SAGE Journal Articles
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Gabbard, G. O. (2009). What is a “good enough” termination?. Journal of the American Psychoanalytic Association, 57(3), 575-594.
In Freud’s technique papers, he failed to develop a systematic approach to termination. Much of the existing literature is based on psychoanalytic mythologies about the way patients are expected to end analysis. The models described in the literature are often starkly at odds with what one sees in clinical practice. A wish for idealized versions of termination underlies much of what has been written, and we need to shift to a conceptual model involving “good enough” termination. A number of different endings to psychoanalysis may, in the long run, lead to productive outcomes; these models are examined, as are various approaches to the dilemmas presented at the time of termination.
Questions to Consider:
- This article discusses “unfulfilled expectations” that both clients and counselors may have at termination when there is no “fairy tale” ending to the time together. Do you tend to have high expectations at termination? As your clients struggle to determine what is personally “good enough” are you struggling with unrealistic expectations as well?
- The author states, “As I reflected on this surprising state of unfulfilled expectation, I recognized that I was caught up in a form of psychoanalytic mythology—I was in the thrall of a narrative derived more from literature and film than from clinical reality.” Do you believe that graduate school sells us on the ideal termination process, that may not parallel the realities of various endings known to occur in counseling? Process with your supervisor the typical termination processes seen at your site. Also, discuss in supervision how far this “good enough” ending is from your ideal.
- Your text book describes several processes leading up to termination: goals accomplished, lack of progress, need for referral, etc. Process with your supervisor how these different circumstances influence both the content and affect of the closure process. How will you have closure to your unfulfilled expectations when clients “drop out” without further contact?
Hatchett, G. T., Han, K., & Cooker, P. G. (2002). Predicting premature termination from counseling using the Butcher Treatment Planning Inventory. Assessment, 9(2), 156-163.
This investigation examined the extent to which premature termination from counseling could be predicted from selected scales on the Butcher Treatment Planning Inventory (BTPI). Ninety-five new clients at a university counseling center agreed to participate in the study and completed the BTPI as part of the intake evaluation. Premature termination occurred when a participant missed a scheduled appointment and unilaterally dropped out of counseling. Higher scores on Closed-Mindedness, Problems in Relationship Formation, Somatization of Conflict, Self-Oriented/Narcissism, Perceived Lack of Environmental Support, and the Treatment Difficulty Composite were associated with premature termination. The General Pathology Composite, a general index of symptomatic distress, also enhanced the prediction of premature termination by suppressing irrelevant variance in other BTPI scales. The results provide support for the validity of the BTPI in identifying clients at risk for premature termination from counseling.
Questions to Consider:
- After reading this article, can you identify some client characteristics that might lead to premature termination from counseling? Have you noticed other specific patterns at your site that might help predict premature termination at your specific site?
- As predicting is only part of the equation, can you brainstorm some steps you would consider to prevent premature termination in clients identified as at risk to do so?
- Though conventional wisdom has typically considered premature termination to be a negative treatment outcome, can you provide some examples from this article and from your own experiences of premature termination as a neutral or even favorable outcome?
- Using this article as a talking point, open a supervisory dialog about clients at risk for premature termination. Does your site attempt outreach to reconnect these clients?
Orgel, S. (2000). Letting go: Some thoughts about termination. Journal of the American Psychoanalytic Association, 48(3), 719-738.
Termination of analysis is discussed from three perspectives. First, considered as a vicissitude of the analytic relationship, termination contains essential elements of the psychoanalytic process itself. Cycles of attachment, loss, mourning, and internalization mark moments in, as well as overviews of, every analysis from its beginning to well past its termination. Second, Freud’s approach to the subject of termination is explored and widened, with an emphasis on its relation to mourning and on the depth and permanence of analytic transference—two dimensions relatively neglected by Freud, perhaps for personal reasons. Finally, clinical issues are presented that are meaningful to the author in his work with analysands, including his work as a training analyst.
Questions to Consider:
- Rather than merely define termination as primarily the practitioner’s decision to end formal work, the author focuses on termination as the mutual decision of two people to leave an extraordinary relationship. From this respectful place, the author allows a more affective process to unfold…one in which both parties will find meaning. Have you considered the personal longer term effects of initiating and ending relationships? If you are placed in a school setting or other agency with predictable patterns of larger scale termination, how will you prepare yourself for multiple terminations in short time periods?
- After reading this article, you may be rethinking any small tendency toward viewing termination as “closing paperwork” and opening your viewpoint to view termination as the closure of a relationship which may include mourning on both sides if it was longer term and depth oriented. How does this issue of termination, present at least latently throughout the counseling process, come increasingly to manifest itself in later sessions? In other words, what does termination look like, sound like, FEEL like? How will you know when you are finished?
- Anticipating that your current supervisory relationship will also come to a close, how can you use your increased knowledge of the termination process to begin facilitating a healthy closure to this supervisory relationship? Perhaps now is the time to open that dialog with your supervisor if it has not already been initiated.