Termination: When and how to stop therapy.

Abstract

In this chapter we discuss the final phase of the therapy. First we raise the question, "When should the therapy come to an end?" By this we mean, "How does one decide that the therapy should stop?" This in turn raises the question, "Who should decide when the therapy comes to an end?" If we remain faithful to the principles we have espoused in previous chapters, we must advocate a commitment to the client's autonomy: It is the client who must decide, ultimately, when the therapy stops. Furthermore, if we are faithful to the principles previously set forth, the client and the therapist work together in helping the client to arrive at the right decision about when the therapy should come to an end.After an extended period of psychoanalytic therapy, the client told his therapist that he believed the therapy had been most successful. Hearing this, the therapist thought to himself that the client was giving the message, "I'm ready to consider bringing the therapy to a close." The therapist then commented to the client, "You seem to be saying you are ready to consider termination." The client protested that he wasn't aware of any such desire, that he did not want to terminate. If he did terminate, he said, it would be only on the condition that the therapist and the client would dine together once a week after the termination.The therapy continued. Therapist and client agreed on a date for termination, some months off. Midway through this period, the client began a session with the comment, "I've been thinking it over, and I've decided that we need to dine together once a month after termination." The therapist understood this statement to indicate that the client still agreed to the plan to terminate-and still accepted all that this plan implied psychodynamically. As we would expect, on the day of termination, while therapist and client were saying their goodbyes, the client said, "You know, I don't think we will have to meet for dinner later on."Even though a collaborative decision-making process is our ideal, there are times, we believe, when it is appropriate, helpful, and necessary for the therapist alone to decide that the therapy should terminate. In these circumstances the therapist usually decides that the therapy should stop at some future time, then announces this decision to the client. Firestein (1978) offers two examples of a constructive decision by the therapist only, that the therapy should come to an end. In one of these cases the client was getting a great deal of pleasure from the regular sessions with the therapist. Firestein viewed the placing of a limit on the length of the therapy (by the therapist's saying, "We will stop some months 207

Termination and abandonment: History, risk, and risk management.

“…CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Jeffrey N. Younggren, 827 Deep Valley Drive, Suite 309, Rolling Hills Estates, CA 90274. E-mail: jeffyounggren@earthlink.net their roots in psychodynamic theory (Auld, Hyman, & Rudzinski, 2005;Joyce, Piper, Ogrondinsuk, & Klien, 2007). Since then, the literature has expanded well beyond a single theoretical orientation into treatments that have little relationship with psychoanalytic theory ( Davis, in press;Walsh, 2007).…”