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  #1  
Unread August 31st, 2006, 09:07 PM
littlethree littlethree is offline
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Location: Spokane, Washington
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Question When to end therapy

I have a quandry about "When is it time to end therapy?" for certain clients. There are many factors, however, and they seem complicated.

Factors include:

1. the medical insurance company is deciding therapy has gone on long enough (coming up on 2.5 years) and likely won't pay anymore.

- the therapist (a.k.a. "the guide") and patient (a.k.a. "the traveler") have discussed a few options about how therapy may continue, if and when the insurance decides to stop paying. but nothing has been formalized.

2. the patient has exhibited increased anxiety and fear and has become increasingly closed off in session.

- the patient is exhibiting "fear" and anxiety about:

(a). Being "jarred away" from therapy: being "jarred away" from a caregiver would create a trauma that would mirror and harshly reinforce past issues of mistrust and abandonment. Thus, the patient seems to be bracing for what feels like to this patient like a "foregone conclusion" that something -- even if not caused intentionally by the therapist -- something will come in to tear the client away.

(b) the client is also going into "deeper" areas in therapy and attempting to "draw" out more "fragile" aspects of self (visualized as a 2-year-old). Thus, because the client is approaching this "most fragile" part, the client seems to be pulling inward and changing direction to avoid putting this part in danger.

- Because mistrust has been part of this client's "survival kit" for over 30 years, the client is tapping into this mistrust and feels that the effort the therapist (and an associated bodywork/massage therapist) is putting forth to connect with that "most fragile" part is only being done so that they can "hurt" that "most fragile and delicate" part of self.

3. The client has recently allowed self to be more open to receive care from the therapist, however, this has alarmed the client for fear of becoming dependent on the therapist and the client is retracting onto self and pulling away.

4. The client is beginning to cancel appointments and cut back on appointment that were previously scheduled.

5. The client is aware and has expressed that things are being held back and seems to pride in it.

6. The client used to feel relatively safe calling the therapist between sessions if there was overwhelming emotional pain. However, now the client takes pride and praises self for not calling for help, and continues to stretch out this praise as the weeks pass. The client even destroyed all phone numbers and removed the therapist's number from personal cell phone directories to "resist the temptation to call." And suggests that calling is a "sin".

7. Overall, the client is attempting to get away, before something comes along to pull them away in a traumatic way.

8. The client has expressed concern that perhaps therapy has stopped being about healing self, but just remaining with "someone to take care of me". That issue is something to differentiate though, when is someone taking care of you in therapy separated from healing self?

If the client's fear and anxiety is so overwhelming and the client indicates such efforts to leave (mainly because of this fear), is it wise to allow them to leave or is there something that can be done to safely dissuade them from leaving when it doesn't feel safe.

Recently, the client asked a hypothetical question: "If the fantasy world is safer and more predictable than the real world and the same emotions can be realized in the fantasy world (the only difference, the client says, is that emotions in the real world may be attached to something "tangible" while those in the fantasy may not be - but they are emotions nonetheless and can be sustaining emotions)...why would I want to want to be in the "real world" when it is less safe and unpredictable".

I do not wish to give up on this client, however, the client seems determined to draw away.

Any comments or suggestions or resources to look to would be appreciated.

Last edited by littlethree; August 31st, 2006 at 11:09 PM.
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  #2  
Unread October 30th, 2006, 08:57 AM
idomind idomind is offline
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Location: The Netherlands (Europe)
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Default Re: When to end therapy

Quote:
Originally Posted by littlethree
I have a quandry about "When is it time to end therapy?" for certain clients. There are many factors, however, and they seem complicated.

Factors include:

1. the medical insurance company is deciding therapy has gone on long enough (coming up on 2.5 years) and likely won't pay anymore.

- the therapist (a.k.a. "the guide") and patient (a.k.a. "the traveler") have discussed a few options about how therapy may continue, if and when the insurance decides to stop paying. but nothing has been formalized.

2. the patient has exhibited increased anxiety and fear and has become increasingly closed off in session.

