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'We Can Work It Out': Working Through Termination Ruptures

机译：“我们可以解决它”：通过终止破裂工作

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摘要

Supportive-expressive (SE) psychodynamic treatment is based on the identification of and working through the patient's signature core conflictual relationship theme. According to the SE framework. when termination is anticipated, separation conflict arises, and the actualization of the patient's interpersonal wish in the relationship with the therapist is no longer possible. The disactualization of the patient's wish in the relationship with the therapist may cause patients to regress to their maladaptive prototype responses (Nof. Leihovich, & Zilcha-Mano, 2017). which may manifest as a rupture in the therapeutic alliance. The present work integrates constructs based on the SE framework, specifically the disactualization of the patient's wish at the end of treatment, with the framework of alliance ruptures and their resolution (Safran & Muran, 2000). We propose a conceptual clinical model to guide therapists in the successful resolution of alliance ruptures, which are the result of the disactualization of the patient's interpersonal wish. We propose a two-stage process to achieve successful resolution of termination ruptures: (a) identification of termination ruptures and (b) addressing and resolving termination ruptures. For each stage, we propose practice-based guidelines and steps to follow. We demonstrate the proposed guidelines based on the case study of a patient with major depressive disorder. We used three sources of information from the case study: verbal transcripts of the therapy sessions, questionnaires, and semi-structured posttreatment interviews.
机译：支持性表达（SE）心理动力学治疗基于识别和处理患者标志性核心冲突关系主题。根据SE框架。当预期终止时，分离冲突就会出现，患者在与治疗师的关系中的人际愿望就不可能实现。患者在与治疗师的关系中的愿望被破坏可能会导致患者回归到其不适应的原型反应（Nof.Leihovich和Zilcha Mano，2017）。这可能表现为治疗联盟的破裂。目前的工作将基于SE框架的结构，特别是治疗结束时患者愿望的失能，与联盟破裂及其解决的框架相结合（Safran&Muran，2000）。我们提出了一个概念性的临床模型，以指导治疗师成功解决联盟破裂问题，这是患者人际愿望失能的结果。我们提出了一个两阶段流程，以成功解决终止破裂：（a）识别终止破裂，以及（b）解决和解决终止破裂。对于每个阶段，我们都提出了基于实践的指导方针和遵循的步骤。我们以一名重度抑郁症患者的案例研究为基础，展示了建议的指南。我们使用了案例研究中的三个信息来源：治疗过程的口头记录、问卷和半结构化治疗后访谈。

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