The Ending Phase of Psychoanalytic Psychotherapy

The Ending Phase of Psychoanalytic Psychotherapy.....In previous posts I have written about the first phase of therapy which is the opening phase, and the second phase of therapy which is the working through phase. In this post I am describing the third and final phase of therapy which is termination. The termination phase of psychotherapy begins when either the patient or the therapist believes it is time to end the treatment. It is usually the client that first brings up termination. Why would they do so? Because they are feeling better. They are no longer suffering from uncomfortable feelings that were symptoms of unmet basic needs. They have, with the help of the therapist, learned how to meet their emotional needs in healthy mature ways rather than the unsuccessful immature ways they were attempting before the therapy began. Some clients did not begin treatment with symptomatic unpleasant feelings such as anxiety or depression, but rather came to therapy experiencing unhappy relationships. These patients will bring up termination because their relationships have improved and they are more able to meet basic emotional needs with others more effectively. Once the client brings up termination during a session the therapist has to decide whether or not they agree with the client that it is indeed time to end the treatment. How does the therapist make this decision? The same way the patient made the decision. The therapist asks themselves has the client greatly reduced their emotional suffering? Have they learned new and better ways to meet their basic needs? Have their relationships improved and are generally happier with those whom they are intimately involved? If the therapists answers these questions affirmatively then the therapist and client agree that it is time to move toward termination. Usually, if all has gone well during the treatment an end date is agreed upon. The end date should not be too long but should be long enough for the client to grieve the loss of the therapist and their deeply meaningful relationship. For a long term treatment of several years a month or two is needed to allow sufficient grieving by the patient. ( Of course the therapist grieves the loss of the client as well but not to the same extent as the client.) Another goal of the termination process is to review the progress the client has made and for the client to feel they have met their goals in the therapy. The client will usually be able to verbalize how different they feel than when the therapy began. They will also speak about how much they have learned about themselves through the therapeutic process. Finally, the therapist and client will decide what their relationship will be like after the therapy ends. Usually their is little contact between the two parties post termination. The client should no longer need the therapist because they have learned how to work through their feelings and conflicts on their own. If the client finds they do encounter a difficulty that they cannot work through on their own, they are free to return to therapy for a few sessions to utilize the therapist to help them work through the problem. If new issues arise such as a death, or a divorce, or the loss of a job, etc then the client might return for further continued treatment of an ongoing nature until the problem is resolved. The point is that the client should always feel free to return to therapy as needed. Termination is a necessary and important phase of therapy. If done properly both patient and therapist end the treatment relationship the same way they began it, with care, respect, and understanding.