The topic of terminating therapy is not one that clinicians normally consider. However, the session limits placed on clinicians by managed care require that the end of therapy be built into the treatment plan from the onset. With a focus on the termination of psychotherapy, A Clinician’s Guide examines the pertinent additional training that will aid mental health professionals in providing the most financially sensible and clinically deep treatment for their clients. Specifically, the book provides information on how to identify and understand when and how to discontinue psychological treatment with clients who have achieved sub-par results, as well as with clients who have ulterior motives such as friendship or support. The volume examines how to identify the client’s motivations early in therapy in order to better plan the course of treatment and to effectively prepare for "unplanned" terminations. It supplies important additional training in its discussions on ethical dilemmas, financial and personal consequences, and troubleshooting when it comes to engaging in termination. Offering a comprehensive and practice-focused guide from distinguished contributors, the book covers a wide spectrum of therapy approaches, patient populations and termination strategies. The book provides an in-depth look at termination by discussing various patient models, types, backgrounds, and problems, noting that with clear goals and a set course of action, the therapist will be better equipped to design a treatment that will best serve the patient’s interest.

With a focus on the termination of psychotherapy, this guide examines the pertinent additional training that will aid mental health professionals in providing the most financially sensible and clinically deep treatment for their clients. It covers a wide spectrum of therapy approaches, patient populations and termination strategies.

The first book of its kind to provide an in-depth approach to termination of therapy, Terminating Therapy guides you through the practical, ethical, legal, and emotional challenges of how and when to end therapy. Written for a wide range of practitioners at every level of experience, this book provides straightforward advice on ending therapy on a positive note.

In this second edition of Endings & Beginnings (Routledge, 2006), Herbert J. Schlesinger explores endings and beginnings within psychoanalysis and psychoanalytic therapy; both the obvious main endings and beginnings of any course in treatment, and the many little endings and beginnings that permeate analysis. The second edition contains new chapters including one on transference and counter-transference as sources of information about the process of therapy and as sources of difficulty in ending. It deals especially with the impact of prospective ending on the therapist, which if not understood and well handled, might interfere with working through and impede termination, if not ending itself. Another new chapter deals with the difficulties in terminating with especially narcissistic patients. One of the main criticisms against psychoanalysis and the psychotherapies derived from it is that it lacks criteria for when the patient has had enough. Herbert J. Schlesinger shows how we may view the process as a series of episodes each with an ending and possibly with a new beginning. He presents the way patients signal, even before they are aware of it, that ending is "in the air," and how it organizes how they experience the therapy. If alerted, the therapist can make use of these signals to locate self and patient in the process. So informed, the therapist is better able to discern when the therapy should end and help the patient work through the issues of separation and loss to terminate the treatment constructively. All patients tend to end psychotherapy in the way they end all other relationships. In several chapters on the problems related to severe regression, therapists can learn how to help vulnerable patients, for whom attachment is problematic, deal with separation non-traumatically. In Endings & Beginnings 2nd Edition, the theory of the continuous experience of ending and beginning and the array of landmarks that parse the clinical process are distinct advances to the technique of psychoanalysis and the psychotherapies derived from it. Schlesinger offers many clinical examples of ending and beginning with their technical problems and solutions. This contribution to the technique of ending and beginning psychotherapy electively will be useful to practicing psychotherapists and psychoanalysts, and to undergraduate and post-graduate students in clinical psychology, psychiatry and social work.

A successful termination phase is a critically important component of psychotherapy of any orientation. The authors synthesize and evaluate the clinical, theoretical, and empirical literature on termination. They then offer their own Termination Phase Model designed to help psychotherapists understand and address the full range of both patient and therapist responses that must be considered as therapy winds down and the patient prepares for life without treatment.

