Are We There Yet? How Do We Know When It Is Time to End Psychotherapy?

Abstract

Most writings about terminating psychotherapy begin with a comment about the relative dearth of previous publications on this subject. This paucity of discussion is evident particularly in comparison with the mountainous piles of communications on most other psychotherapeutic topics. There is some truth to the statement that termination has not been as well studied as have been the psychotherapeutic issues and variables that precede it during the course of treatment. The repeated mention of this imbalance also may express a more profound emotional truth that has nothing to do with numbers of articles or chapters but that touches on the conflictual feelings and ideas that are evoked in patients and therapists by this subject. Few topics in psychotherapy stir up so much doubt and debate, and equally few have such poorly defined empirical parameters and clinical benchmarks. How do we know when most or all of the work has been done? Is what is left important enough to justify more time and expense? Is the idea of ending the therapy a way for either or both parties in the dyad to avoid some important issue? Or, conversely, is the continuation of psychotherapy an avoidance of painful feelings of loss, separation, and anxiety? These and other such questions arise in the minds of patients and therapists alike when termination is (or sometimes isn't) addressed. Termination in Psychotherapy: A Psychodynamic Model of Processes and Outcomes goes a long way in filling in the gaps in the existing literature, particularly with regard to psychodynamically oriented psychotherapy, which is the approach that the authors emphasize. It works as an intellectual manual for the practicing psychotherapist, which will guide her or him down the slippery slope of the termination process. The book also will be effective in reducing the anxiety of those practitioners, as its comprehensive review of the literature and its clear, easily used model for understanding and working though termination can be adapted readily by most psychodynamic practitioners. The specific model of termination can be considered and adapted by therapists who work within theoretical orientations other than specifically psychodynamic. The authors have included a very useful chapter that focuses on the differences in the termination process in cognitive– behavioral therapy, interpersonal therapy, supportive therapy, and experiential therapy. The model that is developed in this volume also will serve as the framework for effective and important future research. The book is organized around a goal-oriented, conceptual framework for planning for and working through termination, which is effectively linked to central and necessary clinical techniques. It offers a set of practical guidelines for evaluating progress in therapy and in using movement toward consensual goals as triggers for consideration of the possibility of termination. These guidelines include clearly defined, termination-specific