Ending treatment

The ending of psychoanalytic therapy is often idealized in clinical descriptions. As there is little agreement on the goals of psychoanalytic therapy, (44,> it is hardly surprising that there is little general agreement about when ending is appropriate. Desirable final outcomes are mostly stated in terms of the process of treatment and are thus mostly specified in theoretical terms (e.g. increased awareness of impulses and fantasies, a reintegration of aspects of the self lost through projective identification, the capacity to engage in self-analysis, etc.). All these, even if observable in the course of treatment, are only loosely related to the aims the patient might have in concluding a lengthy treatment process.

The patient's own goals tend to be outcome rather than process goals and are more easily defined: the decline of symptoms, improved relationships, greater well being, increased capacity for work, higher self-esteem, a capacity for assertiveness. As such changes are clearly achievable without psychodynamic treatment, many psychodynamic clinicians erroneously regard such criteria for ending as superficial. Independent evidence will be required to show that the achievement of process aims results in a more permanent or general achievement of outcome aims, in order to validate process aims as an appropriate criterion for ending.

Of course, ending itself is a process, although there is significant disagreement between authors as to its nature. It has been labelled among other things as a mourning,(89> a detachment/39) and a maturation/90' It is inevitable that there is disappointment and disillusionment at the ending of long-term therapy, as what is achieved is never quite the same as what has been hoped for. (91> Also, the patient loses the object who has been available as a receptacle for projections. (86> It is not surprising then, that symptoms sometimes return, even if only briefly, as part of the process of termination. There is general agreement, however, that with these unconscious issues worked through, the ending of therapy requires no special form of intervention on the part of the therapist.

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