Termination In Psychotherapy Research Articles

Termination in psychotherapy: Contributions of an integrative metamodel.

Termination in psychotherapy: Contributions of an integrative metamodel.

Failure to respond to the patient’s coaching: a case study of premature termination in psychodynamic psychotherapy

ABSTRACT One factor that may help avoid treatment failure by premature termination is the therapist’s responsiveness to the patient’s coaching. Coaching refers to the patient’s efforts to inform and guide the therapist about the kinds of therapist behaviors, attitudes, and interventions that would advance the therapy. The case of Barb, from a naturalistic study of time-limited psychotherapy, was examined as a failed treatment due to premature termination. Using a case study approach, descriptive analysis of the therapy process, along with quantitative ratings of coaching and responsiveness, was employed to examine instances of patient coaching with corresponding therapist responsiveness. Analysis indicated that the patient attempted to coach the therapist throughout each session about her plan for treatment and the responses she sought from the therapist. The therapist’s responses were only partially aligned––and in some instances not at all aligned––with the patient’s coaching. The disparity between the patient’s coaching and the therapist’s responsiveness was widest in the two sessions immediately prior to termination. This case study indicates that patients may coach therapists in order to avoid treatment failure. Therapists who attend to patient coaching and modify their responsiveness may be better able to sustain treatment and help patients achieve therapeutic goals.

Termination in integrated primary care behavioral health.

Termination with patients in integrated primary care behavioral health (IPCBH) is driven by elements that are present in other psychotherapies but more strongly emphasized under the primary care model. All treatments are, by design, time limited, and require transparent communication and almost immediate preparation for termination. Because treatment occurs within a primary care relationship, however, termination conveys a different message than it does in other settings-the conclusion of an episode, but not of a treatment relationship. As with primary care for medical conditions, the expectation is that the patient may return to treatment in the future to address new problems or recurrence of the previously treated condition, possibly making the brevity of treatment episodes more acceptable. This article discusses the process of termination in IPCBH and indicates with a case example how conversations around termination evolve throughout the brief treatment process. Suggestions for addressing termination in IPCBH are adapted from the literature on termination in more traditional psychotherapies. There is currently no published research on termination in the IPCBH setting, and research is needed to clarify how termination discussions affect treatment outcomes and patient satisfaction. As IPCBH models become more common, the meaning of termination in psychotherapy may change, with decreasing emphasis on the dyadic relationship of an individual therapist and patient. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Plan-compatible termination in psychotherapy: Perspectives from control-mastery theory.

Termination processes in psychotherapy vary widely across patients, therapists, and therapies. While general guidelines on termination can inform ethical and responsible termination practices, termination decisions and processes are likely optimized using a case-specific approach. Control-mastery theory (CMT) provides a framework for considering the unique ways individual patients work in psychotherapy and can be applied to help therapists understand and facilitate optimal terminations. The present article provides a brief overview of CMT and outlines perspectives regarding the decision-making and discussion of psychotherapy termination, the processing of termination, and the final session of therapy. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Termination of a Long-Term Harm Reduction Psychotherapy Group for Veterans With Substance Use Disorders

Termination is a complex and challenging phase of treatment, and termination in group psychotherapy adds additional layers of complexity to understanding and navigating the process. This article discusses the experiences and lessons learned at a large Veterans Affairs addiction treatment center during termination of a long-term harm reduction psychotherapy group. Using themes identified in the literature as a conceptual framework, this study analyzes the dynamics that unfolded throughout the course of group termination. Planning, development, and implementation of termination interventions are reviewed. Client and therapist reactions are also discussed.

Improving psychotherapy effectiveness by addressing the problem of premature termination: Introduction to a special section

Premature termination appears to be a consistent problem in psychotherapy, showing up across client, treatment, and therapist types. As psychotherapy researchers and practitioners, it is important that we gain a better understanding of this negative psychotherapy event and identify methods for reducing its occurrence. This article introduces a special section on premature termination in psychotherapy. In addition to briefly introducing the articles contained in the special section, this article offers suggestions for future research on the topic of premature termination.

