The final session of psychodynamic psychotherapy for satisfied and unsatisfied clients who initiate the end of treatment

ABSTRACT

We compared the occurrence of termination behaviors in final sessions of 10 cases where clients stated that they had achieved their goals in therapy (satisfied cases) and five cases where clients expressed dissatisfaction with the therapy or therapist (unsatisfied cases). In all cases, treatment involved individual open-ended psychodynamic psychotherapy, and clients initiated the ending of treatment. In the satisfied cases, therapists and clients mutually engaged in many termination activities (e.g. described helpful aspects in therapy, anticipated challenges in the future). In contrast, in unsatisfied cases, therapists initiated a review of the therapy, noted challenges, suggested future coping strategies, and expressed appreciation for the client’s work, whereas clients did not actively participate in the review. Implications for research, training and practice are considered.

KEYWORDS:

• Premature termination
• reasons for termination
• psychotherapy termination
• client-initiated termination
• psychotherapy process

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Naama Shafran

Naama Shafran is currently working at the Jerusalem Mental Health Center, affiliated with the Medical school at Haddasa Medical Center, Hebrew University, Jerusalem. The author’s research interests include psychotherapy for severe mental illness and the relationship between psychosis and loneliness.

Kathryn Kline

Kathryn Kline is a doctoral student in counseling psychology at the University of Maryland. The author’s research interests include psychotherapy process and outcome, psychotherapist training, and therapeutic relationship.

Ellen Marks

Ellen Marks is an Associate Psychologist at University Health Services at the University of Wisconsin-Madison, Madison, WI USA. The author’s research interests include concealment and disclosure of secrets in psychotherapy, meaning in life, and psychotherapy process and outcome.

Shudarshana Gupta

Shudarshana Gupta is the director of the Mental Health Research Clinic at the International Institute of Innovation and Technology in Kolkata, India. The author’s research interests include psychotherapy process, laughter in psychotherapy, dream work, supervision and training.

Kristen G. Pinto-Coelho

Kristen G. Pinto-Coelho has a private psychotherapy practice in Ellicott City MD USA. The author’s research interests include psychotherapy process and outcome, therapist effects, clinical supervision, and psychotherapist training.

Yoshinobu Kanazawa

Yoshinobu Kanazawa is a professor in the Department of Psychology at Meiji Gakuin University in Tokyo, Japan. The author’s research interests include psychotherapy process, therapist training and supervision, professional development, and professional ethics.

Clara E. Hill

Clara E. Hill is a professor in the Department of Psychology at the University of Maryland.. The author’s research interests include psychotherapy process and outcome, psychotherapy training and supervision, helping skills, meaning in life, dreams, and qualitative research.