Posted by pegasus on February 5, 2006, at 13:02:56
A while back we were discussing books about termination. I decided to read a few, so here's my reviews, FWIW:
"Ending Therapy: The Meaning of Termination" by Kupers
This book was mostly about what termination is. It sets termination apart from just ending therapy, by defining it as a *process* of bringing the therapy to a close. It gives some interesting thoughts about that from Freud and later analysts. At first I was disappointed in this book, but in the end I found it helpful to read the thoughts of some of the big names in psychotherapy on this topic. Interestingly, Freud apparently didn’t believe that therapy should be open ended. He had definite opinions about a reasonable course of analysis lasting a matter of several months or so (I forget exactly). And even more interesting, he had trouble following his own ideas about this. This was a good book to read first, to help understand the historical background for ideas in the books I read later."Positive Endings In Psychotherapy" by Kramer
This book presents the author's views on termination taken from his research about termination and his own practice. He doesn’t distinguish between terminations and other types of endings in therapy. Basically, I think his research shows that a lot of therapists don't have much of a clue about termination. There are a fair number of stories about good and bad endings. Probably the most interesting chapter is the one about guidelines for positive therapeutic endings. Although I’ll admit that I found the guidelines a bit hollow and obvious. I mean, ok, yeah, maintain empathy and be aware of countertransference, and review the treatment, and observe termination cues from the client. But it was all dealt with on a really shallow level. For example, one of the recommendations was to discuss termination early in the therapy, but there was no mention of how bringing up termination might make a client panic. I think that aspect of termination was neglected throughout this book."Endings and Beginnings" Schlesinger
This was the most useful to me of the three books, but it's not light reading. Schlesinger distinguishes therapy ending from therapy terminating. Most of the book is about proper termination, although he touches on the situation with therapists in training who have to stop therapy at the end of an internship, and on clients who just stop showing up. His take on termination is that therapists should be conscious of eventual termination even at the beginning of therapy. If they are, then they view every small ending in therapy (i.e., change of issue being worked on, vacations, impasses) as an opportunity to work on the issues that will come up for the client during a termination phase. And then the actual termination phase of the therapy is more tolerable for the client, because they’ve already worked on a lot of the issues that make it difficult.The author also believes that many therapies go on longer than they really need to, and that therapists would do well to pay more attention to when a therapy might be ready for termination. Interestingly, as he is an analyst himself, he sort of defends short-term therapies, and suggests that a lot can be gained by a brief therapy in which limited goals are the focus. He talks about how sometimes limited time therapies actually can go on longer than they need to for their limited goals.
He believes that a proper termination of therapy means working through all of the issues that come up around termination. He seems to believe that if this is done properly, termination is more natural for the client, and not such a ripping away. He also acknowledges (very nicely I think) that the client-therapist relationship is often permanent, regardless of the status of the therapy. There is an interesting chapter at the end about why people become therapists, and how termination fits into that. It's nice to hear him write about clients becoming important people to the therapist, and how therapists miss clients after termination. My one gripe is that he doesn’t even mention that therapies sometimes end prematurely (therapist closing their practice or what not). I’d have liked to know his thoughts about those situations, and how the problems of a mid-therapy ending might be mitigated.
peg
poster:pegasus
thread:606580
URL: http://www.dr-bob.org/babble/psycho/20060131/msgs/606580.html