The Consultant's Role When the Analyst Terminates Therapy

In keeping with a personal commitment to examine difficult and hidden dilemmas in our profession, I am going to focus on therapeutic relationships in which the therapist1 terminates the therapy. We know that therapist-initiated terminations occur, the result of the therapist's life changes, psychological state, or assessment of the patient and the therapy. We know that these terminations are problematic, regardless of the reason for them. Patients can plummet into states of catastrophic anger, grief, or disillusionment that make a turbulent termination or rupture unavoidable. They can have difficulty preserving the positive aspects of the therapist and be left with a subjective sense of having been harmed or of being beyond help. Therapists suffer too. They agonize over the decision to end a therapy and may struggle with feelings of guilt, helplessness, anxiety, sadness, doubt about the effectiveness of depth psychotherapy, or too little concern. Therapists who are ending a therapy because they have been tripped into an area of personal vulnerability may be psychologically unavailable for a constructive termination process.

Using my experience as a consultant to patients and therapists, I will focus in this presentation on both the structure of therapist-terminated therapies and the special resource of consultation for patients and therapists in this situation. I have found that a consultant can often help limit the negative consequences for both patients and therapists, maximize patients' chances of making meaning of the termination, and facilitate future therapeutic relationships for patients. But it is not an easy job. I currently receive approximately five requests for consultation each month, largely because for the past eight years I have been writing and speaking publicly about the role of a consultant for impasses and ruptures in therapy. I believe the