Feeling stuck with your client? The client has threatened suicide? Do you dread the next session? Has the client become over-familiar, or unreasonably hostile? Do you feel that it's time to end the treatment, but you can't bring yourself to do it? If so, read on …

Psychotherapies progress in different ways. Some seem to be quite straightforward. Others seem to be a series of crises. The most common pattern in longer-term therapy is for there to be a series of sessions in which the discussion between client and therapist seems to be a fairly predictable working out of themes raised in an earlier session. Then there may be a crisis that, if it is surmounted successfully, throws up new themes for working through over the next few sessions.

Some of the crises to be considered in this chapter are shown in Table 11.1.

General principles of managing crises

It would not be possible to write this chapter without some outcome criterion. If a person kills himself, people sometimes say, ‘He's better off dead’. If a person remains miserable or confused or frustrated, there will always be someone who says that that person is more realistic about how life really is, than if he or she had been happy or goal-directed or fulfilled. If any outcome is as good as another, there can be no criterion of what constitutes competent psychotherapy.