Length Frequency and Termination of Therapy

Length, Frequency, and Termination of Therapy

In the AFP we were required by research design to work within a 10 (weekly) session model, with some allowance for exceptions if a family was undergoing a crisis at the end of this period. We consider this model unduly constraining and do not advocate use of such a rigid paradigm. Instead, we recommend that a contract be negotiated with the family at the outset for, say, 8 to 12 sessions. This might be extended to 20 sessions with recontracting, but rarely more unless the family wants to make a new contract for other problems. Even within an 8-session program, however, it is best to space final sessions further apart (e.g., 2 to 6 weeks). An -inoculative" follow-up session should be scheduled 2 to 4 months after termination, with perhaps another 6 to 8 months after that, in order to insure the continuation of positive change and monitor continuity of care. Such a system also seems to make families less hesitant to take the initiative in re-engaging in treatment, since they know they are not committing themselves to interminable therapy if they do contact the therapist.*

Concerning termination, the establishment of a contract for a specific number of sessions helps to avoid its coming as a surprise or appearing to be too abrupt. Of course, the therapist needs to be sensitive to termination issues, and can avoid problems related to this phase, if, during treatment, he helps the family to establish appro-priate natural support systems that will remain in place beyond therapy. Generally, termination difficulties will not arise if adequate change has occurred and been maintained long enough for the family to feel a sense of real accomplishment. In this way the therapist can prevent them from becoming fearful and generating crises or other problems in order to keep him involved.

In sum, a brief or time-limited, active, problem-focused therapy makes the most sense. As noted in the excerpt from Haley earlier in this chapter, rather than continual, long-term therapy over years, the treatment should follow a pattern of intense involvement and rapid disengagement, with a provision to reconvene briefly if and when appropriate at some point in the future.

Caseload

In Chapters 14 and 15 the point is made that working with addicts' families can be both demanding and draining—especially in a brief therapy context. Consequently, while a therapist may be able to maintain many such cases for extended follow-up sessions (i.e., beyond the initial block of sessions), we do not recommend that he carry more than three or four active addict cases at a time, particularly while learning these techniques.