The Final Act: What Happens When Therapy Ends and Relationships Change?

Therapy is often a transformative journey, a space where individuals confront their deepest fears, unresolved conflicts, and emotional wounds. But what happens when the therapy ends? What does it mean when a patient simultaneously ends an external relationship with a partner, whether that be through separation, emotional withdrawal, or a profound shift in the relationship dynamic?
From a psychoanalytic perspective, the end of therapy — and the ending of a relationship in parallel — often involves deep psychological processes that can reveal unconscious desires, fears, and dynamics. It is not uncommon for patients to act out unresolved feelings in their personal lives as they reach the end of their therapeutic work. These acts, often unconscious, may mirror or reflect the emotional work that has been unfolding in the therapy room.
In this blog, we will explore the phenomenon of acting out at the conclusion of therapy, why it sometimes manifests in the form of relational shifts, and what should be worked through to understand the deeper meaning of these changes.
The End of Therapy: A Moment of Confrontation and Change
In psychoanalysis, the „end“ of therapy is not simply a final session where patients leave the office. It is often a complicated and charged moment, one that can bring up feelings of abandonment, closure, and completion. For some patients, the idea of ending therapy triggers a profound existential confrontation — the loss of the therapist, the symbolic loss of a secure holding space, and the challenge of facing the world without the constant emotional support of the analytic container.
Sigmund Freud referred to the process of termination as “the working through,” a phase in which the patient revisits and integrates key themes that have arisen throughout therapy. In this process, the patient may begin to externalize the emotional growth and understanding they have achieved, but often, it is also a time where old wounds are reactivated. The ending of therapy, much like any other emotional transition, can provoke feelings of instability, uncertainty, and vulnerability.
When a patient simultaneously ends an external relationship with a partner during this time, it is often a direct manifestation of what is happening inside. In many cases, this shift can feel as though the emotional system is realigning — the therapeutic work, in a sense, has completed its course, but old patterns of behavior still linger, often acted out in significant personal relationships.
Acting Out: The Unconscious Communication in Relationships
Psychoanalyst Melanie Klein introduced the concept of acting out in psychoanalysis, referring to the unconscious enactment of emotional conflicts or repressed impulses. When therapy ends, particularly if it feels prematurely or incompletely resolved, patients might unconsciously project unresolved internal conflicts into their external relationships. These relationships, including romantic partnerships, can serve as the stage for these conflicts to play out in real-time.
For example, a patient who has worked through issues of abandonment, neglect, or emotional neglect in therapy may unconsciously „test“ their partner by creating a similar dynamic of emotional distance or rejection. The breakup or ending of a relationship can be seen as an enactment of old attachment patterns, where the patient feels compelled to distance themselves or sabotage intimacy because, on some level, it feels more familiar or safe. This may be a defense mechanism against the anxiety of fully committing to their partner or the fear that intimacy will ultimately lead to abandonment.
Similarly, if a patient has become dependent on their therapist as a secure attachment figure, the impending end of therapy may evoke feelings of losing that secure base. This can sometimes be projected outward in relationships, resulting in a partner being overwhelmed or pushed away.
The Unfinished Business of Separation: What Needs to Be Worked Through?
The ending of therapy and a relationship often triggers an emotional reaction that needs to be carefully understood and worked through. If a patient abruptly ends a relationship after therapy finishes, this may be indicative of unresolved feelings that need to be processed. Psychoanalysts argue that termination — both of therapy and relationships — often brings up feelings of grief, loss, and unresolved attachment dynamics.
What needs to be worked through in these situations is both the grief and the integration of what was learned in therapy. Just as a child may need to mourn the loss of the security that was once provided by their caregivers, a patient must also grieve the loss of the therapeutic relationship. This grief is not only about the therapist but also about the aspects of the self that were discovered, confronted, and worked through in the therapy process.
In many cases, the termination of a therapeutic relationship may be experienced as a form of psychic rupture, akin to a breakup or an emotional crisis. The „acting out“ — whether in the form of emotional withdrawal, leaving a partner, or making drastic life changes — is a way of symbolically reenacting the ruptures in early relationships that have yet to be fully worked through.
This is where the deeper therapeutic work comes into play: the patient must be able to integrate the emotional and psychological shifts that therapy has fostered. This involves finding a new balance, where the patient can maintain their sense of self and autonomy without relying on old defense mechanisms or emotional crutches.
What Happens When Patterns Shift?
The shift in a relationship dynamic at the end of therapy can also reflect the internal changes that the patient has undergone. When therapy ends, many patients have gained insights into their behavior, desires, and motivations. For some, this newfound self-awareness may create friction in existing relationships, particularly if the other partner does not understand or support these changes.
For example, a person who has gained insight into their codependency in therapy may begin to assert themselves more in their relationship, causing a rift with their partner who may have previously benefitted from the patient’s emotional dependence. Conversely, a patient who has worked through unresolved attachment issues might suddenly find themselves needing more space, which may leave their partner feeling confused or rejected.
In these cases, the shift is not necessarily a sign that the relationship must end, but rather an opportunity for growth. The key to working through this shift lies in understanding how the therapy work is playing out in the relationship and discussing these changes openly with the partner. This means recognizing how therapy has empowered the patient to set boundaries, assert their needs, and explore a more authentic sense of self.
The Final Act: Integration and Moving Forward
As therapy comes to a close, both the patient and the therapist must engage in the important process of integration. This involves taking what has been learned and applying it to everyday life in a way that feels organic, manageable, and sustainable. It is often helpful for patients to reflect on how their relationships — including romantic partnerships — may shift or change as a result of this new understanding.
At the same time, the patient may also need to engage in some grieving for what is lost — not only the therapeutic relationship but also the old ways of interacting with others that no longer serve them. Therapy, like any significant emotional experience, asks for a reorganization of the self. It is an opportunity to let go of old patterns and embrace new ways of relating to others.
In the end, when therapy ends and significant relationships shift, it is a moment of transition. These emotional shifts need to be understood as a process of growth, one that requires both patience and introspection. By working through the unfinished business that arises in these transitions, patients can move toward a healthier, more authentic way of being in their relationships, free from the unconscious enactments of past emotional conflicts.
Literature References:
• Freud, S. (1923). The Ego and the Id. SE, 19:12-66.
• Klein, M. (1932). The Psycho-Analysis of Children. Hogarth Press.
• Bowlby, J. (1988). A Secure Base: Parent-Child Attachment and Healthy Human Development. Routledge.