Termination Phase

The termination phase, encompassing the last five sessions, is an essential component of IPT-G. On a basic level, this specified stage gives members the chance to consolidate progress, formally say goodbye, and discuss concerns about relapse and the possible need for future treatment. More poignantly, it is a time when members learn to manage the emotions evoked by ending relationships that they have found useful and meaningful. Hence, many complicated and conflicted feelings come up. How members grapple with their feelings likely determines how each approaches the basic tasks of the phase. When managed successfully, this aspect of treatment can promote motivation and application that continues long after the group ends.

During this significant stage of treatment, therapists encourage the group to confront several themes central to the termination process (Table 20.8 I . Therapists should discuss termination explicitly and raise the issue of reactions to impending termination in each of the last several sessions. Therapists should conceptualize termination as a formal, powerfully therapeutic part of the treatment. Before the group ends, members should be afforded many opportunities to reveal their feelings about stopping and their methods for managing these feelings.

Inevitably, some members will suggest that the group get together outside the clinical setting and exchange a flurry of telephone numbers and email addresses. The therapist may suggest that the group explore what they want to get out of such a reunion. The therapist needs to maintain a calm firmness about the ending of the group and the importance of talking about it.

Table 20.8. Themes Central to the Termination Process

1.

Recognizing that termination is a time of possible loss, an analogue of grieving

2.

Acknowledging negative reactions regarding not getting enough treatment or being abandoned

3.

Emphasizing the progress that each member has made, especially in terms of improved relationships and socialization outside of group

4.

Maintaining the stance of adopting personal responsibility for continued work on problem areas

5.

Discussing concerns about future need for treatment

6.

Specifically saying goodbye to each other and to the therapist(s)

A brief vignette from the final session of a group for members with binge eating disorder:

therapist: Today we’d like to take time to give feedback to each other about changes you’ve made during the course of group. Why don’t we start with Marilyn? You’ve done quite a bit of work and had a breakthrough with your husband. marilyn: I did make some good changes in my relationship with my husband, but I don’t feel I’ve made as much progress as I should have if I’d taken better advantage of the group.

therapist: Marilyn, let me stop there. You have a tendency to be overly self-critical at the expense of recognizing the gains you’ve made. For today, I’d like you to focus on your accomplishments throughout the group process. For instance, you took the time to make connections between your relationships and food. You stuck with it, even though initially you weren’t sure how it even applied to you. marilyn: I did. I let go of caretaking more, too. I realized I have to take care of myself and that no one will do that for me. therapist: What have others noticed about Marilyn?

ted: I’ve seen a shift in you. Even in group you changed, not apologizing as much but being more direct.

therapist: How about you, Ted? What do you think about your own progress? ted: I’ve gotten some tools . . . I don’t doubt myself as much, so I am more clear with other people now. My relationships at work are better, I think, because I work hard to be more aware of what I think and not to so easily take on the opinions of others. I feel more confident and others respond to that. therapist: Other feedback for Ted . . .?

Group members should be encouraged to continue until all have commented on their own and each other’s progress.

 
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