Basic psychological needs satisfaction, working alliance, and early termination in psychotherapy

The goal of this study was to evaluate the relationship between basic psychological needs satisfaction and working alliance in psychotherapy and to determine whether client ratings of basic needs and working alliance during psychotherapy were associated with early termination of therapy. Former psychotherapy clients (n = 87) completed a semi-structured interview regarding basic needs satisfaction in therapy, working alliance and dropout status. Participant ratings on the Basic Needs Satisfaction in Psychotherapy scale (BNSP) and the Retrospective Working Alliance Inventory – Short (RWAI-S) were significantly correlated (r = .77) in our sample. A comparison of intercorrelations between working alliance subscales and basic needs subscales indicated higher factorial distinctiveness within the basic needs measure. T-tests comparing those who terminated psychotherapy early with those who had planned endings on scores on the BNSP and RWAI-S were significant (Cohen’s d = .65 and 1.82, respectively). Results suggest that the basic needs measure might tap into a wider breadth of the therapist and client interaction than the RWAI-S.

Symptom reduction and termination: client change and therapist identified reasons for saying goodbye

Empirical efforts have focused on predicting whether or not clients prematurely terminate therapy, with nonattendance of last session equated to premature termination. However, this fails to explore the relationship between clients’ distress reduction and reasons for termination. With this study, we aimed to understand how clients’ distress change relates to premature termination and examine clients’ distress change in conjunction with therapists’ perceptions of termination reasons. We collected data from 797 clients who prematurely terminated or attended termination but completed therapy a minimum of three individual sessions provided by 38 therapists. Clients completed an assessment of psychological symptoms before each session. At the end of treatment, therapists identified the reasons they believed termination occurred for all clients in the sample. Results demonstrate that total sessions attended and missed predict premature termination, whereas distress change does not. Additionally, clients who were believed to accomplish goals do show greater change. However, therapists’ indicated that over half of clients did not reach goals at termination and they did not perceive nonattendance at last session to equate to drop out in all cases. Implications are discussed with respect to understanding why clients’ terminate, therapeutic goal conceptualization, and review of goals during termination in time-limited psychotherapy.

Multiple Strategies to Prevent Premature Termination in Psychotherapy

A Review of Premature Termination in Psychotherapy: Strategies for Engaging Clients and Improving Outcomes by Joshua K. Swift and Roger P. Greenberg Washington, DC: American Psychological Association. 2015. 212 pp, ISBN 978-1-4338-1801- 1. $69.95 http://dx.doi.org/10.1037/a0038612 Premature Termination in Psychotherapy: Strategies for Engaging Clients and Improving Outcomes is one of the very best examples of the new generation of psychotherapy development. Based on rigorous research findings and a deep look into the preexisting literature, this book presents practical guidelines to understand premature termination and provides evidence-based strategies for how to engage patients in treatment. It will especially be a highlight for practitioners who are interested in a broad insight of the overall empirical literature. For graduate students in clinical and counseling psychology, this book might be an excellent prototype for how to bring rigorous quantitative research and convenient practice examples together.

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

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

Ideas of cure as a predictor of premature termination, early alliance and outcome in psychoanalytic psychotherapy

This study examines how young adult patients' ideas of cure prior to psychoanalytic psychotherapy are associated with premature termination, early alliance and therapy outcome. The hypotheses were that ideas about approaching one's problems would be related to fewer premature terminations, higher early alliance and better outcome, than would ideas about distancing oneself from one's problems. Young adult patients (N=46) were interviewed prior to therapy regarding their ideas of cure. Outcome measures were administered pre- and post-therapy. Alliance measures were administered early in treatment. A typology of the patients based on their ideas of cure was performed using ideal type analysis. Clusters of patients were then rank ordered in accordance to the theoretical dimension 'approaching-distancing'. The relation between rank ordered ideas of cure and premature termination was analysed using Mann-Whitney's U-test. These ideas' associations with early alliance and therapy outcome were analysed using Spearman's rho. Patients who terminated therapy prematurely were significantly closer to the 'distancing' pole regarding ideas of cure, while the therapy completers were more often found near the 'approaching' pole. No associations were found between ideas of cure and early alliance or therapy outcome. In addition, patients with attrition due to failure to participate in interviews and complete interviews were significantly closer to the 'distancing' pole than those who had completed their research commitments. The positive finding regarding premature termination indicates the importance of negotiating ideas of cure as a part of the initial assessment process. Possible explanations for the negative findings are discussed.

