Family factors in failure of psychotherapy

Family factors involved in the failure of psychotherapy for some adolescents and young adults are explored. These treatment failures are distinguished by expulsion of the therapist(s) and by reunification of the previously adversarial patient and parents. Such abrupt terminations may occur when treatment challenges the family's habitual image and understanding of the identified patient. The revolution against therapy appears to result from: (a) an intolerable threat to the family's heretofore stable delineation of the patient, along with (b) the therapist's failure to empathically engage the parents and ease their commitment to that delineation. It is shown how a parallel process can lead to failure in individual, adult psychotherapy. When therapy threatens the patient's familiar but dystonic self-image, and calls for change to a new image that is discordant with the family image of him/her, separation anxiety may precipitate a regressive flight from treatment. Clinical implications are discussed.