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Chapters 23 & 24 - Reimbursement and Documentation & Termination and Outcome Evaluation - TB

Terms in this set (25)

Global Rationale:
From a psychodynamic viewpoint, all requests from the patient to terminate should be explored. Often, the patient's desire to end treatment is thought to reflect resistance. Gabbard (2004) states
that underlying motives should always be explored with these questions in mind: Is the patient anxious and afraid and running from something? Angry at the therapist? Enacting a flight into health? Discouraged about the therapy? Feeling judged by the therapist? If the goals of treatment have not been met, it is likely that anxiety is underlying the wish to terminate. The person may not be aware of any underlying reason other than the stated "I am fine now." For example, one patient who had been in treatment for depression and had difficulty in sustaining long-term
relationships came only for several sessions and then unexpectedly announced that this would be her last session because she was feeling much better. The therapist was quite surprised because during the previous session, the patient had talked about how sad she had felt as a little girl about her mother's absence in her life due to her alcoholism. This issue of loss seemed to permeate all
relationships and situations, and the therapist had been moved by the previous session. The therapist gently explored whether the patient felt that her goals of being able to sustain a longterm relationship and trust someone were already met. As the session unfolded, the therapist wondered aloud whether her desire to leave now was based on some of the sad feelings she had expressed during the last session. Tearfully, the patient realized that she was fleeing as she was
beginning to feel vulnerable in therapy. After this was expressed, she was able to stay and continue to work in ongoing psychotherapy.