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April 1974

Patients Who Abandon PsychotherapyWhy and When

Author Affiliations

From the Psychiatry Department, Toronto Western Hospital, University of Toronto.

Arch Gen Psychiatry. 1974;30(4):486-491. doi:10.1001/archpsyc.1974.01760100054009

Patients abandon psychotherapy when the interaction between patient and therapist approximates conditions within the family at the time the patient left home. Dependent patients of overprotective parents leave therapy to avoid the "smothered" experience of adolescence. Schizophrenic patients who function only as part of a symbiotic unit leave therapy, usually to relapse, when the symbiosis with the therapist is interrupted. Obsessional patients who have been over-whelmed by scruples and obligations at home stop treatment when continuing seems to have become a moral responsibility. Patients of rejecting parents drop out of therapy when they feel rejected. Patients whom parents appear to have cast in certain roles, abandon psychotherapy when they feel pressed by the therapist into reenacting those roles.

The therapist can prevent premature termination by anticipating crucial milestones in the therapy of individual patients and interpreting flight from therapy against the background of leave-taking from home.