When do I decide to discontinue seeing my client?
I wish to share a paper that had benefitted me in my own clinical practice, and addresses a big area that I don't believe has been insufficiently discussed in clinical supervision and the like. The question of when should I terminate or discontinue psychotherapy with my client had often been asked, but little if any attempt to answer the question always seem to come up short. Admittedly, it's not something that one trains specifically to address in the more contemporary psychotherapy or psychology training programmes per se. Besides, Freud had asked the same question and addressed it somewhat in his exposition on whether Analysis is Terminable or Interminable. In lay-therapist terms, the answers lie in the process of therapy. To better access these complicated dynamics, we look toward Attachment and its manifestations in psychotherapy. These can assist the therapist to start any client with an end in mind, facilitate therapeutic separation, and assist the next therapist (if they continue another round with a different therapist) to proceed with psychotherapy after inheriting a transfer client.
Jeremy Holmes, Consultant Psychotherapist and author of, The Search for the Secure Base, writes brilliantly and clearly on these issues from an Attachment perspective. He provides us thoughtful consideration into endings that may be premature or delayed. He pulls together psychotherapy research, and expounds on an attachment-informed approach to ending, based on the distinction between avoidant and ambivalent attachment, and how this may be played out by both therapist and patient in the transference-countertransfence situation.
- The paper is freely available online, and can be downloaded here, for your convenience.
Download (.pdf): Endings in Psychotherapy - An Attachment Perspective.pdf
- Also, from the other side of the couch, here's an interesting article on the Independent.co.uk, advising clients what to do when they don't know how to bring up the subject of discontinuing therapy in the face of analyst resistance, or unethical practice. An amusing piece, but highly needful considering many clients may find it difficult to bring up the subject in the face of power differentials and withdrawn responses to controlling others.
Stopping Therapy: We have ways of making you talk, by Rhodri Marsden, 16 June 2014.
You may also like to check out his book...
The Search for the Secure Base: Attachment Theory and Psychotherapy
In recent decades, attachment theory has gained widespread interest and acceptance, although the relevance of attachment theory to clinical practice has never been clear. The Search for the Secure Base shows how attachment theory can be used therapeutically. Jeremy Holmes introduces an exciting new attachment paradigm in psychotherapy with adults, describing the principles and practice of attachment-informed therapy in a way that will be useful to beginners and experienced therapists alike. Illustrated with a wide range of clinical examples, this book will be welcomed by practitioners and trainees in psychotherapy, psychoanalysis and in many other disciplines.