Objective
When the end is not preset and the outcome is a matter of negotiations, the decision to end psychotherapy will be an experiential concern for the two participants. This case study brings attention to how ambiguities in the process of ending may be settled.
Design
A case with “good enough” alliance (WAI) and “good enough” outcome (OQ-45) was strategically selected for close inspection due to the complicated process of negotiating an end. Interactional data together with both patients’ and therapists’ post therapy reflections were explored.
Methods
Recordings of sessions and qualitative interviews were analysed using a hermeneutically modified method of systematic text condensation. Analytical questions are: When and how is the theme of ending introduced? Who takes the initiative and how is the others response? How is ending negotiated when the theme reoccur?
Results
When ending is initiated by the therapist and resisted by the patient, the decision will both be postponed and actualized again. Structurally, preparations for a break due to vacation and reduction of frequency will be used to test how the patient manages life without therapy. Substantially, ending appears as the final proof of improvement, and the patient inhabits a position where she can affirm that she has grown better only by accepting that treatment is coming to an end.
Conclusion
In reaching a concerted decision to end therapy, the patient and therapist use explicit as well as implicit negotiations to find their ways to resolve the basic ambivalence concerning ending. Particularly that the therapy shall end and the alliance shall continue.