When long-term treatment is not long enough.

Abstract

The author describes the evolution of his practice of psychiatry over 35 years, disputing the traditional valuation placed on the concept of termination and endorsing the value of ongoing therapy. Seven dimensions of ongoing therapy are described: narrative, privacy, counsel, personality, enrichment, reality, and anchoring. Two principles provide some insurance against unrecognized countertransference factors that might lead the therapist to prolong therapy: avoiding interpretation of resistance when patients suggest they wish to discontinue and explicitly informing patients when an acute disorder has abated sufficiently for therapy to cease.