- the patient is exhibiting "fear" and anxiety about:

(a). Being "jarred away" from therapy: being "jarred away" from a caregiver would create a trauma that would mirror and harshly reinforce past issues of mistrust and abandonment. Thus, the patient seems to be bracing for what feels like to this patient like a "foregone conclusion" that something -- even if not caused intentionally by the therapist -- something will come in to tear the client away.

(b) the client is also going into "deeper" areas in therapy and attempting to "draw" out more "fragile" aspects of self (visualized as a 2-year-old). Thus, because the client is approaching this "most fragile" part, the client seems to be pulling inward and changing direction to avoid putting this part in danger.

..... ..... ....

Any comments or suggestions or resources to look to would be appreciated.

I believe that you should let go some clients when no progress is made.
If you check out the book on focussing by Eugene Gendlin, you will find that some clients do not have the ablillity to heal themselves. Helping them in learning to focus in their inner feelings will start the process of progressive healing on them. You as a therapist must be the observer and you must have the abillity to really listen. If that does not work you may have to say goodbye to that client.
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  #3  
Unread November 2nd, 2006, 01:38 AM
littlethree littlethree is offline
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Default Re: When to end therapy

Thanks for replying.

It does seem like we are at the limit. We had a 120 minute session recently and about 75 minutes of that session was spent in silence (though not in one long stretch). And the client fell silent for 5 of the last 10 minutes of session. And then 5 minutes before the end, the client said "I might as well go" and left.

Though when the client says something like "Not everything can be saved" and that client then indirectly compares self to garbage (asking "You take out garbage once a week, don't you? See...not everything can be saved.")...when the client says something like this...it is hard to say goodbye when the therapists task it to help them see they are not garbage.

Thanks again for the reply.
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  #4  
Unread November 2nd, 2006, 02:12 AM
idomind idomind is offline
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Location: The Netherlands (Europe)
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Default Re: When to end therapy

It is true that not everything can be saved. But what does the client wants? Do he wants to live or not?

I would ask him the question: Can you make one chooice? Can you go for life or do you go for die? Do you want to be treated as trash or as a living being?

Ok but that would be me wouldn't it?
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  #5  
Unread February 6th, 2007, 09:38 AM
Lil'Pon Lil'Pon is offline
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Posts: 24
Default Re: When to end therapy

If your client, after over two years, is still this distressed, it appears that you have done little good for the client. In my opinion, you should terminate therapy, possibly refer the client to a therapist who is better able or qualified to assist.
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  #6  
Unread February 19th, 2007, 10:55 PM
littlethree littlethree is offline
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Join Date: Jul 2004
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Default Re: When to end therapy

Well...some decisions have been made, though I'm not sure if anyone needs to know. (By the way, I'm the client, sorry.) I've decided to take a break from therapy for 1 to 3 months.

My therapist said she was "mixed" about me taking a break, for safety reasons that I won't get into.

I went through a list of pros and cons of me taking a break. "Cons" largely revolve around me either: (1) hurting self or (2) not returning to therapy ever again or (3) me degenerating further back into myself (as opposed to coming out into the world).

But most of me wants to take a break. I'm feeling so stretched thin --- between work and therapy and "regular life". i can't take a break from work and I can't take a break from "regular life"...so the only thing left is "therapy". So, while she is still mixed, we expected to have some safety rules and to have some "goal" of the break set up...even if it just to literally take a break from thinking so much about all my issues. Also, that if I have not come back to therapy in 3 months, that she would call me so that I wouldn't give up therapy completely.

I feel such connection with my therapist. And that is rare. I rarely feel connection with anyone. And if I decided to quit therapy forever with her, I doubt I'd go back to anyone. Trying to find and build a relationship with yet another therapist is just too daunting and depressing to do yet again.

I like the notion of a "team" approach...it takes a "village" to raise a child.

we'll see if i actually return after a 1-3 month break.......or actually we'll first have to see if I last even one month.

thanks and sorry
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