TERMINATION OF CLIENTS FROM COUPLE AND INDIVIDUAL THERAPY:
A Typology of Levels of Psychological Maturity Utilized by Clients
in Ending Their Therapeutic Work with Their Psychotherapists
–By Lawrence Kaufman; 561-302-0568; email@example.com; www.kaufmancounseling.com
Introduction: This is the first of a series of articles written explicitly for clinicians. In this article, I set out a proposed, hierarchically organized schema to conceptually organize the different levels of psychological maturity utilized by psychotherapy clients in terminating work with their therapists. While acknowledging that all behavior exists on a continuum, I outline below a simplified hierarchy of approaches or methods used by clients to disengage from therapy sessions.
In proposing this schematic, psychotherapeutic understanding (perhaps a controversial one, for some), I am anchoring my thinking around the concept of “enactment” (a word I am using here in the psychoanalytic sense.) That is, a central thesis of mine is that most clients (both inside and outside of therapy), to a large degree, function on the level of acting out – substituting actions for talking (i.e., substituting the pre-verbal for the verbal, or put another way – expressing oneself in a less developmentally advanced way).
For many, it is “easier” to end a relationship (in this case – with a therapist) by absenting oneself than to experience the tension, unpleasantness, and challenge of directly talking about one’s feelings, thoughts, and decisions. The short-term avoidance of conflict is thus preferred over the medium and long-term gains accrued in talking things out (especially with someone who has a different point of view, or has differing values than yours). Further, I ask the reader to draw parallels between the predominate levels of psychological maturity utilized in terminating professional work with a therapist, and the “levels” of psychological, developmental behaviors utilized in the relationship one has with his or her relational partner (i.e., spouse or other committed partner).
I hope the ideas presented in this article will help enhance and expand the focus and clarity of your thinking on the issues addressed, and will have practical utility in your daily work with your clients. I welcome your feedback on this article. I wish to establish a dialog with you – for mutual benefit.
Levels of Psychological Maturity Expressed by Clients in the Act of Terminating from Couple and Individual Psychotherapy
Notes: The proposed levels below are listed in order of the least to the most psychologically and developmentally advanced. Within each major level are, in effect, sub-categories of levels of psychological maturity expressed or enacted by prospective and present clients. There are different variations in clients’ behaviors within each level. The reader may differ with this writer with regard to the inclusion of certain behaviors within one categorical level or another.
Level 1: Client is, or clients are, a “no show” at appointed time. Client may or may not return the therapist’s call with regard to the missed appointment.
Level 2: Hours or minutes before the appointment, the client (including the spokesperson for the couple) calls to cancel the appointment – with or without an explanation. (Sometimes they say they are sorry; other times not.) They may say they will be calling back to reschedule (which they subsequently may or may not do), or they may say that they decided to not come back for further sessions (with or without an explanation).
Level 3: Client(s) may arrive late to the scheduled session, without calling the therapist prior to arrival. An explanation may or not be given for this lateness. At the end of the last session, client may or may not pay the therapist’s fee. (Or the check they give to their therapist may subsequently “bounce.”) They may say that they will send a check, and will call to schedule another appointment, but they do not follow up on this. Client(s) may not be able to be reached at the telephone number(s) they previously gave to the therapist.
Level 4: The last session with the client(s) seems to go well. When clients are asked (at the end of the session) what they didn’t find helpful or useful in the session, they claim that they were well-satisfied with what they got from the session and the therapist. With regard to setting another appointment time, they then say that they need to call the therapist later since they are unsure about their upcoming schedule. The therapist then does not hear back from the client(s).
Level 5: Client(s) sets another appointment time (or even sets a “regular” [ongoing, standing appointment time]) but subsequently cancels this appointment and never calls back again to reschedule. No explanation is given for this termination of services.
Level 6: During the session, the client makes no mention of his/ her plans to discontinue working with the therapist. After session time is up, or nearly up, the client tells the therapist that s/he has decided to “take a break from” or terminate from therapy. There is thus no time left for the therapist to explore and examine with the client, the dynamics behind this important decision
Level 7: During the last session, the client notifies the therapist that this will be her/ his last session. However, the therapist has the sense that the client is rationalizing or is otherwise not telling the therapist the “actual” reason(s) for the planned termination. The client may either not be conscious of the reason or reasons for wanting to terminate, or may be (for a variety of reasons – including wanting to avoid conflict at all costs) not as yet ready to become aware of, or talk directly about, the “actual” or underlying reasons for making this decision, at this time. The therapist is left with ambiguity and not knowing why the client decided to end work with him/ her. The client may or may not be willing or able to examine and explore the “deeper” reasons for leaving therapy.
Level 8: At the most mature (or developmentally advanced) psychological level, the client demonstrates an ability to think through, and talk out, in a reasonable and reasoned way, the reason(s) for his/ her termination of services at this time. The subject of impending termination may have come up and been discussed in a previous session or sessions. The therapist may or may not agree with the client’s positions and point of views, but sufficient time and thoughtfulness has clearly gone into this important decision.