Negotiating ending: A qualitative study of the process of ending psychotherapy

Objectives: When psychotherapy is open-ended, the question of termination is a matter for negotiation. A model based on both content and the process of ending may explain how ‘good enough’ psychotherapies can be brought to ‘good enough’ endings.

Design: Twelve processes of ending were explored through a combination of audio recordings made during therapy sessions and post-therapy interviews with clients and therapists. Therapies had been tailored to the needs of the clients and were based on a broad spectrum of theoretical affiliations.

Methods: A procedure for systematic text condensation was used on a case-by-case basis. Issues surrounding the initiation and negotiation of ending were pointed out in each case and were then compared across cases.

Results: The initiation of ending and exchanges concerned with when and how to end therapy unfolded as a concerted process because both parties seemed to be aware that the theme of ending contained a potential challenge to the alliance. Dual affect regulation, implicit communication and a future-oriented perspective were important features. Structural elements such as schedule changes and temporary breaks served several psychological functions. Therapies seemed to reach ‘good enough’ endings when the client and therapist joined in their efforts to resolve basic ambivalences embedded in the decision to terminate contact with the affirmation of a continuing emotional bond.     

Making the Intangible Tangible: Using Expressive Art During Termination to Co-Construct Meaning

In this article, a creative termination activity grounded in relational-cultural theory is presented. In addition to providing a means for summarizing the counseling experience, this activity promotes relational development in the midst of client termination. Following implementation of the activity, the client and counselor are provided tangible, co-constructed gifts that are symbolic of the therapeutic relationship and relational growth. The authors provide a rationale for how this intervention promotes self-awareness, outline directions for implementation, and provide a case illustration to demonstrate how counselors can help promote relational closure and solidify clients’ therapeutic gains.     

Théorie de l’autodétermination et modèle multimodal d’engagement : un pairage prometteur pour mieux comprendre les liens entre motivation et engagement scolaires chez des étudiants universitaires

Introduction

Psychological mechanisms associated with academic motivation and academic commitment constitute promising targets for the understanding of the undergraduate students’ well being, during a particularly critical adulthood developmental period in terms of identity formation and vulnerability to psychopathologies.

Termination: the hidden face of analysis

Although the question of analytic endings has been the subject of many contributions and round tables, it always presents a theoretical and clinical dilemma that remains unresolved by the search for more explicit criteria. The problem of the final phase is a post‐Freudian development which coincides historically with the emergence of studies on the countertransference, and it presupposes prior questions concerning the goals and results of analytic treatment. The following question is posed: what is the specific psychoanalytic event of the final phase? The author begins by examining the theoretical issues linked to temporality and separation, clarifying certain clinical aspects linked to the precession of the countertransference in determining the ending, before going on to illustrate a number of indicators with a clinical vignette. He proposes that the movement which develops in analysis from the transitional relationship towards the patient’s capacity to ‘stand on his own two feet’ in the clinical setting constitutes a crucial factor in the decision to embark on the process of termination. The conclusion opens out onto ethical issues, in view of the prior necessity for a movement to occur in the countertransference.     

Transcendence,transmission and transformation: the transcendent function in infant observation

Abstract: This article discusses the activation of the transcendent function as it operates through a series of complex parallel processes occurring within a Tavistock Model Infant Observation Group whose location is Palo Alto, California. We follow the observer, a seasoned female analyst, through her final two observations as she is caught initially in the central family complex that does not allow for a conscious ending to this three‐year observational period. Subsequently through the work of the transcendent function within the group, a discussion of the observer's ensuing paradoxical enactment takes place as we watch how this observer becomes able to help the family reach a termination not previously possible. Moving within a dynamic field that includes the infant observation group, the observed baby and his family, we experience the numinosity of the transformation that is activated. We will explore the ongoing encounter between the group mind, the observer and the observed as mutations within this dynamic field enable a genuine experience of mourning that has a profound effect on the observed baby and family.     

