Beginnings, endings and outcome: A comparison of methods and goals

Abstract

Therapeutic beginnings, endings and outcome are discussed in relation to brief, time-limited and long-term psychodynamic counselling work, and are compared and contrasted in terms of the specific tasks and techniques needed for each of these therapeutic modes. It is shown how beginnings determine the end and how important it is at assessment which mode is chosen for clients. A description is given of how the time-limited practitioner, who pursues a modest, focused goal, uses planned endings as a valuable tool, while the long-term open-ended counsellor grapples with problems of when to end and how much is enough, with difficult notions of dependence which complicate the issue of termination and with the participant's universal wish to have a perfect ending. Finally, there is an attempt at discussing post-termination issues of outcome, evaluation and research which focus on questions of what works, who needs what, and which treatment is best for whom, while still seeking valid measures for defining improvement, establishing psychic change and long-lasting effects, and for ensuring reliable standards of evidence-based practice.