Impact of personality on termination of short‐term group psychotherapy in depressed elderly outpatients

Termination in group psychotherapy is an essential phase of the psychotherapeutic process, yet its clinical determinants remain largely unknown, especially in elderly patients. The aim of this study was to assess how patients' personality traits influence their way of leaving a short-term psychotherapy group as well as a larger therapeutic community program. Personality traits were assessed with the NEO Five-Factor Inventory in 24 elderly depressed outpatients. Patients' terminations from the group as well as from the community were ranked into four classes according to their appropriateness (completeness of experience and ability to deal with feelings of separation). Neuroticism was not related to the quality of termination. In contrast, agreeableness and openness to experience were strongly associated with successful termination. Conscientiousness and extraversion may have a differential impact depending on the type of group (group psychotherapy versus therapeutic community). Personality traits may be important clinical determinants of the quality of termination process in both group psychotherapy and therapeutic community settings for elderly depressed patients.

The transtheoretical stages of change as a predictor of premature termination, attendance and alliance in psychotherapy.

The Transtheoretical Model proposes that clients' stage of change will predict their engagement in therapy. This study tested the hypotheses that clients with high Precontemplation scores would prematurely terminate from therapy and that clients with high Action scores would attend a greater number of sessions and establish a more positive therapeutic alliance. Using a within-subjects design, baseline measures of stage of change were used to predict the number of sessions attended, premature drop-out from therapy, and the therapeutic alliance after sessions one and three. Sixty clients completed the Stages of Change Scales and the Brief Symptom Inventory prior to therapy. The therapeutic alliance was assessed after the first and third therapy session using the Agnew Relationship Measure. The specific hypotheses were not supported. Premature termination from therapy was predicted by high level of initial symptom severity and low Contemplation scores. Positive therapeutic alliance at session one and session three was predicted by high Contemplation at baseline. These results suggest that the Transtheoretical Model, which was developed in the context of interventions for behavioural change, may not be directly generalizable to outpatient psychotherapy populations. However, Contemplation did predict premature termination and engagement. This implies that with adaptation the model may be a useful adjunct to psychotherapy assessment.

Predicting termination and continuation status in psychotherapy using the transtheoretical model.

Predicting termination and continuation status in psychotherapy using the transtheoretical model.

Supervision of termination in psychotherapy.

To propose a model for teaching and supervising the termination process in psychoanalytic psychotherapy. Group supervision of the 12-week termination phase of psychotherapy with a patient who had been in psychotherapy with a senior resident for 2 years. This supervisory method provided a positive termination experience for the patient and valuable group-teaching experience for residents at various levels in their training. A group supervisory teaching process is a particularly effective way of teaching the termination process and is more efficient in terms of time, energy, and dissemination of knowledge than a traditional one-on-one supervision model.

Notes on emotional components of musical creativity and performance.

We explored emotional accompaniments to stages of a musician's cycle of creativity through interviews with musicians. Creativity was defined in terms of performance or composition. These musicians described strong emotional vacillations that occur across the creative cycle and discussed ways of dealing with emotional issues involved in moving from one work to the next. Parallels were drawn between emotional aspects of completing a performance or composition to emotional aspects of termination in psychotherapy. Suggestions were offered to musicians for means of dealing with naturally occurring but powerful emotional components of creativity. In addition, some of the musicians suggested that music educators consider teaching students about potential emotional issues that may accompany creative effort. An integration of these issues into music education programs might better prepare students for careers as professional musicians.

The difference between termination in psychotherapy and psychoanalysis. Panel report.

The difference between termination in psychotherapy and psychoanalysis. Panel report.

Secrets versus privacy in group psychotherapy

Secrets lead to subgroup formation and premature termination in group psychotherapy. Privacy is the right of each individual to choose the appropriate time and manner in which he or she reveals intimate knowledge about him/herself. Secrets are the conscious or unconscious withholding of information, often as a protective mechanism to avoid fear and shame. Holding secrets is a form of acting out in groups. When secrets are revealed, working through occurs and shame is overcome. This occurs when boundaries are maintained and safety develops as a result of acceptance within the group.

Client reasons and experiences in treatment that influence termination of psychotherapy

Thirty-one male and female university counseling center clients completed questionnaires that identified reasons for termination and experiences in psychotherapy. Early terminators responded that they ended therapy because of situational constraints and discomfort with services more often than did late terminators. Late terminators said they stopped treatment because of improvement attributed to therapy more often than did early terminators. Late terminators also reported higher levels of belief that the therapist respected them, therapist warmth, and therapist competency than did early terminators. It was concluded that motivational factors in which volition plays a greater (reasons for termination) and lesser (client experiences) role combine to influence psychotherapy termination.

Termination in brief psychotherapy: The case for an eclectic approach.

Termination in brief psychotherapy: The case for an eclectic approach.