Forced terminations

Forced terminations are common clinical experiences and pose particular challenges and opportunities. They fall into four categories: mutually agreed upon, unilaterally forced by the patient, forced by realistic external circumstances, and unilaterally forced by the therapist. These differing situations are examined and compared, with attention directed to the use of reality as resistance, to the narcissistic injury in forced terminations, and to the potential transference-countertransference collusions to avoid powerful reactions to separation and loss. Problems with masochistic patients are considered opportunities for "bad endings." Technical considerations are discussed.