Chapter 8.Ending Treatment

Ending treatment takes many forms with adolescent patients. Transitions, dropouts, and terminations bring treatment to a pause or an ending in both expected and unexpected ways. Adolescents in general are more difficult to engage in lengthy treatments than are adults. When adolescents’ attention turns to building relationships with peers and activities in their communities, caregivers should let go and provide space for independence and growth. For this reason, many of the evidence-based treatments for borderline personality disorder (BPD) adapted to adolescents are brief by design (see Table A1–1 in Appendix A, “Relation of Good Psychiatric Management for Adolescents to Other Evidence-Based Treatments for Adolescent Borderline Personality Disorder”). We encourage offering good psychiatric management for adolescents (GPM-A) in a flexible format. You can start with a short-term commitment for a specific number of sessions (see Chapter 4, “Getting Started”). These short stretches allow the teen, the family, and you a chance to both collaborate on short-term goals and evaluate the treatment for its effectiveness in manageable chunks. Also, it gives pause for adolescents to figure out what they need, which will change as they make progress, and puts them in charge of asking for what they want in a way that is credible.