ABSTRACT
It is a sad commentary on their education and training that even experienced psychotherapists and analysts tend to remain neophytes with respect to understanding the natural history of therapy as it winds down and how to evaluate the possibility of ending treatment electively with a phase of termination. The reasons are not entirely, or even mostly, the fault of the individual therapists; rather, they lie in the training system, mostly the public clinics affiliated with the academic programs in which therapists receive their basic clinical training. Let us consider the background of this situation. For many years, public hospitals and clinics served mainly medically indigent patients. The better clinics usually were affiliated with the medical schools of universities and served as centers for teaching physicians and members of the other helping professions the skills they needed for practice. With or without their consent, the patients were also “teaching material”; they paid for their care, as it were, by submitting to much more poking and prying into their bodies and minds than would be necessary for their care. In that way they provided opportunities for novice clinicians to learn their skills. With the advent of Medicaid and Medicare, there are fewer truly indigent patients with no claim on public programs.
