| 英文摘要 |
Background/Objectives: Psychotherapy termination may be conceptualized as an intentional process that occurs over time when a patient has achieved most of the goals of treatment, and/or when it becomes reasonably clear that the patient no longer needs the service, is not likely to benefit, or is being harmed by continued service. Psychotherapists maintain an obligation to ensure that this process is handled in an ethical manner consistent with each patient's best interests. Patients with Borderline personality disorder are notoriously to have high dropout rate in mental health services, which would delay the solutions of personal problems and the development of group process. In this presentation, the authors discuss how the group members and therapist faced group termination together; In addition to therapist's interventions, members' participating process were reviewed, and members' follow up and aftercare were also described. Method: Commenced in March 2001, this long-term outpatient group was based on Psychodynamic model, and lastly taken a Mentalization-informed approach. This group was designed to be heterogeneous to buffer the tension evoked by BPD patients. Besides old members, new members were recruited every 3 months to enrich the development & vitality of this group. The study period is from July to December 2017. All group sessions were recorded, verbatim transcribed, and analyzed by method of case study research. Results: I. Dropout and termination: 1. Dropout: The dropout new members usually characterized as higher functioning, more narcissistic trait, or pseudo-normality. The dropout old members were due to inevitable extra-group obligations, did not have adequate treatment adherence, or anxious attachment style. 2. Termination: Successfully terminated long-term participants often because of extra-group changes, such as go back to work, participate new pre-occupational training etc. Also, they maintained good therapeutic alliance, group cohesiveness, internalized and generalized group gains, and had positive progress in personal development. II. Aftercare: Individualized aftercare was provided unless dropout completely from treatment program, continuous OPD follow up, individual psychotherapy, or/and monthly community 2. Termination: Successfully terminated long-term participants often because of extra-group changes, such as go back to work, participate new pre-occupational training etc. Also, they maintained good therapeutic alliance, group cohesiveness, internalized and generalized group gains, and had positive progress in personal development. II. Aftercare: Individualized aftercare was provided unless dropout completely from treatment program, continuous OPD follow up, individual psychotherapy, or/and monthly community group program were arranged as needed. Conclusion: Psychotherapists terminate therapy when it becomes reasonably clear that the patient no longer needs the service, is not likely to benefit, or is being harmed by continued service. Before group termination, therapist provided pre-termination counseling within the group, such as reviewing gains made in treatment, considering potential relapse risks and how to handle them, addressing future challenges to be dealt with either outside of psychotherapy or when returns to psychotherapy. This long-term outpatient group was ended not totally as expected; before the ending of this long-term outpatient group, the research team responded contingently to the developmental process of group, and the short-term follow up revealed as not inappropriately. |
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