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Termination Revisited: Dispelling Myths - Clarifying Issues
Clinical Update
By Zur Institute
For a complete list of all Clinical Updates, click here.
The issue of how to terminate a therapeutic relationship is a very important one. Some terminations are short and swift, while others may be long and protracted. In many situations, the client simply drops out, affording therapists neither the luxury of planning and discussing termination with clients nor the chance to go through a gradual and thorough termination process. About half of all terminations are initiated and executed by clients, who often do not inform their therapists that they have decided to quit therapy.
Clients simply do not show up. Unlike the common myth to the contrary, there is no legal mandate for therapists to always send a letter to the client, call the client, offer referrals, or offer one more free "closure" session. Each situation is different. Sometimes all the therapist needs to do is to be respectful of the client's decision and document the termination process (or lack off) in the patient's records. .
We have developed a new online course: Termination in Psychotherapy & Counseling 3 CE Credits
This course is based on audio (MP3) interviews with experts on the most important and cutting edge aspects of termination and includes extensive Termination Guidelines.
Check out our Audio Trailer for the course.
NOT ALL TERMINATIONS ARE CREATED EQUAL:
- Ideally, termination is discussed and reviewed by therapist and client prior to the last session. In reality, however, this often does not take place.
- Clients have the right to terminate therapy any time.
- Therapist-initiated termination may involve situations in which there is no progress in therapy, a client is non-compliant, or a client threatens or stalks the therapist, their family members, or their employees via phone, e-mail, online, or in-person.
- Therapists should use caution and patience with clients who can no longer pay for therapy but are in crisis. A few extra sessions may be necessary to avoid abandonment.
- Office Policies and Informed Consent (given to clients before or at the start of therapy) should discuss termination issues. (Office Policies are available with our Clinical Forms.)
- Therapists can also terminate treatment with clients who intrude into their private life via the Internet or in "real" life.
- Therapists are allowed to protect their privacy and secure their own, their family members' or employees' privacy and safety.
- Generally, therapists must terminate therapy when it becomes reasonably clear that the patient no longer needs the service, is not likely to benefit, or is being harmed by continued service.
- There are also situations when therapists are terminated by their clinic or employer or unexpectedly relocate, fall ill, or die.
- Therapists who practice intermittent-long-term therapy view termination differently. In this modality, therapy may continue on-and-off throughout the life span of individuals and families. Rather than a final termination, this modality involves a series of 'end of a phase' of therapy.
- Regardless of how or why therapy is terminated, it is essential to document, document and document: who initiated the termination, why, treatment summary, and, if appropriate, referrals or follow-ups, etc.
- In difficult and complex cases, consultation with an expert can be very helpful in determining ways to practice within the standard of care.
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