The therapeutic discharge

Completing a therapy well is a task that requires knowledge and sensitivity: we are talking about a delicate step, to say the least, in the reconquest of autonomy. In fact, therapeutic discharge represents the closure of a process that may have been crucial in the lives of many people. Thus, This important moment cannot be done in any way..

Although the vast majority of professionals know how to make a good evaluation and identify the best intervention to propose, fewer give the importance that therapeutic discharge deserves. In fact, many times therapeutic discharge is not even included within the therapeutic process itself.

Vélez and Alveiro (2008) already addressed therapeutic discharge in their article The termination process in time-limited psychotherapy: clinical and technical aspects. The main conclusions they reached are presented below.

Therapy, a finite or infinite process?

Problems are phenomena that will always occur in people’s lives. There are no individuals free of obstacles or setbacks, for whom fortune always fulfills their desires or minimizes their fears, for whom courage frees from limitations. We have all, at some point, felt and will feel emotionally overwhelmed.

People, as long as we are people, we live, we experience, we will always have new challenges to face. Psychological therapy does not seek to make the person happy for as long as possible; or may I never feel regret or sadness again. If this were your goal, therapy would never end.

In fact, even with a therapeutic process as support, subjects They will feel sad again, they will feel anxious again and they will have worries again.

Psychological therapy is finite because its goal is not to end forever with the so-called “emotions of negative valence,” but it is finite because its objective is to provide the person with valid, useful and sufficient tools to meet the demands of the environment that arise at all times.

For these reasons, it seems a good idea that, for a good number of cases, the therapy be limited in time. If this did not end, the person would never be able to recover their autonomy, when The psychologist must ensure that his client does not need him.

Vélez and Aveiro cite in their article Frieda Fromm-Reichman, pioneer and exponent of psychoanalytic therapy, in relation to the issue at hand. For her, therapy must end:

Grief at the end of treatment

These authors expose the problems that arise at the end of therapy under the name of “grief.” Therefore, they find it very relevant, within the completion process itself, stop the feelings and emotions that the “goodbye” generates in the client.

For this reason, we talk about “completion process” and not “completion session”. When a therapist determines that therapy is coming to an end, he must initiate a process that It can last several sessions depending on each case..

Some of the feelings that may appear at the end of therapy are: worry, rejection, guilt, anger, failure, demoralization or a feeling of wasted effort.

The correct management of these feelings is vital so that they do not interfere with the subject’s closure process; so that they do not feel helpless and so that your feelings of self-efficacy do not dissolve. Vélez and Alveiro advise not to underestimate the importance that the psychologist can have for the patient as a point of support.

The forced end: the discharge that is not discharge

Psychological therapy does not only end when clients are discharged for having achieved its objectives. In fact, many therapies end abruptly, without much time to achieve proper closure..

Sometimes, The therapy has to end because it no longer helps. Either because a good therapeutic relationship has not been established, because the client does not let go of his or her resistance long after starting the process, or for reasons that may be unknown, the psychologist may decide to end the therapy.

The forced end of therapy is even more relevant than therapeutic discharge, because will determine the relationship the client will have with psychology and therapy in the future. Vélez and Alveiro cite Bostic, Shadid and Blotcky (1996), who studied the emotions that forced terminations provoked in clients. We highlight:

Experimentation of abandonment.Belief that it is Irrelevant for the therapist.Feelings of guilt for what has been done (or not done) in the therapeutic process. Thoughts such as “Therapy is useless.”Feelings of distress.

When is the best time to introduce it?

Depending on the therapy and the client, the idea of ​​therapeutic discharge should be introduced at one time or another. The issue of closure, as we have seen above, can raise multiple emotions in the client.and therefore the duration of therapy is especially relevant.

As a rule, closure of therapy will take longer the stronger the therapeutic alliance. Therefore, Bostic et al. refer that, in therapies lasting more than a year, it would be advisable to announce the termination of therapy at least three to six months in advance.

Although therapy continues during these months, it is also a period where the person’s progress can be reviewed since they know that the process has a deadline.

Likewise, the nature of the client himself is equally relevant. If we are dealing with an impulsive subject, it may be a good idea to delay the introduction of therapeutic discharge, since he or she may want to end therapy at the time the issue is raised. This excessive anticipation for the client’s characteristics could prevent several months of therapeutic work.

Finally, it is worth mentioning that not all phenomena that occur in the process of closing a therapy are the responsibility of the client. In fact, many therapists, especially new ones, also experience contradictory emotions when they understand that they are going to abandon the sessions with someone with whom, for example, they could have an excellent therapeutic alliance.

The therapist may feel guilt, relief, or sadnessbut at no time should these emotions contaminate the end of the therapy.

Bostic et al. They understand the termination of therapy as follows:

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