Termination in Psychotherapy: A Case Report which Consists of the Difficulties in Termination Phase

Abstract

In this paper, the termination phase in psychotherapy is discussed and a case report of a psychotherapy process which consists of difficulties in the termination phase is presented. The personality structure of this case displays high-level borderline organization, a diagnosis of major depression according to Axis I and histrionic personality disorder, and schizoid personality features according to Axis II of the Diagnostic and Statistical Manual (DSM-IV). For this patient, individual art psychotherapy with psychodynamic orientation was used. In the first year of the psychotherapy process, the patient idealized and reflected needs for "ideal motherhood/self-object" by developing a positive transference for the therapist. The utilization of art therapy (painting) can function as a container that holds traumatic and chaotic inner lives of the patient. It can serve as a means for a dyadic relationship with painting therapy and thereby allow repairing narcissistic structure and overall improvement of well-being. In this individual study, depressive symptoms were resolved through fulfilling the patient's need of self-object. However, in later stages when patient realized the limits of the therapy/therapist, a feeling of disappointment occurred and it revealed the patient's struggle of separation-individualization and desire to terminate the psychotherapy process. At the same time, this process triggered the patient's efforts to perceive herself as an individual. In the third year, the patient terminated the psychotherapy process without even informing the therapist. The outburst was considered an "acting out" response. To validate our assessment, the patient returned one year later to complete the process by interview with the therapist. In this case, the patient's object relationships, difficulties about the separation, and the effects of psychotherapy that continued after completing the process were presented.