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Managing Endings in Therapy: How much is enough?

Dr Andrew Eagle

Thursday, 18 April 2024

Introduction

Managing endings in therapy is an important skill and successful negotiation of the ending of therapy can enhance clinical outcomes and strengthen future help-seeking behaviour. In a context where most public therapy provision is relatively brief and time limited there are particular challenges for clinicians and clients in managing endings effectively in a genuinely collaborative manner. The reality is that resources are limited and it is not always possible to provide the more intensive and/or specialist therapy that may be indicated. The underlying question is therefore often: How much is enough? 


This workshop will offer participants the opportunity to think about how to most effectively manage endings in real-world health care settings to achieve the best possible outcomes within a time-limited framework. 


The event will be equivalent to 2 hrs of CPD.

Content

Successful therapeutic endings are more difficult to achieve where there have been poor clinical outcomes or where patients’ express dissatisfaction during the ending phase. In a context of finite resources, patients may feel they do not have any meaningful control over decisions about how and when to end therapy. Equally, therapists’ may be frustrated that they cannot offer more flexible or extended treatment. The gold standard criteria for termination are often not achieved in practice. Clients may continue to experience significant symptoms and emotional distress and clinicians face difficult decisions about whether to extend, modify or end treatment. This is particularly the case where standard treatment models are adapted to meet the needs of a more complex client group with more chronic difficulties.

This workshop introduces models of endings that can support best clinical practice. A distinctive CBT approach to ending therapy will be presented. Emphasis will be given to the beginning phase of therapy, because effective and genuine collaboration in goal setting and treatment planning at the outset of therapy is usually the key to achieving a good and mutually satisfactory endings. The workshop will discuss criteria for ending therapy and the skilled use of outcome measures and client feedback to guide the ending process.

Particular attention will be given to the management of difficult endings and participants will be given opportunity to discuss challenging cases from their clinical practice and to reflect on their experience of endings and beliefs which may impact on their clinical practice

Learning Objectives

By the end of this workshop participants will have achieved the following learning objectives:

1. To understand the different models of therapy that may support clinicians in manging endings in therapy with an awareness of service context as an important reality.
2. Learn to properly prepare for and plan therapy to minimise the possibility of unsuccessful endings.
3. Learn to more effectively manage endings in cases with poor treatment outcomes and dissatisfied clients.
4. Learn to understand how therapist beliefs and practice may contribute to ineffective management of the ending process.

Training Modalities

The workshop will include a variety of teaching methods including didactic content, PowerPoint slides, clinical case material, large group discussion, self-reflection exercises and opportunities for questions and comment.

Key References

French, L.R.M et al. (2017). Individual’s Long-Term Use of Cognitive Behavioural Skills to Manage their Depression: A Qualitative Study. Behavioural and Cognitive Psychotherapy, 45, 46-57.

Holmes, J. (1997). ‘Too early, too late’: Endings in Psychotherapy - An Attachment perspective. British Journal of Psychotherapy, 14, 2, 159-171.

Jacobsons. L., Brown, J., Gordon, K & Joiner, E. (2007). When are Clients Ready to Terminate? Cognitive and Behavioural Practice, 14. 218-230.

Murdin, L. (2000). How Much is Enough? Endings in Psychotherapy and Counselling. London: Routledge.

O’Donohue, W.T. & Cucciare, M.A. (2008). Terminating Psychotherapy: A Clinician’s Guide. New York: Taylor and Francis

Quintana, S.M. (1993). Towards an Expanded and Updated Conceptualisation of Termination: Implication for Short-Term Individual Psychotherapy. Professional Psychology: Research and Practice, 24, 4, 427-432.

About the presenter

Dr Andrew Eagle has worked for many years as a Consultant Clinical Psychologist with Central and North West London Foundation NHS Trust (CNWL), managing and supporting community and acute mental health services. He has a particular interest in the management of endings in therapy and the updating of existing theoretical models to support brief time-limited therapy. He has run numerous workshops and training events and has conducted research in this area.

He continues to take a keen interest in the management of endings in mental health services against a background of ever-increasing service demand, significant ongoing pressures on waiting lists and challenges recruiting and training staff.

Who should attend

While this workshop has a focus on managing endings in therapy it is relevant to any mental health staff who have to manage endings in their clinical practice. It is thus suitable for a wide range of delegates including primary care low and high intensity practitioners, psychologists, nurse therapists, counsellors, psychiatrists, occupational therapists, and social workers. Practitioners may work in adult primary or secondary care or with children and young people, or other specialist services.

Details coming soon

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