Therapy Termination Quotes

Julie told me that she wanted people to keep her in mind the way she keeps me in mind between sessions. “I’ll be driving, and I’ll panic about something, but then I’ll hear your voice,” she explained. “I’ll remember something you said.” I thought about how I did this with Wendell—how I’d internalized his lines of questioning, his way of reframing situations, his voice. This is such a universal experience that one litmus test of whether a patient is ready for termination is whether she carries around the therapist’s voice in her head, applying it to situations and essentially eliminating the need for the therapy.

When clients relinquish symptoms, succeed in achieving a personal goal, or make healthier choices for themselves, subsequently many will feel anxious, guilty, or depressed. That is, when clients make progress in treatment and get better, new therapists understandably are excited. But sometimes they will also be dismayed as they watch the client sabotage her success by gaining back unwanted weight or missing the next session after an important breakthrough and deep sharing with the therapist. Thus, loyalty and allegiance to symptoms—maladaptive behaviors originally developed to manage the “bad” or painfully frustrating aspects of parents—are not maladaptive to insecurely attached children. Such loyalty preserves “object ties,” or the connection to the “good” or loving aspects of the parent. Attachment fears of being left alone, helpless, or unwanted can be activated if clients disengage from the symptoms that represent these internalized “bad” objects (for example, if the client resolves an eating disorder or terminates a problematic relationship with a controlling/jealous partner). The goal of the interpersonal process approach is to help clients modify these early maladaptive schemas or internal working models by providing them with experiential or in vivo re-learning (that is, a “corrective emotional experience”). Through this real-life experience with the therapist, clients learn that, at least sometimes, some relationships can be different and do not have to follow the same familiar but problematic lines they have come to expect.

Once I had been diagnosed with a terminal illness, I began to view the world through two perspectives; I was starting to see death as both doctor and patient. As a doctor, I knew not to declare “Cancer is a battle I’m going to win!” or ask “Why me?” (Answer: Why not me?) I knew a lot about medical care, complications, and treatment algorithms. I quickly learned from my oncologist and my own study that stage IV lung cancer today was a disease whose story might be changing, like AIDS in the late 1980s: still a rapidly fatal illness but with emerging therapies that were, for the first time, providing years of life. While being trained as a physician and scientist had helped me process the data and accept the limits of what that data could reveal about my prognosis, it didn’t help me as a patient. It didn’t tell Lucy and me whether we should go ahead and have a child, or what it meant to nurture a new life while mine faded. Nor did it tell me whether to fight for my career, to reclaim the ambitions I had single-mindedly pursued for so long, but without the surety of the time to complete them. Like my own patients, I had to face my mortality and try to understand what made my life worth living—and I needed Emma’s help to do so. Torn between being a doctor and being a patient, delving into medical science and turning back to literature for answers, I struggled, while facing my own death, to rebuild my old life—or perhaps find a new one. —

But he gave no greater gift than the one he offered me shortly before he died, and it was a gift that answers for all time the question of whether it is rational or appropriate to strive for “ambitious” therapy in those who are terminally ill. When I visited him in the hospital he was so weak he could barely move, but he raised his head, squeezed my hand, and whispered, “Thank you. Thank you for saving my life.

Julia had been angry most of her life. She may have grown up in wealth and privilege but she’d had to fight to be heard and seen. To be validated. To be something other than a piece to be moved around her parents’ Monopoly board. Rage had given her a voice against their manipulations and the guts to walk away. But it had also become ingrained. There were times when she’d contemplated therapy for it. Right now, she was pleased she hadn’t. If anything could kill this cancer it would be the weight of Julia’s wrath.

Rank hoped that if this primal trauma were dealt with by a subsequent analysis the whole neurosis would be got rid of. [...] And a few months should be enough to accomplish this. It cannot be disputed that Rank's argument was bold and ingenious; but it did not stand the test of critical examination. Moreover, it was a child of its time, conceived under the stress of the contrast between the post-war misery of Europe and the 'prosperity' of America, and designed to adapt the tempo of analytic therapy to the haste of American life.

Analysis, however, enables the ego, which has attained greater maturity and strength, to undertake a revision of these old repressions; a few are demolished, while others are recognized but constructed afresh out of more solid material. These new dams are of quite a different degree of firmness from the earlier ones; we may be confident that they will not give way so easily before a rising flood of instinctual strength. Thus the real achievement fo analytic therapy would be the subsequent correction of the original process of repression, a correction which puts an end to the dominance of the quantitative factor.

