Aim
This study explores a strategically chosen case where both client and therapist regarded the alliance as poor for the approximately first 15 sessions. After this they managed to develop a solid and stable alliance. The client completed therapy with good outcome. The termination process is complicated and the dialogue in this phase contains some of the difficulties similar to the early phase, though with important differences. The aim is to give a close inspection of the ambiguous termination process.
Data
The client is a depressed woman in her thirties who sought help from a senior male psychotherapist. The therapy lasted for 43 sessions. The data is drawn from an intensive process-outcome study at the University of Oslo, Norway in which 18 highly experienced therapists and their patients participated.
Methods and analysis
Quantitative measures (WAI) were used to guide strategic selections of qualitative data and to describe the therapeutic process and outcome. The qualitative material (session- and interview recordings and transcribes) was analysed by hermeneutic phenomenological analysis.
Analytical questions were: What does the client express about her wishes for the therapeutic relationship? What does the therapist express about how their relationship can be? How do they react to each other’s initiatives? The analysis is ordered thematic and in a narrative sequence to study changes over time.
Findings and discussion
The analysis shows how important relational problems, such as mutual incompatible expectations and demands, were handled on an interpersonal level. Some important hallmarks of the termination process were identified. The therapist takes the initiative to terminate treatment, and stays firm in his decision despite the patients repeatedly dissents. The dialogues in the late phase though seem to reflect a more equal relationship and the patient seems more capable of asserting herself. An ambiguity concerns whether the patient really feels it is a good time to end, even if she ends up with saying so. To study interactional data together with patients’ and therapists’ reflections makes room for different perspectives on the same process, and to explore ambiguity and complexity.
Conclusion
Individuals may be different in important ways and complexity and adversity need to be acknowledged. Decision making in therapy can not be based solely on statistically acquired knowledge and quantitative measures need to be more fine-meshed.