Ending psychotherapy.
Whether formal or informal, planned or unplanned, it’s going to happen every time treatment is initiated.
What do we know about the subject?
Nearly 50% of people who start, discontinue without warning. At the time they end, half have experienced no meaningful improvement in their functioning or well-being. On the other hand, of those who do continue, between 35-40% experience no measurable benefit despite continuous engagement in lengthy episodes of care.
Such findings remind me of the lyrics to the Beatles’ tune, “Hello Goodbye.”
“You say yes, I say no;
You say stop and I say go, go, go, oh no!
Hello, hello?
I don’t know why you say goodbye, I say hello.”
Here’s another key research finding: the most effective therapists have significantly more planned terminations.
In a recent study, Norcross, Zimmerman, Greenberg, and Swift identified eight core, pantheoretical processes associated with successful termination. You can read the article here. Better yet, download and begin using the “termination checklist”–a simple, yet helpful method for ensuring you are putting these evidence-based principles to work with your clients. Best of all, listen to my recent interview with John Norcross, Ph.D., the study’s first author, as we discuss how therapists can master this vitally important part of the therapeutic experience.
Until next time,
Scott
Scott D. Miller, Ph.D.
Director, International Center for Clinical Excellence
Wow… great interview.
Its incredible how nicely this connects with Daryl’s latest post on principles.
Ive been thinking how in Chess, instructional material seems to get broken down into different periods of a game. Specifically, the game phases are Opening, Middle Game and End Game, and the aims of each phase are described here:
https://en.m.wikipedia.org/wiki/Chess
I was thinking that this might have application to therapy also, and was thinking that Howard’s theories on stages of change might have something to offer here…
Any thoughts on this as a means of organising checklists in our work Scott?
Nice interview. Thanks for the checklist list link provided. Over the years we try to be much more intentional on planning terminations and often try to start the conversation at the initial interview or session. Challenging for all the reasons shared.
It is disheartening when clients disappear. But in running into them later I find if isn’t always a sign of not progressing but because they got better & moved on.
Now that I am working with seniors I have to get used to a new kind of goodbye..sickness or dying..frequent reminders of my own mortality.