When it is time to end the therapy?

When it is time to end the therapy?

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"It is time to stop or even to continue? I can not take a decision - says 38-year-old Natalia. - And still once a week come to consult a therapist. At the same time I have a feel that most of the work has already been done, and I no longer need help. But I did not dare to stop our meetings ... "

How do you determine that it is time to complete their therapy? This is a simple question to which there is no simple answer. Psychoanalysts and psychotherapists of different directions are confident that the doubts of the patient - a sure sign that it's time to stop the session has not yet come. And they all say that the cessation of therapy - is a complex process. First of all, because we are talking about the end of relationships between two people. "But often the sessions are interrupted when the patient simply stops coming, despite the fact that the psychologist believes that work should continue," - noted with regret the therapist Tatiana Bednik. We asked the therapists of different schools and directions describe how to constructively and safely complete the therapy.

Temporary or permanent cooperation?

In most schools of psychotherapy therapy termination is stipulated in the first meeting. This applies to both short and long therapies (behavioral, cognitive, gestalt therapy, transactional analysis ...). In this case, the therapist and the patient enter into a temporary alliance, explains psychotherapist Christophe Andre (Christophe André): "Put a specific goal of this joint work (fear, phobia, communication difficulties, procrastination ...) and agree on the duration: 5 meetings, 6 months, a year, two years…". As a rule, when the goal is achieved, the therapy is completed. 28-year-old Anna for 12 sessions overcame her shyness: "I have a whole bunch of other problems, but at the time I just had to get rid of that specifically." For psychoanalysis, on the other hand, the finishing time is much more difficult to determine. "I went to a shrink with the general malaise and vague for the sole purpose - to improve their health - shows 48-year-old Natalia. - I knew it would take a lot of time, and I did not care much. The further I progress, the more I feel the need to continue. But for how long "Since the" absolute mental health? "- this is an illusion, even Sigmund Freud, founder of psychoanalysis, wondered" whether there is a natural conclusion of psychoanalysis, whether it is possible in principle to bring such an analysis before the end of "1. Nevertheless, he admitted that the treatment can be finished under two conditions: symptoms, fears or obstacles that caused the patient's treatment, no longer cause him suffering; and work with the unconscious allows us not to fear the return of the problem.

Thus, "neither I, none of my colleagues never tell you:" psychoanalysis is completed, "- explains the analyst Jean-Pierre Winther (Jean-Pierre Winter). - We simply can not know. And we can not be sure that the patient does not perceive these words as a rejection of him. " Everyone should determine when to stop to visit a psychoanalyst. But do not do it too early ...

surmountable desire to escape

"It is difficult to resist the temptation to jump from a moving train," - says about his experience 42-year-old Victor. Twice in the past year, he began psychotherapy. In any therapy there comes a moment when it seems that running around in circles, said Vitalina lapwing, psychoanalytically oriented therapist: "It is not clear what else to do, and where it leads. Already felt some changes, but they are superficial and largely aimed at to please the therapist. " It is at such moments, and you may receive the reluctance to deepen the work. "Twice I met with a therapist and thought cope with their problems. In fact, I marked time. In the following months, I again slipped to the usual for me and unbearable for close communication style. I went to therapy, but when I finally decided to talk about the main problem, which was trying not to think, and that ruled me, my behavior, my life. " Such premature termination of the meetings with the therapist often means that "somewhere in the process of transferring a problem," - said Jean-Pierre Winter. Transfer was discovered by Sigmund Freud. During this process (it occurs during psychoanalysis) the patient is in a relationship with the therapist recreates the desires and feelings that he felt toward his parents. He relives anxiety, resentment, internal conflicts, unfulfilled expectations, strong emotions in a safe environment psychoanalysis. "Due to the fact that the analyst does not evaluate or condemn, but listens carefully and takes his feelings, the patient has a better understanding of himself." Relationship patient and analyst strictly limited scope and it allows you not to be confused with real therapeutic relationship. Yet every patient inevitably relives the excitement associated not with a therapist and a person whom he represents. "I angrily left his analyst, as I have the impression that he does not respect me" - sorry 38-year-old Mark. Tatiana Bednik explains: "Abrupt discontinuation of treatment may be one way to recreate the scenario of the past, in which, for example, started never ends. In this case, the task of the therapist and the analyst is to help the patient understand the reasons for his desire to quit therapy and so avoid self-deception. "

The feeling of freedom

"Once I made it clear that it really ended - says 33-year-old Christine. - So, which is why I came almost six years ago to therapy, ceased to torment me. For the first time in many years, I could easily communicate with his mother and tell her clearly "no" when it is out of habit continued to meddle in my life. I can not quite imagine a mechanism that has happened to me, but it happened. " How to distinguish the healing of a false result? According to Vitalina lapwing, in general, "you begin to feel better, you realize that you can live without my therapist." Painful symptoms subside. "It is very important - says Christophe Andre, - to gain a degree of freedom in relation to these symptoms. For example, you can still be afraid of anything, but stop being a slave of fear. " Visible improvement is the result of work on the invisible: convictions, grievances, the images created by the problems in behavior or in relationships.

