A psychodynamic study on premature termination of therapy sessions

Objectives: In this study, the author compared the psychodynamics of three patient groups before the termination of individual psychotherapy to understand how the patients differed in related themes and their dysfunction levels, conflicts and modes of conflict processing, defense immaturity level, and disintegration levels of some aspects of the psychodynamic structure. Methods: I used detailed process notes of 97 adult psychotherapy patients treated by a psychotherapist in a Taiwan psychiatric hospital. The study patients were divided into three groups: the treatment completers, premature terminators with prior information (informers), and premature terminators without prior information (non-informers), according to their completion of the treatment protocol and offering premature termination (PT) information in advance. I also used the core scheme of Operationalized Psychodynamic Diagosis-2 to evaluate the psychodynamics of the last two sessions before ending therapy. Results: Three groups of patients were not different in primary relational themes and total dysfunctional level of relations, also in conflict significance and mode of conflict processing. The completers and informers were not different in conflict types, but the completers presented themselves higher frequency of “individuation-dependency” conflict and a lower frequency of “Oedipal” and “un-notable” conflicts than noninformers. The completers showed less disintegrated “internal communication” and “external world communication” than informers and noninformers. Conclusion: Premature terminators less communicated internally and externally with the therapist than therapy completers, and non-informers depend less on dyad therapeutic relationships than informers and completers. Psychodynamics represented in preterminate therapy sessions can provide insight into predicting patients' inclination to PT with or without advance information that is difficult to detect in another way.