Teach them how to say goodbye: The CMRA model for treatment endings.

Abstract

The ending of treatment brings with it unique challenges. Traditionally, different therapeutic approaches have emphasized distinct aspects of the termination process. Insight-focused approaches emphasized the therapeutic relationship and retrospection, whereas symptom-focused approaches emphasized therapy goals and prospection. In this paper, we present an integrative model for treatment endings, which unites the different approaches' emphases and identifies four main challenges for the end phase. Specifically, we argue that as termination nears, therapists need to actively assess and address (a) the progress and consolidation of gains achieved in therapy, (b) the maintenance and generalization of those gains in the future;, (c) the celebration of the meaningful relationship alongside resolution of ruptures that may have occurred in it, and (d) the acceptance of the impending separation between therapist and patient. We argue that these four challenges map onto two axes. One axis is temporal, and helps distinguish tasks focused on reviewing or reflecting on the past from ones devoted to planning and anticipating the future. The other axis is substantive, and helps distinguish tasks focused on the therapy's goals from ones centered on the therapeutic relationship. We conclude the paper with a discussion of the model's implications for clinical practice, training, and research.

Conflicted Anger as a Central Dynamic in Depression in Adolescents—A Double Case Study

“…Their experiences during therapy had made them stronger, and they both had established healthier relationships with family and friends. Rethinking how participants in dyads label and conceptualize helpful aspects during the final phases of treatment may help clients to engage in dynamic work as well as healthy and helpful cognitions following treatment, supporting previous findings [ 17 , 76 , 85 , 86 ].…”

A survey of therapists’ experience of ending therapy with people with intellectual disabilities

“…The survey reported here is the first systematic attempt to understand how therapists working with clients with intellectual disabilities manage endings in therapy. The respondents’ practices appear to fit with the integrated model of therapy endings developed by Shaharabani Saidon et al (2018). More in-depth qualitative research using semi-structured interviews may be helpful, to further explore the management of endings from therapists’ perspectives.…”

Key issues and recommendations for ethical and effective endings in psychotherapy.

“…Others may reduce the frequency of treatment sessions from weekly to biweekly, to monthly, and so forth, as a means of assisting the patient prepare to move forward on their own effectively outside of treatment. These approaches have historically been associated with insight-oriented approaches and symptom-focused/skill development-focused treatments, respectively (Saidon et al, 2018). As Macneil et al (2010) emphasized, based on different patient needs, it would be appropriate to engage in different types of endings.…”