When problems of transference are involved, as they usually are, psychotherapy is, among other things, a process of map-revising. Patients come to therapy because their maps are clearly not working. But how they may cling to them and fight the process every step of the way! Frequently their need to cling to their maps and fight against losing them is so great that therapy becomes impossible, as it did in the case of the computer technician. Initially he requested a Saturday appointment. After three sessions he stopped coming because he took a job doing lawn-maintenance work on Saturdays and Sundays. I offered him a Thursday-evening appointment. He came for two sessions and then stopped because he was doing overtime work at the plant. I then rearranged my schedule so I could see him on Monday evenings, when, he had said, overtime work was unlikely. After two more sessions, however, he stopped coming because Monday-night overtime work seemed to have picked up. I confronted him with the impossibility of doing therapy under these circumstances. He admitted that he was not required to accept overtime work. He stated, however, that he needed the money and that the work was more important to him than therapy. He stipulated that he could see me only on those Monday evenings when there was no overtime work to be done and that he would call me at four o’clock every Monday afternoon to tell me if he could keep his appointment that evening. I told him that these conditions were not acceptable to me, that I was unwilling to set aside my plans every Monday evening on the chance that he might be able to come to his sessions. He felt that I was being unreasonably rigid, that I had no concern for his needs, that I was interested only in my own time and clearly cared nothing for him, and that therefore I could not be trusted. It was on this basis that our attempt to work together was terminated, with me as another landmark on his old map. The problem of transference is not simply a

When you are depressed, you may have a tendency to confuse feeling with facts. Your feelings of hopelessness and total despair are just symptoms of depressive illness, not facts. If you think you are hopeless, you will naturally feel this way. Your feelings only trace the illogical pattern of your thinking. Only an expert, who has treated hundreds of depressed individuals, would be in a position to give a meaningful prognosis for recovery. Your suicidal urge merely indicates the need for treatment. Thus, your conviction that you are "hopeless" nearly always proves you are not. Therapy, not suicide, is indicated. Although generalizations can be misleading, I let the following rule of thumb guide me: Patients who feel hopeless never actually are hopeless. The conviction of hopelessness is one of the most curious aspects of depressive illness. In fact, the degree of hopelessness experienced by seriously depressed patients who have an excellent prognosis is usually greater than in terminal malignancy patients with a poor prognosis. It is of great importance to expose the illogic that lurks behind your hopelessness as soon as possible in order to prevent an actual suicide attempt. You may feel convinced that you have an insoluble problem in your life. You may feel that you are caught in a trap from which there is no exit. This may lead to extreme frustration and even to the urge to kill yourself as the only escape.

The first of our questions was: 'Is it possible by means of analytic therapy to dispose of a conflict between an instinct and the ego, or a pathogenic instinctual demand upon the ego, permanently and definitely?' To avoid misunderstanding it is not unnecessary, perhaps, to explain more exactly what is meant by 'permanently disposing of an instinctual demand'. [...] we mean something else, something which may be roughly described as a 'taming' of the instinct. That is to say, the instinct is brought completely into the harmony of the ego, becomes accessible to all the influences of the other trends in the ego and no longer seeks to go its independent way to satisfaction. If we are asked by what methods and means this result is achieved, it is not easy to find an answer. We can only say: 'So muss den doch die Hexe dran!' — the Witch Metapsychology.

talk therapy for the terminally introverted.

Oliver W. Addison attended Palmer College and Trident Technical College in Charleston and studied accounting, industrial health and safety, and automobile mechanics. In 2006 he was awarded the Doctor of Humane Letters by the Medical University of South Carolina. He worked for Norfolk Southern Railroad for a total of 28 years, 12 of them as a switchman and conductor and 16 as General Yard Master. He was awarded for having the safest terminal on the railroad in its size category and received accolades for on-time service for the industry. Mr. Addison has been a leader in Union Heights for 38 years and served on the Community Council for over 20 years. He recently received a commendation from the Medical University of South Carolina for his work in bringing a health clinic to the Union Heights community and developing programs for youth. Mr. Addison served on the Charleston County School Board for 8 years and was the board's chair for 1995-1996 and 2001-2002. For his work on the school board, he received a high-profile award from the Post and Courier newspaper.

Syphilis is caused by a spiral bacterium (aka a spirochete) known as Treponema pallidum. The bacterium is usually acquired during sexual contact, whereupon it corkscrews its way across mucous membranes, multiplies in the blood and lymph nodes, and, if a patient is especially unlucky, gets into the central nervous system, including the brain, causing personality change, psychosis, depression, dementia, and death. That’s in the absence of antibiotic treatment, anyway; modern antibiotics cure syphilis easily. But there were no modern antibiotics in 1917, and the early chemical treatment known as Salvarsan (containing arsenic) didn’t work well against late-stage syphilis in the nervous system. Wagner-Juaregg solved that problem after noting that Treponema pallidum didn’t survive in a test tube at temperatures much above 98.6 degrees Fahrenheit. Raise the blood temperature of the infected person a few degrees, he realized, and you might cook the bacterium to death. So he began inoculating patients with Plasmodium vivax. He would allow them to cycle through three or four spikes of fever, delivering potent if not terminal setbacks to the Treponema, and then dose them with quinine, bringing the plasmodium under control. “The effect was remarkable; the downward progression of late-stage syphilis was stopped,” by one account, from the late Robert S. Desowitz, who was a prominent parasitologist himself as well as a lively writer. “Institutions for malaria therapy rapidly proliferated throughout Europe and the technique was taken up in several centers in the United States. In this way, tens of thousands of syphilitics were saved from a sure and agonizing death”—saved by malaria.

