Working with psychosis Part 4: Therapy online – ending by email

Abstract

This is the fourth and concluding paper from a series about psychotherapy with a man suffering from a psychotic illness. The paper describes the ending of the therapy which was precipitated by my decision to leave the country. News of ending was extremely disturbing for my client and stirred fears that he would again break down and need re-admission to hospital. Six weeks before the ending he stopped attending but continued to stay in contact by email. I decided to reply to his emails during the session times, and we developed what he came to call his ‘email therapy’. This online technology provided a means for my client and me to separate, to find a third perspective and to begin to mourn this ending without him losing his mind and breaking down. Following James Fisher's ideas about ‘mourning in the presence of the loved object’ I understand aspects of this email ending as enabling a relinquishing of projective identification used to possess and control, a recognition of the freedom of the other and of the need to mourn omnipotence. I discuss some of the problems presented by premature ending with a vulnerable client – problems which can be seen in my difficulty of mourning and working through the ending reflected in the long time it has taken to finish writing this paper.

Keywords:

• psychosis
• ending
• online
• email
• projective identification
• mourning