18. The end of treatment

  1. Beth S. Brodsky PhD Associate Clinical Professor of Medical Psychology1 and
  2. Barbara Stanley PhD Professor of Clinical Psychology2

Published Online: 6 MAY 2013

DOI: 10.1002/9781118556603.ch18

The Dialectical Behavior Therapy Primer: How DBT Can Inform Clinical Practice

The Dialectical Behavior Therapy Primer: How DBT Can Inform Clinical Practice

How to Cite

Brodsky, B. S. and Stanley, B. (2013) The end of treatment, in The Dialectical Behavior Therapy Primer: How DBT Can Inform Clinical Practice, John Wiley & Sons, Ltd, Chichester, UK. doi: 10.1002/9781118556603.ch18

Author Information

  1. 1

    Department of Psychiatry, Columbia University College of Physicians and Surgeons, Research Scientist New York State Psychiatric Institute, New York, NY, USA

  2. 2

    Department of Psychiatry, Columbia University College of Physicians and Surgeons, Research Scientist New York State Psychiatric Institute, New York, NY, USA

Publication History

  1. Published Online: 6 MAY 2013
  2. Published Print: 15 JUL 2013

ISBN Information

Print ISBN: 9781119968931

Online ISBN: 9781118556603

SEARCH

Keywords:

  • patient suicide;
  • treatment termination;
  • treatment drop out

Summary

Patients often drop out of treatment against medical advice or at least before the clinician determines that they have achieved their treatment goals. Patients also stay in therapy but do not engage in a meaningful way to achieve progress. In dialectical behavior therapy (DBT), there are guidelines for the clinician to determine when to recommend a “vacation from treatment” when the patient does not seem to be able to maintain the minimum commitment that will make the therapy viable. There is also a clear limit regarding when to consider a patient to be out of treatment when they do not explicitly quit. However, there are fewer guidelines for the clinician regarding when to determine when DBT may no longer be indicated, or when it is time to transition from Stage 1 DBT to later stages, 2 and 3. In this final chapter, we consider the various circumstances regarding the end of treatment, as well as issues surrounding completed suicide and the experience of having a patient make a serious, high-lethality suicide attempt.