The Case of Long-Term Treatments: How They Unfold and Whether to End Them

In this article, the author considers long-term psychodynamic treatments: How do they develop? In what circumstances are they an outgrowth of treatments that should have ended? When is it beneficial for the patient to continue working with the same therapist for a long period of time? What are indications for return to therapy during the lifecycle? The author gives his definition of long-term treatments, and then reviews pertinent literature on termination, stalemates, and effectiveness of long-term treatments. He describes the therapist’s confronting five clinical situations that raise questions about how and whether to end treatment. He concludes with several guiding principles: (1) paying attention to treatment goals and certain transferences prevents impasses; (2) attending to specific countertransferences prevents avoidance of ending; (3) self-analytic capacity is necessary but not sufficient for readiness to end; and (4) the patient’s forming an intimate relationship with a person other than the therapist facilitates ending.