Use of farewell letters in the context of brief psychodynamic-interpersonal therapy with irritable bowel syndrome patients

Irritable bowel syndrome patients being treated by brief psychodynamic-interpersonal therapy were given a farewell letter written by the therapist in the final session. The context was a randomized controlled trial to assess the cost-effectiveness of psychotherapy and antidepressant treatment for painful functional bowel disorders. A year after the end of treatment patients completed a questionnaire to evaluate their perceptions of the usefulness of farewell letters. Five case vignettes illustrate different ways in which patients reacted to the farewell letters during and after treatment. Patients who benefited from therapy found the letter helpful as a means of sharing their experiences with others, continuing the work of therapy and dealing with the ending. The letter seemed to act as an embodiment of the therapist or transitional object, facilitating the continued assimilation of problematic experiences. Where therapeutic outcome was poor there was less evidence of helpfulness. Preliminary impressions suggest that farewell letters may be a helpful tool enhancing the benefits of brief therapy.