Many clients unilaterally decide to drop out of therapy. They may do so with a phone message, email or simply by not showing up to their next scheduled appointment or not returning follow-up phone calls.   Many clinicians wonder if they should send a follow-up (registered) letter inviting the client to "one last closure session", and/or whether they should offer referrals.  Neither is mandatory nor are they always necessary. Our online course on Termination discusses premature terminations and many related issues.  The course is offered for 4 CE credits and fulfills the law and ethics requirement in many states. On Premature Termination: When Clients Drop Out Premature termination is very common.  Many clients unilaterally drop out of therapy with or without notification. It is not unusual for therapy to abruptly stop or break down rather than go through a smooth, clear or distinct (textbook) termination. Clinicians must remember that it is the client's prerogative and choice whether to continue in therapy or not.  A client's drop out neither means that therapy was ineffective nor that the client may not come back at a future date. Except in extreme situations, such as when the client poses a danger to self or others, therapists need to respect their clients' choices. There is no ethical, clinical or legal mandate to send a registered letter to all clients who drop out of therapy. There is no ethical, clinical or legal mandate to offer referrals to all clients who drop out of therapy. Different clients and situations may require different actions and, at times, lack of action. The question of whether therapists need to send a letter to clients who unilaterally dropped out (i.e., premature termination) was recently addressed by Davis & Younggren. In a 2009 PPRP article, they clearly stated, "In ordinary circumstances, however, letters are typically unnecessary and potentially counterproductive to the natural dissolution of the relationship (Davis, 2008). . . For instance, the client might feel embarrassed or scolded for his or her oblique termination and be less inclined to return. The client might perceive the psychotherapist's actions as controlling and unnecessarily intrusive . . . It might seem that the psychotherapist is trying to break up with the client or get rid of him or her with such a formal action."  (Davis, D. D. and Younggren, J. N. (2009). Ethical competence in psychotherapy termination.  Professional Psychology: Research and Practice, 40 (6), 572-578, p. 575.) Sending a follow up letter or offering referrals can be insulting and clinically inappropriate for some clients in certain situations and may be clinically correct with other clients and other situations. Routine letters of closure present an unrealistic administrative burden on the therapists.  We have enough mandatory and necessary paperwork as it is.

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