Psychoanalysis - and not only him - considering another phenomenon as a signal to the end of a course of therapy: a "stop transfer". "Jacques Lacan (Jacques Lacan) said that there are three stages of psychoanalysis - like Jean-Pierre Winter. - In the first stage, when I say, it's really not me, and I'm not referring to that, to whom my words are addressed. In the second stage I mention, but still did not turn to his companion. At the end of the course I was really in touch with his companion, a psychotherapist. "

Founder of transactional analysis Eric Berne (Eric Berne) formulated the same way. "He believed that the course ends when the patient is able to perceive their therapist as an adult, not as a carer or controlled by the parents in the context of the three states I" - explains transactional analyst Vadim Petrovsky. In fact, the therapy is completed when the patient through the person of the psychoanalyst can be reduced all the scores with those he represents, and to reconcile the reality with images of 2.

Last session ...

Behavioral and cognitive therapy, Gestalt therapy, transactional analysis and some other types of psychotherapeutic care is provided in the end of the course one or two final meetings. "Yesterday I read all the entries made during our meetings. The patient also brings her up, and I told him about the progress which it has reached, "- explains Tatiana Bednik. "Last Browsing Session has some solemnity - says Christophe André. - I have to make sure that the patient is well received by all the things we have worked for. Finally, I give him a few tips on maintaining the future. " Sometimes the patient and therapist agree to meet at 6 months, to take stock. Nothing like this happens in psychoanalysis. Jean-Pierre Winter said: "Sometimes, at the beginning of the session the patient said that he no longer comes. Or mentions the desire to complete the analysis and at the same time reveals a palette of internal arguments, which may contribute to his healing. " Christina humorously recalls his last conversation: "It was a bit strange. We had nothing else to say to each other ... just because it was to say, in principle, nothing more! We warmly shook hands. And this work is finished. " "Last session has a sad undertone - Christophe Andre said. - the story ends the relationship between two people. Me too sad, but is dominated by a sense of pride, akin to that experienced mother sending her child into adulthood. "

And then what? "And then I cried for three hours - says Christina. - I restrained myself not to rush to the phone and do not sign up for the next reception. It was only the next day felt turned the page of his life. " Jean-Pierre Winter, confirms: "Just be sure that something happens after the session ends. The analyst does not report, but indirectly he learns. And this is also an important experience for him! Some patients sleep day and night, some noted a sharp pain in the joints. Some dream incredible dreams, they are not, how can it not tell your shrink. " And then it turns out that you can. It has become possible.

"My psychologist does not want me to stop therapy"

"I wanted to finish our meeting, said about the psychotherapist during our session on Thursday, it was with this decision does not agree - says 29-year-old Svetlana. - However, I stopped to visit him ... "if the therapist has the right to object to the care of his patient? "Regardless of whether or not the therapy is completed, you have the right to stop it at any time, and no one can interfere in it," - recalls the therapist Christophe Andre (Christophe André). But psychologists also have the right to disagree with your intent and tell you about it. "Failure is difficult to interpret in isolation from the situation and from the form in which it was formulated, - says the analyst Jean-Pierre Winter. Often in the course of psychoanalysis intention to leave the patient speaks only want to make sure that the analyst is interested in continuing the work that the patient is interested in him. " In other words, he threatens to leave in the hope that it will keep. The role of the therapist in this case is to "identify the metaphorical level of the requirements of the patient end of the session: if he tries to leave his therapist, instead of, for example, to part with his mother" - continues Jean-Pierre Winter. In any case, the reluctance to wait for the green light or the consent of his therapist at the end of the sessions can be - but not always! - a good indicator.

1 Freud, "Analysis Terminable and Interminable" (MG Management, 1998).

2 From the point of view there are three states of our transactional analysis "I": parent, child and adult. These conditions affect our needs and our behavior.