{'fraction_non_alphanumeric': 0.026533996683250415, 'fraction_numerical': 0.0041459369817578775, 'mean_word_length': 4.899755501222494, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Termination of therapy: what can clinicians do to maximise gains?

Although there has been a significant emphasis in the clinical literature on therapeutic engagement and process, there has been surprisingly little focus on how to conclude therapy in a way that maximises gains. Preparing for termination of therapy can be extremely important when working with most clinical populations. The clinician may have played a significant role, often at a time when a patient is most distressed, and it is likely that there could be some sadness or concern in relation to this potential loss of support. Indeed, Ryle and Kerr (1) noted that ‘. . . as termination is approached, the absence of anxiety and disappointment would suggest that the reality of the end is not yet felt by the patient . . .’ (p. 113). Although a sense of loss may be experienced by most clinical populations when concluding therapy, additional care may need to be taken with patients who have experienced difficult attachment histories, particularly when this has included significant loss or abandonment. Sensitive management is also required when difficulties remain at the conclusion of therapy and the patient does not feel ‘cured’, and particularly when the sense of hope that may have been present at the commencement of therapy is replaced by sadness or anger. Termination with individuals who have experienced these difficulties is arguably the most important part of therapy, and if managed well, can give the patient a sense that endings need not be traumatic or inevitably involve a profound sense of loss. Mathews (2) noted that ‘Despite its attendant complications, therapist-initiated terminations, like other endings, provide potentially important grist for the growth mill’ (p. 34). Having said this, it is important that the clinician does not assume the patient’s response to the termination of therapy. It can be surprising when some patients for whom therapy appears to have been extremely important do not seem overly concerned by termination, whereas others appear significantly more affected than the clinician may have anticipated. As Kramer (3) succinctly noted ‘To each patient, termination means something different . . .’ (p. 63). Perhaps the easiest solution to this potential difficulty is for the clinician to simply ask what concluding therapy means to each patient and to provide time for discussion about this.