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"We can work it out": Working through termination ruptures.

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Supportive-expressive (SE) psychodynamic therapy can lead to separation conflicts at termination. This study proposes a model to resolve these ruptures by identifying and addressing the disactualization of the patient's interpersonal wish.

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Area of Science:

  • Psychology
  • Psychotherapy
  • Clinical Psychology

Background:

  • Supportive-expressive (SE) psychodynamic treatment focuses on core conflictual relationship themes.
  • Anticipated termination in SE therapy can trigger separation conflicts and disactualization of the patient's interpersonal wish.
  • This disactualization may lead to maladaptive responses and therapeutic alliance ruptures.

Purpose of the Study:

  • To integrate SE framework constructs with alliance rupture resolution.
  • To propose a conceptual clinical model for resolving termination-related alliance ruptures.
  • To provide practice-based guidelines for therapists to manage separation conflicts during therapy termination.

Main Methods:

  • Integration of SE framework with alliance rupture and resolution models.
  • Proposal of a two-stage process: identification and resolution of termination ruptures.
  • Demonstration of guidelines using a case study of major depressive disorder, incorporating session transcripts, questionnaires, and interviews.

Main Results:

  • A conceptual model for resolving termination ruptures is proposed.
  • A two-stage process (identification and resolution) is outlined with practical guidelines.
  • The model's application is illustrated through a detailed case study.

Conclusions:

  • Therapists can successfully resolve termination ruptures by addressing the disactualization of the patient's interpersonal wish.
  • The proposed two-stage model offers practical guidance for managing separation conflicts in psychodynamic therapy.
  • Effective resolution of termination ruptures can strengthen the therapeutic alliance and improve patient outcomes.