When psychotherapy is indefinite and there is no final outcome: case study of a community mental health clinic.

Little is known about long-term patients for whom there is no anticipated endpoint to treatment. In this qualitative case study, we used a focus group methodology to understand how psychotherapists at a community mental health clinic work with low-income adult patients who are seen indefinitely. Narrative themes that emerged from the focus group discussion include the nature of these patients' diagnoses and life problems; the sociocultural contexts in which they live; the kinds of treatment goals and interventions; the internal and external barriers to termination; and how therapists recognize the need to work indefinitely with some patients to keep them alive or functioning in the community. Although a diagnosis of major mental illness was the foremost reason for not planning a termination, participants also mentioned working indefinitely with some higher functioning patients whose lives are perpetually in crisis. Participants emphasized the importance of having a compassionate clinical team and supportive administration for seeing patients indefinitely, even when third party payments end. Results are discussed in terms of their implications for service delivery as well as their implications for future investigations of psychotherapy that has no foreseeable endpoint.