What sets off the termination of analysis and psychodynamic therapy from the variety of endings that enter into all human relationships? So asks Herbert J. Schlesinger in Endings and Beginnings: On Terminating Psychotherapy and Psychoanalysis, a work of remarkable clarity, conceptual rigor, and ingratiating readability. Schlesinger situates termination - which he understands, variously, as a phase of treatment, a treatment process, and a state of mind - within the family of "beginnings and endings" that permeate one another throughout the course of therapy. For Schlesinger, therapeutic endings cannot be aligned with the final phase of treatment; ending-phase phenomena are ongoing accompaniments of therapeutic work. They occur whenever patients achieve some portion of their treatment goals and supervene when therapy stagnates. Small wonder that an assessment of the patient's relationship to time and capacity to end therapy are key aspects of diagnostic evaluation. By linking beginning and ending phases not to the chronology of treatment but to the patient’s experience of it, Schlesinger brings revivifying insight to a host of psychodynamic concepts. Nor does he shy away from a trenchant critique of the instrumental “medical model” of psychiatric and psychotherapeutic training, which militates against the therapeutic exploration of treatment endings. Schlesinger's exemplification of how to begin treatment from the point of view of ending; his sensitive delineation of the mid-treatment "ending" crises characteristic of "vulnerable patients"; his richly woven case vignettes illustrating various "ending" contingencies and permutations - these inquiries are gems of pragmatic clinical wisdom. Endings and Beginnings distills lessons learned over the course of a half century of practicing, teaching, and supervising psychotherapy and psychoanalysis and is a gift to the profession.

This essential work provides the ideal text for psychiatry residents who need to develop and demonstrate competency in providing psychotherapy and pharmacotherapy in both integrated and split approaches -- a competency required by the Residency Review Committee in Psychiatry. Clinically and developmentally oriented, Competency in Combining Pharmacotherapy and Psychotherapy: Integrated and Split Treatment focuses on competencies in adult psychiatry in the outpatient setting. The authors detail guidelines for assessing residents' competency to provide both integrated treatment (delivered by one professional) and split treatment (delivered in collaboration by two or more professionals). They present these guidelines in two main standalone sections, which can and should be read separately. Both sections deal with similar problems and thus contain similar information, such as selection of medication and psychotherapy, evaluation and opening, sequencing and maintenance, and termination of integrated and split treatments. Today, the combination of pharmacotherapy and psychotherapy is the most widely used treatment modality for a broad range of psychiatric disorders. Many clinicians believe that it is also far more efficacious and beneficial than either modality used alone. This volume ably addresses some of the more complicated aspects of combining treatments, such as how patient presentation affects pharmacotherapy and psychotherapy, the timing and staging of combined treatment, which therapies should be used in combination with pharmacotherapy, and which professionals should be included in split treatment. This eminently practical volume will be welcomed by residents and training directors alike as an integral part of all psychiatric residency training programs, and will also be useful to nurse practitioners, physician assistants, social workers, and psychologists.

Dr. Firestein examined the cases of four men and four women who entered the termination phase of analysis at the Treatment Center of the New York Psychoanalytic Institute. In the current paperback edition the case records of the eight psychoanalyses that formed the main portion of the earlier edition remain as they were. Although none of the analysts would today conduct those treatments in the same manner as is summarized, the accounts are faithful to what unfolded in each of the treatment collaborations. The current edition accomplishes several purposes: to amend the essay that reviewed the literature up to 1978 with selected references to contributions of the past two decades; to discuss ways in which termination of psychotherapy resembles, and is different from, termination in analysis, and to consider many facets of treatment termination in some detail.

Ending therapy in an appropriate and meaningful way is especially important in work with children and adolescents, yet the topic is often overlooked in clinical training. From leading child clinicians, this much-needed book examines the termination process--both for brief and longer-term encounters--and offers practical guidance illustrated with vivid case material. Tools are provided for helping children and families understand termination and work through associated feelings of loss and grief. Challenges in creating positive endings to therapy with children who have experienced trauma and adversity are given particular attention. Several reproducible forms can be downloaded and printed from the companion website in a convenient 8 1/2" x 11" size. The companion website also features nine full-color figures.