When therapy must stop

“Every therapy will eventually end but how do you deal with termination when the length of therapy is predetermined by a hospital or inpatient unit? What do you consider important principles towards the end of therapy: working with the patient’s main problem to the end, working with grief over losing the patient-therapist relationship, focus on consolidation/repeating what they have learned, focus on recognizing patient’s growth and positive feelings about how far they have come, focus on installing hope/motivation for future therapeutic work, working with predicting future pitfalls?” Thanks to Peter for this important question!

Often therapy ends when the goals of a hospital have been achieved but not the usual psychotherapy goals of therapists and patients. Under these conditions we celebrate the goals we could achieve within the limits that we faced, recognizing that there is more work to be done in another therapy. As Peter points out, we need to work on the grief over ending a relationship that has been so meaningful, and yet consolidate the gains the patient has been able to make. After all, his gains show the potential he can achieve in the future. Help the patient see the strengths he demonstrated in therapy. His success with you is a sign of increasing success he could achieve with others in the future. It is a sign of his potential. It is also important with some patients to point out what defenses they use that could cause a relapse in the future.

Th: “It is not that you are depressed. It’s just that when you use self-attack, self-doubt, and turn anger on yourself, you get depressed. So in the future when start feeling down, take a moment and ask yourself: “When did this start?” “What was my feeling toward that person?” Then let yourself feel that anger instead of turning it on yourself. That will help you stop the depression and get back on track.”

Some therapists claim that termination does not involve too much grieving with short-term therapy patients because the relationship is not that intense. I have not found that to be true. If a patient has a life changing experience with you, he will have powerful feelings: gratitude for your help, grief over losing you, grief that this help did not occur earlier in life, and deep feelings of love. All of these powerful feelings will often trigger more unconscious mixed feelings toward earlier figures which needs to be worked through during termination.

During termination, sometimes the old symptom returns because of a new rise of unconscious feelings which the symptom is holding down. Help the patient face those feelings toward you, and the resulting unlocking of the previously buried feelings will make his defense unnecessary, the symptom will disappear, and the patient will now be able to face an even deeper level of his inner life.

 


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