Using termination as an intervention (UTAI): A view from an integrative, cognitive-existential psychodynamics perspective.

Abstract

Treatment termination is, arguably, one of the most important events in the course of psychotherapy. In the present article, we present an approach to termination that views the latter as a key intervention. Developed from an integrated, cognitive-existential psychodynamics (CEP) perspective (Shahar & Govrin, 2017), Using Termination as an Intervention (UTAI) is a prescheduled, albeit tentative, treatment termination that may be used as an intervention for patients' remoralization (Howard, Kopta, Krause, & Orlinsky, 1986). Specifically, for some psychotherapy patients, prescheduling a treatment termination is useful in instilling a sense of responsibility and agency and in deepening a therapeutic examination of patients' interpersonal schemas and scripts (i.e., "object relations"). The integrative nature of Using Termination as an Intervention is delineated, and caveats are discussed. Clinical Impact StatementQuestion: How should treatment with highly demoralized, often treatment-resistant, patients coming to therapy be terminated? Findings: Drawing from Using Termination as an Intervention, clinicians may inquire about the smallest therapeutic achievement that would still render-according to the patient-worthwhile and set a deadline for attaining this goal, and then-tentatively-terminate. Meaning: Tentatively prescheduling a termination date that is tied to what the patient deems as the smallest, but still worthwhile, therapeutic gain may bolster remoralization, instill a sense of agency, and-paradoxically-encourage continuation. Next Steps: We aim at testing Using Termination as an Intervention in the context of a randomized clinical trial, to identify patient characteristics that render it either counter indicated or particularly pertinent for some patients.

Clients’ experiences of therapy ending.

“…Two special issues dedicated to termination in the journal Psychotherapy (2017 and 2020) included papers devoted to different perspectives on termination. These papers explored termination in short-term, psychodynamic treatment (16 sessions; Harrison, 2020), cognitive behavioral dynamic therapy (Shahar & Ziv-Beiman, 2020), and cognitive behavior therapy (Vidair et al, 2017). Norcross et al (2017) studied the commonalities in termination across these theoretical orientations and found that there were some things that all therapists did when helping their clients end therapy.…”