

 

How have you connected with what you have seen and read about in the MOOC? What were the most difficult parts? What have been key learnings you will take with you into the future? Can you make sense of what you have experienced during the MOOC, and how does that process help you understand mental health?

Mindfulness

Mindfulness is an ancient meditative practice that helps you pay attention to the present moment, and being accepting.
Accept that your emotions are valid responses to difficult situations. Accept that we have the resources to deal with situations within us, if we can learn to focus attention

Practice mindfulness
A mindful walk can bring much pleasure, and improve our mental health. Walking and exercise is a great way to pay attention to the ‘here and now’, rather than being bombarded with worrying thoughts and anxious feelings.Take a couple of minutes when on a walk to really notice the colours of things, the smell, the sounds, the act of walking, muscles being used. Notice your breathing.Thoughts will intrude, but try to bring your attention back to the walk and your walking. Bring your attention back to within you. Take notice of how you are feeling now, and when you started the mindful walk.

Being resilient is about being aware of the situation and your own emotional reaction and behaviours of those around. Resilient people can think through and creatively solve and tackle each different situation. Resilient people often have other people (a social network) they can rely upon to help them resolve situations.