Endings and Transitions

Learning objectives:  

In this guide you will learn to:  

• Collaboratively structure the intervention within a time-limited framework, using clear contracting, goal-setting, and phased planning to support engagement and prepare the young person for a meaningful ending. 

• To explore and normalise endings, using anticipatory conversations to help young people process loss and transition. 

• Use therapeutic tools such as ending letters, shared understanding maps, and staying well plans to consolidate progress and support continuity beyond therapy. 

• Support transitions and discharge by scaffolding onward planning, validating responses, and promoting reconnection with life outside services. 

Time-limited working 

• As previously outlined, this intervention uses the principles of cognitive analytic therapy, which is a time-limited intervention. To manage the young person’s expectations, the duration of treatment is agreed from the beginning. We aim to convey that endings are a natural part of life by acknowledging that we are working together for a specific period in a young person’s life. It is not essential that all 16 sessions are attended; many young people may conclude earlier. 

• The advantage of time-limited working is that the ending is anticipated from the outset. Some young people may not feel ready to end or feel they have not reached their desired goals. Exploring hopes and expectations early can help manage this and support young people to see that goals can take different forms. We might ask: what would you like to feel different at the end of this work, or, what you like to be able to do when you leave here?  

• It could be helpful to assess the value of counting down sessions or whether it is more supportive to work in blocks; for example, it can be helpful to map out the ‘phases’ of the intervention, including shared understanding and learning new skills. The young person can have ownership of their own experience in the intervention, including the ending, by explicitly exploring what they want to have achieved by the end of your time together. 

• Remember: the intervention supports the work and development that happens outside sessions, helping reduce longer-term dependence on services. 

 

*Video 10: Endings* 

 

 

Concluding the intervention  

• It is important to notice the emotional impact of an ending in therapy. There can be a dip in mood, or a re-emergence of symptoms as the young person is confronted with independence. This is a valid emotional response in an intervention and it can be mitigated by allowing space to process and grieve the ending in sessions. When developing a shared understanding of the young person’s life and difficulties, we can explore possible responses to endings (see module on shared understanding). For example, young people who have developed strategies to keep others close by going to extremes may experience a return of earlier symptoms or behaviours to hold on to the service. Conversely, a young person who strives to be perfect to feel seen may not acknowledge difficult feelings in response to the ending, aiming to be a ‘good patient’. 

• An ending letter is shared between the young person and practitioner in the second-to-last session. The young person is invited to contribute or write a goodbye letter in response. This letter provides a summary of the work completed, reflects on progress which is made during sessions, and serves as a reminder of the therapeutic journey which the young person can revisit. It may also reflect on the therapeutic relationship and any ongoing goals. 

• By marking ongoing tasks, the clinician shows confidence in the young person’s ability to move forward or transition to new services without continued support, whilst acknowledging the limits of the work. 

Ending letters 

While there is no fixed format for a goodbye letter, Corebridge (2019) offers a helpful summary. This may includes: 

1. An introduction to the purpose of the letter. 
2. A summary of the context, objectives and work that has taken place in the intervention. 
3. A summary of the shared understanding of the young person’s difficulties. 
4. New coping strategies or new patterns of relating learnt. 
5. Predictions and acknowledgements about what may be difficult going forward. 
6. The practitioner’s personal reflection on the therapy and the therapeutic relationship. 
7. Any plans for follow-up appointments. 

• Young people who have ended with the service will have the opportunity to attend a three-month follow-up appointment to reflect on the experience and process of the intervention. This also provides an opportunity to share how things are going since concluding the work. 

 

*Video 11: Endings and transitions* 

  

Transitions 

Many young people with symptoms of personality disorders may present with anxiety about endings. The techniques discussed in this approach can help reduce feelings of abandonment and rejection. For many young people, further scaffolding is required around transitioning into new health services, systems, or vocational settings.  

What is a transition? 

In healthcare, transition is the process of preparing, planning, and moving from young people’s services to other forms of support. This may include adult or community mental health services, third sector organisations, education, employment, or residential care. The Scottish Government’s Transition Care Plan (TCP) (2018) helps outline needs, preferences, and concerns from young people ahead of the move. The best practice is to begin this process early and collaboratively. As this intervention we offer is time-limited, the practicalities around transition planning will take place in the latter or ending phase of the intervention e.g. appointments 10 – 16.  