TERMINATION OF A FE/MALE TRANSSEXUAL PATIENT'S ANALYSIS: AN EXAMPLE OF GENERAL VALIDITY

The author describes the termination of an analysis, which, while relating to the particular case of a male-to-female transsexual patient, may be relevant to all analysts, particularly those whose patients need to integrate disavowed and split-off parts of themselves. The patient had undergone sex-change surgery at the age of 20. Having lived as a woman thereafter, she had asked for analysis some twenty years later. The author, who discussed the first three years of that analysis in an earlier paper, as well as her hesitation about undertaking it, considers that its termination after seven years illustrates not only the specific problems posed by transsexuals but also the general ones presented by 'heterogeneous patients'. To the best of her knowledge, this is the first published case history of a transsexual patient who has undergone surgery. In the author's view, the patient has acquired a new sense of internal unity based on a notion of sex differentiation in which mutual respect between the sexes has replaced confusion and mutual hate, and her quality of life has improved. On the general level, this termination shows how the reduction of paranoid-schizoid anxieties and the reintegration of split-off parts of the personality lead, as the depressive position is worked through, to a better toleration of internal contradictions, a new sense of cohesion of the self and a diminution of the fear of madness.     

Premature termination as a function of intake data based on ethnicity, gender, socioeconomic status, and income

Although it is acknowledged that premature termination is detrimental to the therapy process, there is limited information on how to utilize client demographic data to indicate which clients have greatest potential to prematurely terminate. The study assessed how client ethnicity interacts with client gender, therapist gender, therapist ethnicity, and client socioeconomic status (education and income) to affect premature termination. The study consisted of 527 cases which received therapy services from the Auburn University Marriage and Family Therapy Center from October 1993 to October 1999. The three definitions of premature termination used were termination after one session, prior to six sessions, and by therapist report. Results indicated that interactions of client income and ethnicity and therapist gender and ethnicity were the most useful demographic data indicators of premature termination.     

Attitudes to Genetic Testing for Deafness: The Importance of Informed Choice

With recent progress in the identification of genes for deafness, it is highly likely that genetic testing, including pre-natal testing, for deafness will become more widely available. In a context where there are concerns about pre-natal testing, and where many in the Deaf community contest the understanding of deafness as a disability, it is important to examine the attitudes of Deaf/deaf people toward genetic testing. This qualitative study employed in-depth interviews to investigate the views about genetic testing for deafness of 19 participants, who were identified as functionally deaf or hearing impaired, or as belonging to the Deaf community. The key findings are that participants were generally supportive of genetic testing for deafness but only when full information about all relevant aspects of deafness is given to prospective users of genetics services. Participants emphasized informed choice, stating that information about medical and technological options for deaf people should be provided, together with information about communication, education, and the experience of being deaf. Although there was less support for pre-natal diagnosis and termination of pregnancy for deafness, most participants nonetheless felt that individual choice was important and that pre-natal diagnosis should be made available to those who wanted to use it.     

A Focus on Neglect: Comparing the Characteristics of Children and Parents in Cases of Neglect,Abuse, and Non-CAN (Child Abuse and Neglect) in Israeli Rulings on Termination of Parental Rights

This study attempts to expand the knowledge base about neglect by comparing the characteristics of children and parents involved in termination of parental rights proceedings in the Israeli legal system. Cases were classified as neglect (72.7%), abuse (19%) or non-child abuse or neglect (non-CAN; 8%) and were compared on a range of variables. The results show that neglected children have the most developmental problems, and generally come from single-parent families, compared to abused children, who suffer the most mental health problems and come from 2-parent families. Finally, neglect is associated with the mother’s history of drug abuse, and abuse is associated with the father’s drug abuse and criminal record. In non-CAN cases, the courts criticize the Child Protective Service more than in neglect and abuse cases. Implications of the findings for social work practice as well as future research directions are discussed.