Sometimes I think of my death,’ wrote Kurosawa, ‘I think of ceasing to be... and it is from these thoughts that Ikiru came.’ The story of a man diagnosed with stomach cancer, Kurosawa’s film is a serious contemplation of the nature of existence and the question of how we find meaning in our lives. Opening with a shot of an x-ray, showing the main character’s stomach, Ikiru, tells the tale of a dedicated, downtrodden civil servant who, diagnosed with a fatal cancer, learns to change his dull, unfulfilled existence, and suddenly discovers a zest for life. Plunging first into self-pity, then a bout of hedonistic pleasure-seeking on the frentic streets of post-war Tokyo, Watanabe - the film’s hero, finally finds satisfaction through building a children’s playground. In this, the role of his career, Shimura plays Kanji Watanabe, a senior civil servant sunk in ossified routine - a man who, as the dispassionate narrator tells us, has lived like a corpse for twenty-five years. Confronted with the news that he has terminal cancer with only months to live, he finds himself driven to give some meaning to his life. This was one of Kurosawa’s own favourites among his films. It grew, he said, out of a sense of his own mortality. Although he was only 42 and had yet to make most of his finest films, he was tormented with doubts about what his own life would be worth, saying, ‘I keep feeling I have lived so little. My heart aches with this feeling.’ From this angle, the film can be seen as a form of therapy, Kurosawa reassuring himself, and us, that life *can* be made to have meaning, even under the shadow of imminent death. As the critic Richard Brown wrote, Ikiru ‘consists of a restrained affirmation within the context of a giant negation. What it says in starkly lucid terms is that ‘life’ is meaningless when all’s said and done; at the same time one man’s life can acquire meaning when he undertakes to perform some task which is meaningful *to him*. What everyone else thinks about that man’s life is utterly beside the point, even ludicrous. The meaning of his life is what he commits the meaning of his life to be. There is nothing else.

This is such a universal experience that one litmus test of whether a patient is ready for termination is whether she carries around the therapist’s voice in her head, applying it to situations and essentially eliminating the need for the therapy.

Yet after my diagnosis and despite my hunch about the disease’s fatality, I did undergo all the operations, therapies, and interventions specialists advised. Given my love of life and of the people in my life, it seemed wrong simply to submit to the cancer’s inevitable progress, to succumb passively and helplessly to the determinism of a preordained death. I had to embark on doing what could be done against the disease—even if, even though it would eventually terminate my existence. To treasure the gift of life and the people in my life, I wanted to take responsibility for dealing with a condition admittedly beyond my control. Like many people with cancer, I sought to cultivate acceptance while consulting and following the advice of medical specialists.

kept up with my therapy sessions and I was in an online support group for people living with terminal loved ones. I took care of my mental well-being with the same commitment that I took care of my family—because I couldn’t do one unless I did the other.

hospice care? Some of the services are as follows: Home visits by specialty trained hospice nurses and Medical Director Pain management and symptom control Personal hygiene care from certified home health aides All medications related to the terminal diagnosis All specialized therapies required for the terminal diagnosis Psychosocial, spiritual, and grief support services Volunteers as requested

If you come to me for analysis and therapy, and you absolutely refuse to have any spirituality, I will still work with you, but I will have to tell you honestly that without a spiritual practice it will be much more difficult, perhaps impossible, for you to deal effectively with your archetypal Self, its grandiose energies, and its unconscious projections. If you come into analysis with me without a spiritual life, you might project your god-complex onto me if you like me and idealize me. I will probably try to carry it, and we will be tempted to have one of those Woody Allen, twenty-year analyses. This is what happens with Freudians and other therapists who do not understand that an idealizing transference of the god-complex onto the therapist is a mythic and spiritual phenomenon. If a therapist has trouble letting people terminate their therapy, it is because it is not therapy, but unconscious religion. The therapist has become a little Holy Father with his own little pseudo-religion.

the case of Nelene Fox. Fox was from Temecula, California, and was diagnosed with metastatic breast cancer in 1991, when she was thirty-eight years old. Surgery and conventional chemotherapy failed, and the cancer spread to her bone marrow. The disease was terminal. Doctors at the University of Southern California offered her a radical but seemingly promising new treatment—high-dose chemotherapy with bone marrow transplantation. To Fox, it was her one chance of cure. Her insurer, Health Net, denied her request for coverage of the costs, arguing that it was an experimental treatment whose benefits were unproven and that it was therefore excluded under the terms of her policy. The insurer pressed her to get a second opinion from an Independent medical center. Fox refused—who were they to tell her to get another opinion? Her life was at stake. Raising $212,000 through charitable donations, she paid the costs of therapy herself, but it was delayed. She died eight months after the treatment. Her husband sued Health Net for bad faith, breach of contract, intentional infliction of emotional damage, and punitive damages and won. The jury awarded her estate $89 million. The HMO executives were branded killers. Ten states enacted laws requiring insurers to pay for bone marrow transplantation for breast cancer. Never mind that Health Net was right. Research ultimately showed the treatment to have no benefit for breast cancer patients and to actually worsen their lives. But the jury verdict shook the American insurance industry. Raising questions about doctors’ and patients’ treatment decisions in terminal illness was judged political suicide.