Terminating Psychotherapy

With a focus on the termination of psychotherapy, this guide examines the pertinent additional training that will aid mental health professionals in providing the most financially sensible and clinically deep treatment for their clients. It covers a wide spectrum of therapy approaches, patient populations and termination strategies.

The first book of its kind to provide an in-depth approach to termination of therapy, Terminating Therapy guides you through the practical, ethical, legal, and emotional challenges of how and when to end therapy. Written for a wide range of practitioners at every level of experience, this book provides straightforward advice on ending therapy on a positive note.

What sets off the termination of analysis and psychodynamic therapy from the variety of endings that enter into all human relationships? So asks Herbert J. Schlesinger in Endings and Beginnings: On Terminating Psychotherapy and Psychoanalysis, a work of remarkable clarity, conceptual rigor, and ingratiating readability. Schlesinger situates termination - which he understands, variously, as a phase of treatment, a treatment process, and a state of mind - within the family of "beginnings and endings" that permeate one another throughout the course of therapy. For Schlesinger, therapeutic endings cannot be aligned with the final phase of treatment; ending-phase phenomena are ongoing accompaniments of therapeutic work. They occur whenever patients achieve some portion of their treatment goals and supervene when therapy stagnates. Small wonder that an assessment of the patient's relationship to time and capacity to end therapy are key aspects of diagnostic evaluation. By linking beginning and ending phases not to the chronology of treatment but to the patient’s experience of it, Schlesinger brings revivifying insight to a host of psychodynamic concepts. Nor does he shy away from a trenchant critique of the instrumental “medical model” of psychiatric and psychotherapeutic training, which militates against the therapeutic exploration of treatment endings. Schlesinger's exemplification of how to begin treatment from the point of view of ending; his sensitive delineation of the mid-treatment "ending" crises characteristic of "vulnerable patients"; his richly woven case vignettes illustrating various "ending" contingencies and permutations - these inquiries are gems of pragmatic clinical wisdom. Endings and Beginnings distills lessons learned over the course of a half century of practicing, teaching, and supervising psychotherapy and psychoanalysis and is a gift to the profession.

The topic of terminating therapy is not one that clinicians normally consider. However, the session limits placed on clinicians by managed care require that the end of therapy be built into the treatment plan from the onset. With a focus on the termination of psychotherapy, A Clinician’s Guide examines the pertinent additional training that will aid mental health professionals in providing the most financially sensible and clinically deep treatment for their clients. Specifically, the book provides information on how to identify and understand when and how to discontinue psychological treatment with clients who have achieved sub-par results, as well as with clients who have ulterior motives such as friendship or support. The volume examines how to identify the client’s motivations early in therapy in order to better plan the course of treatment and to effectively prepare for "unplanned" terminations. It supplies important additional training in its discussions on ethical dilemmas, financial and personal consequences, and troubleshooting when it comes to engaging in termination. Offering a comprehensive and practice-focused guide from distinguished contributors, the book covers a wide spectrum of therapy approaches, patient populations and termination strategies. The book provides an in-depth look at termination by discussing various patient models, types, backgrounds, and problems, noting that with clear goals and a set course of action, the therapist will be better equipped to design a treatment that will best serve the patient’s interest.

First Published in 1988. Routledge is an imprint of Taylor & Francis, an informa company.

Handbook of Contemporary Psychotherapy explores a wide range of constructs not captured in the DSM or traditional research but that play important roles in psychotherapy cases. To provide readers with a tool bag of practical techniques they can use in these cases, editors William O'Donohue and Steven R. Graybar present chapters written by leading clinical authorities on such topics as the process of change in psychotherapy, attachment and terror management, projective identification, terminating psychotherapy therapeutically, shame and its many ramifications for clients, dream work, boundaries, forgiveness, the repressed and recovered memory debate, and many others.

In this second edition of Endings & Beginnings (Routledge, 2006), Herbert J. Schlesinger explores endings and beginnings within psychoanalysis and psychoanalytic therapy; both the obvious main endings and beginnings of any course in treatment, and the many little endings and beginnings that permeate analysis. The second edition contains new chapters including one on transference and counter-transference as sources of information about the process of therapy and as sources of difficulty in ending. It deals especially with the impact of prospective ending on the therapist, which if not understood and well handled, might interfere with working through and impede termination, if not ending itself. Another new chapter deals with the difficulties in terminating with especially narcissistic patients. One of the main criticisms against psychoanalysis and the psychotherapies derived from it is that it lacks criteria for when the patient has had enough. Herbert J. Schlesinger shows how we may view the process as a series of episodes each with an ending and possibly with a new beginning. He presents the way patients signal, even before they are aware of it, that ending is "in the air," and how it organizes how they experience the therapy. If alerted, the therapist can make use of these signals to locate self and patient in the process. So informed, the therapist is better able to discern when the therapy should end and help the patient work through the issues of separation and loss to terminate the treatment constructively. All patients tend to end psychotherapy in the way they end all other relationships. In several chapters on the problems related to severe regression, therapists can learn how to help vulnerable patients, for whom attachment is problematic, deal with separation non-traumatically. In Endings & Beginnings 2nd Edition, the theory of the continuous experience of ending and beginning and the array of landmarks that parse the clinical process are distinct advances to the technique of psychoanalysis and the psychotherapies derived from it. Schlesinger offers many clinical examples of ending and beginning with their technical problems and solutions. This contribution to the technique of ending and beginning psychotherapy electively will be useful to practicing psychotherapists and psychoanalysts, and to undergraduate and post-graduate students in clinical psychology, psychiatry and social work.

What sets off the termination of analysis and psychodynamic therapy from the variety of endings that enter into all human relationships? So asks Herbert J. Schlesinger in Endings and Beginnings: On Terminating Psychotherapy and Psychoanalysis, a work of remarkable clarity, conceptual rigor, and ingratiating readability. Schlesinger situates termination - which he understands, variously, as a phase of treatment, a treatment process, and a state of mind - within the family of "beginnings and endings" that permeate one another throughout the course of therapy. For Schlesinger, therapeutic endings cannot be aligned with the final phase of treatment; ending-phase phenomena are ongoing accompaniments of therapeutic work. They occur whenever patients achieve some portion of their treatment goals and supervene when therapy stagnates. Small wonder that an assessment of the patient's relationship to time and capacity to end therapy are key aspects of diagnostic evaluation. By linking beginning and ending phases not to the chronology of treatment but to the patient’s experience of it, Schlesinger brings revivifying insight to a host of psychodynamic concepts. Nor does he shy away from a trenchant critique of the instrumental “medical model” of psychiatric and psychotherapeutic training, which militates against the therapeutic exploration of treatment endings. Schlesinger's exemplification of how to begin treatment from the point of view of ending; his sensitive delineation of the mid-treatment "ending" crises characteristic of "vulnerable patients"; his richly woven case vignettes illustrating various "ending" contingencies and permutations - these inquiries are gems of pragmatic clinical wisdom. Endings and Beginnings distills lessons learned over the course of a half century of practicing, teaching, and supervising psychotherapy and psychoanalysis and is a gift to the profession.