Pregnancy After Loss & Related Topics

To see my blog posts about pregnancy after loss and related topics, visit

My latest blog post at deals with the loss of “everyday” symbols that can happen following a pregnancy loss. This is true of other types of losses and also of traumatic experiences. Read the blog post here:

Rachel Freedman
Running and Therapy As Forms of Play

I discovered running in 2012.  In 2015, I ran my first marathon, the Marine Corps Marathon in Washington, D.C.  I am no longer running long distances but I do still run and participate in shorter races and therefore reap the physical and psychological benefits of this activity.

One psychological benefit of running is the elusive and mysterious runner’s high, which I define as the state of elation, freedom, and spirituality that can occur while running.  I am not aware of an agreed-upon definition of this state but all runners will know what I am talking about.  I have experienced this phenomenon on both casual runs and during races.  (Hint:  You don’t have to be a fast runner to experience this.) 

In my favorite book about running, “The Courage To Start,” John Bingham writes:

“In the end, it is this state of being both inside and outside of oneself that best describes a runner’s high.  It is that delicious moment when you realize that, on the one hand, you know yourself better than you ever have, and on the other hand, you don’t know yourself at all.”

The above passage about the runner’s high is reminiscent of Donald Winnicott’s transitional space.  The famous child analyst discussed psychotherapy as a form of play.  He refers to the playground (therapy) as the “transitional space,” or the “potential space,” an intermediate area between psychic reality and external reality.  The runner’s high as I have experienced it does seem to involve a collapse of the boundary between my internal experience and what is going on around me. 

I have also experienced something akin to the runner’s high in the therapy room with clients.  In therapy, these moments are rare and precious and can rarely be captured with words.  They feel like moments of deep connection and understanding.  They can feel like electricity, or a new energy that has entered the consulting room.  Sometimes they happen concurrently with achieving a new insight, either about a client or about myself.   In these moments, I feel very focused, yet relaxed.  It’s similar to a state of “flow.”  It’s a euphoria that feels very similar to a runner’s high.   Like Bingham describes, it is being both “inside and outside of oneself.” 

So is running then also a type of transitional space?  In considering my experience with running and therapy (on both sides of the couch), I have concluded that running is a type of transitional space.  (I realize that this phenomenon may not be unique to running but might extend to other types of physical activities.) 

Bolstering my idea about running as a transitional space, George Sheehan, in Running and Being, writes about running as play and specifically about timelessness in running:

My fight is not with age. Running has won that battle for me. Running is my fountain of youth, my elixir of life. It will keep me young forever. When I run, I know there is no need to grow old. I know that my running, my play, will conquer time.

This concept of play recurs throughout Sheehan’s book.  The concept of timelessness is certainly an aspect of play in therapy as I have experienced it.  Sometimes, when these moments are occurring between me and my client, the time seems to fly by.  Before we both know it, the hour has come to an end and neither was aware of the passage of time because we were so deeply engaged in the “play” of therapy, which in this setting, is the exchange of words, thoughts, feelings, and ideas. 

While running and therapy appear to have much in common as far as the concept of the transitional space goes, they are also different, each with unique elements.  Popular coffee mug slogans might tell you that running is the only therapy you need.  While this might be true for some, for others there really is no substitute for good psychotherapy when in need of emotional support or concrete help with difficult life events. 

And if running isn’t your thing, there are many other ways to play as an adult.  Riding a bicycle, board games, playing an instrument, crafting, or even just getting together with friends can constitute adult forms of play. 

If you are a runner and a therapist, I’d love to hear from you on whether you think running (or the runner’s high) might qualify as a type of transitional space. 

Rachel Freedman
Ending Therapy and Continued Growth

It may seem strange to kick off a new blog with a post about ending therapy, but it’s one of my favorite topics (and a somewhat neglected topic in the clinical literature.)  

I almost called this “The Blog Post that Proves I’m Not Just After Your Money.”  I think it’s a misconception that therapists want to keep therapy going as long as possible regardless of client progress.   The reality is a lot more complicated.

The end of therapy is formally called “termination.”  For the therapist, termination is about a lot of things, not only a loss of income for the therapist.  It is obviously about the end of the therapy relationship, but it is also about facing endings in a healthy way.  Looking at how we say goodbye to people can teach us a lot about ourselves especially how we conduct ourselves in relationships.  

From a therapist’s perspective, termination can present a complex challenge with a long-term client.  The termination phase of therapy can last weeks or months, depending on many factors. There is no right or wrong length of time as each therapy dyad is different.

How termination is handled is of critical importance to the therapy process.  How a therapist and client plan for the ending and then deal with that planned ending can have lasting consequences.  How a therapy dyad ends can lead to positive, negative, or conflictual feelings about the entire therapy. When the termination phase begins, lots of new (and old) feelings may arise that the client already believes she has “worked through.”  The resurgence of old feelings in the face of a difficult goodbye can provide an opportunity to gain even more insight into earlier dynamics and ways of being. Endings are part of life. In therapy, the end of this unique relationship can create lots of complicated feelings:  relief, sadness, regret, and/or optimism about the future. The process of termination is not always straightforward. Sometimes, clients will taper off to less frequent sessions. Some will want a hard stop and others wish to leave the door open to return in the future. All of this gets negotiated in the termination phase of therapy.  

For me, endings with clients are often bittersweet.   Jill Salberg, in Good Enough Endings (2010), eloquently speaks to the therapist’s experience:  “We also have our own attachments to our patients: the ones we feel we helped, or the ones we feel we still need to help, or even the ones we feel help us to be better versions of ourselves.”   

For the client, post-termination growth can include a sense of renewed competence, a feeling of “I can do it myself.”  After months or years of having been committed to the therapy process (and to the therapist), some people feel liberated.  Ending therapy frees up and time and money, but more importantly, it gives the client a chance to implement new skills and insights into daily life.  If therapy has gone well, the client will have internalized the therapist’s voice.

Salberg posits that “termination is not the final phase of an analysis.  It hovers over every session.”

Considering this concept of termination as an ever-present factor, it can be useful for the therapist-client dyad to check in with each other about therapy goals. Explicit discussion about the client’s goals can only serve to enhance the work.  And just like death, the ultimate of all terminations, thinking about the end of something can bring into sharp focus where one is now and what, if anything, needs to change.

And finally, it should be noted that the conversation with one’s therapist continues even in the absence of actual sessions.  No longer being physically present with one another doesn’t mean the relationship or the bond has ended. It can persist into the future and may serve as a source of great comfort if the therapy has been meaningful or reparative.  

After ending my own therapy, I found myself continuing the dialogue with my former therapist (in my head) and using those “conversations” to stay focused on larger life goals.  I kept a running list of things I’d have to remember to tell him when I returned to therapy in the future. (I always assumed I would, perhaps as a way to deal with the grief of ending.)  Even when you don’t learn certain facts about your therapist’s life, you come to know them quite well and can anticipate what they will say and how they will say it. This deep knowledge of your therapist (and her predictability) are some of the benefits of long-term therapy.  You can and should grieve the loss of this relationship but try to also connect with the positives and the reasons you decided to end in the first place. Termination is the end of something very meaningful but it is also the beginning of something new.

Rachel Freedman