Guiding principles for transition to adult services, education or third sector services  

To transition a young person to other services, below are some guiding principles:   

• Consider the rationale or need for additional support. 

• Identify what support is needed, based on strengths, needs, context, and the intervention journey. 

• If it is appropriate to transition to adult services, prepare and educate young people about differences from child or adolescent services and consider how this might be experienced by the young person. 

• Frame adult or third sector services as person centered, designed to meet an individual’s strengths and needs where they are now. 

• Practitioners should connect with adult services, education, or third sector supports, and arrange planning meetings or visits if appropriate 

• With the young person’s consent, learnings from the intervention (shared understanding of difficulties, ending letters and maps etc.) can be shared with the new care team to support risk management, build trust, and empower the young person to tell their story. The shared understanding can also help identify potential ruptures during the transition.  

 

If there is not an onward referral to adult services, the following principles may be helpful: 

• Tune into current needs and offer transparency around decisions (e.g. “we think you need a break to consolidate the work you have done, but you have a period of time to get back in touch to re-establish contact with services”). 

• Validate feelings of uncertainty and disappointment in the young person around loss of services to help mitigate feelings of shame around help-seeking. 

• Base follow-up plans on new learnt skills, using a strength-based and personalised approach, emphasising activities outside of mental health services. 

• Consider how to maintain improvements in functioning through structured activities and tasks e.g. study, volunteering, work, or new hobbies. 

• Refer to the shared understanding and maps developed to inform risk management and crisis planning. 

• Consider practical support in planning, e.g. empowering young people to contact other agencies in scaffolding their ongoing support systems.  

  

 Managing endings,  reframing “goodbye” as a transition 

Many young people do not transition to adult mental health services and are discharged when the intervention ends. We can support young people to reconnect with their communities and systems, returning to their developmental path with the benefit of shared understanding and improved relationships. This emphasizes the importance of connecting with life outside of services. 

When work has ended, there is a transition of responsibility back to the young person with respect to their care, increasing agency and autonomy. The end of each appointment also represents a ‘mini ending’; the practitioner and young person rehearse the ending many times over the course of the intervention. By creating ending rituals, young people can process the experience and build a smoother transition out of the intervention. Therapeutic gains as well as the limitations can be named and evaluated using appropriate tools e.g. Goal based outcomes (Law, 2015) cognitive analytic therapy rating sheets (ACAT) or patient reported experience measures. 

Adolescence is a time of identity formation and intervention can help support young people to think about how they as individuals with strengths and needs can engage and contribute meaningfully to other systems. The ending mirrors their growing independence.  

Interventions like this can help young people learn the skills to become their own therapist, taking what they’ve learned and using it in everyday life. You might say: “This is a conversation you can keep having with yourself, even after the intervention ends.” It can be reassuring to remind them they will still be able to hear your voice and remember what you worked on together. Tools like maps, goodbye letters, and staying well plans can support them as they move forward. Co-created staying well plans can be devised if this is helpful to the young person. 

 

By the ending phase, we are hoping that: 

• The young person may recognise helpful and harmful patterns of relating and can explore ways of being with themselves and others. 

• They are establishing a sense of stability and reducing harmful coping strategies 

• They are developing an ability to self-manage their symptoms, and in a way, learn to be their own therapist. 

• The young person is re-engaging in life, through recreational, occupational or educational pursuits. 

• They are managing feelings of disappointment and loss in relation to the ending. 

Summary  

In this module, you have learnt: 

• How to structure interventions within a time‑limited framework, setting clear goals and preparing for closure. 

• Use anticipatory conversations to normalise endings and help young people process change, to create a space for reflection and grieving. 

• Apply tools such as ending letters, shared maps, and staying well plans to consolidate progress. 

• Scaffold transitions into adult services or community supports. 

• Promote autonomy and reconnection with life outside services, reframing endings as growth opportunities. 

• Key takeaway: Endings are not simply closures, they are opportunities for young people to consolidate learning, rehearse independence, and reconnect with their wider lives.