The Capacity to End: Termination of Mentalization-Based Therapy for Borderline Personality Disorder

Terminating a therapeutic relationship can be a challenging phase with patients suffering from borderline personality disorder. Despite the critical importance of the termination phase, the proportion of psychotherapy literature devoted to the demands and challenges of this phase is small. This paper describes a mentalization-based approach to detect and intervene against such challenges. It is proposed that termination challenges, while operating through overlapping and interactive mechanisms, can be attributed to (1) patient factors, (2) therapist factors, and (3) therapeutic relationship factors. The paper has clinical implications and suggests that the aim of enhancing mentalizing capacities should include mentalizing the often complicated and mixed feelings associated with separation and loss of the therapeutic relationship. To facilitate this process, we propose the use of a “termination formulation”, in which patients’ outcomes and future goals are recapitulated in the termination phase of mentalization-based therapy.