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Unread July 8th, 2006, 09:44 PM
James Pretzer James Pretzer is offline
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Join Date: Jun 2004
Posts: 283
Default Re: Schema Therapy Article

It has been several years since I read Jeff's book so I'm not sure if he suggests that one refrain from alleviating the client's distress in order to keep them in therapy longer or not. However this is an idea that I've heard a number of times. Here are a few of my thoughts on the topic.

It is true that there are quite a few individuals who seek therapy simply seeking relief from their current distress. Many of those individuals will be inclined to discontinue therapy as soon as they are feeling better and, if they do so, they will get less out of therapy than they could if they persisted in treatment longer. Does that mean it is a good idea to hold off on interventions that would alleviate their distress quickly in order to keep them in therapy longer? I don't think so.

In fact, I think there would be major ethical problems with doing so. (Imagine that your family doctor intentionally prescribed ineffective medication in order to get you to come back for follow-up visits. I bet you'd be pretty irate about it even if the doctor argued that there were important reasons for you to come back for continued treatment and that he or she was afraid that you wouldn't come back if he or she prescribed medication that alleviated all your symptoms).

Also, it is more that a little duplicitous for the therapist to intentionally (and secretly) refrain from using interventions that would be likely to alleviate the client's distress. This doesn't seem at all compatible with a collaborative approach to therapy.

What else can we do if it seems as though the client will discontinue treatment as soon as they feel better?
  1. When negotiating goals for therapy, work to identify goals other than alleviation of distress that are important to the client.
  2. Discuss the pros and cons of persisting in treatment once one feels better.
  3. Predict that the client will be tempted to discontinue treatment as soon as they feel better, explain why that's not a good idea, and ask them to talk it over with you if they are thinking of discontinuing treatment.
  4. When discussing problem situations during therapy, watch for opportunities to point out the value of working on goals that go beyond alleviation of distress.
  5. Discuss your treatment plan with the client. If your plan would require the client persisting in treatment once they're feeling better, make sure that they are willing to do so.
  6. If the client is not willing to persist in therapy once they feel better, work towards limited goals that are likely to be accomplished before the client discontinues treatment. Explain how this limits what can be accomplished.
  7. Consider working with the client intermittently (meeting when they're in distress, discontinuing when they feel better, resuming when they experience more distress), if they prefer.
  8. If the client wants to discontinue treatment before important goals have been accomplished, discuss how they can continue working towards those goals on their own and make it clear that they can return to treatment in the future if they wish to. Recommend self-help books and support groups if they are interested.
  9. Remember that competent adults have the right to discontinue treatment whenever they want to. They have the right to make different choices than you would. We do not have the right to imposed our goals for therapy on the client through trickery, not even if we think we have good intentions.
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