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Termination: Ethical & Clinical Considerations

Resources

This resource page is part of two online courses
Termination in Psychotherapy: Ethical & Clinical Considerations
Understanding and Handling Therapy Terminations

CE Credits for Psychologists. CE Credits (CEUs) for LMFTs, Social Workers, Counselors and Nurses.
CE Approvals by BBS-CA, ASWB, NBCC, NAADAC, CA-BRN & more.
Zur Institute is approved by the American Psychological Association to sponsor continuing education for psychologists. Zur Institute maintains responsibility for this program and its content.

 

 

General Resources on Termination

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Closing a Psychotherapy Practice

Abandonment

Premature termination, Client Dropout, & Clients' Responsibility

  • On Pre-Mature Termination or Dropout
    Many clients unilaterally decide to drop out of therapy. They may do that with a phone message or by simply not showing up to their next scheduled appointment. Therapists must remember that it is the client's prerogative and choice whether to continue in therapy or not. 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 a myth or faulty belief that therapists must follow up premature termination with a letter. This is not always the case. There is no ethical, clinical or legal mandate to send a registered letter to client. Different clients and situations may require different actions and, at times, lack of action. This issue was addressed by Davis & Younggren in a 2009 PPRP article, where 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. Routine letters of closure not only present an unrealistic administrative burden on the provider, they add to the risk of negative client reactions." (Davis, D. D. and Younggren, J, N. (2009). Ethical competence in psychotherapy termination. Professional Psychology: Research and Practice, 40 (6), 572-578. p. 575)
  • On Clients' Duty
    "Patients also have a duty of compliance with treatment if they expect to get better and to have their psychotherapist remain in a relationship with them. This is because in psychotherapy the psychotherapist becomes a "fiduciary" in the treatment relation- ship. This type of fiduciary relationship is not simply a financial relationship but is actually much broader in both duty and obligation. It is a special type of relationship that requires that the patient have confidence and trust in the recommendations that are being made by the psychotherapist (Simon & Shuman, 2007). That is not to say that they have to agree with every suggestion the psycho-therapist makes but they, at a minimum, have to see value in cooperating with at least some of what is being offered. This begins with regularly attending treatment sessions. A psychotherapist's duty to treat patients is significantly reduced when they voluntarily fail to attend treatment sessions in a consistent fashion. Simply put, this lack of compliance on the part of patients is a violation of their responsibilities to the treatment alliance." From Younggren, J. N (2011). A Legal and Ethical Review of Patient Responsibilities and Psychotherapist Duties. Professional Psychology: Research and Practice, 2011, Vol. 42, No. 2, 160–168. P. 161.

Information for Clients/Consumers Regarding Therapy

Journal Articles

Bartle-Haring, S.et. al (2012). Alliance and termination status in couple therapy: A comparison of methods for assessing discrepancies, Psychotherapy Research, (Apr 5, 2012), 1-13

Brady, JL, Guy, JD et. al (1996). Difficult good-byes:A national survey of therapists' hindrances to successful terminations, Psychotherapy in Private Practice,14 (4), 65-76

Connell, J.,Grant, S., & Mullin, T (2006). Client initiated termination of therapy at NHS primary care counselling services, Counselling and Psychotherapy Research, 6(1), 60-67

Guy, J.D., French, R.J., Poestral, P & Brown, C.K (1993). Therapeutic terminations: how psychotherapists say good-bye, Psychotherapy in Private Practice, 12(2), 73-82

Hopwood, C, Ambwani, S & Morey, L (2007). Predicting nonmutual therapy termination with the personality assessment inventory, Psychotherapy Research, 17 (6), 706-712

Knox, S., Adrians, N., Everson, E., Hess, S., Hill, C. & Crook-Lyon, R (2011). Clients' perspectives on therapy termination, Psychotherapy Research, 21 (2), 154-167

Lampropoulos, G.K. (2010). Type of counseling termination and trainee therapist-client agreement about change, Counselling Psychology Quarterly, 23(1),111-120

Piselli,A., Halgin, R.P., & MacEwan, G.H (2011). What went wrong? Therapists' reflections on their role in premature termination, Psychotherapy Research, 21(4), 400-415

Taylor, L, Kaminer, D & Hardy, A (2011). Risk factors for premature termination of treatment at a child and family mental health clinic, Journal of Child & Adolescent Mental Health, 23(2), 155-164

Tryon, G.S. & Kane, A.S. (1995). Client involvement, working alliance, and type of therapy termination, Psychotherapy Research, 5(3), 189-198

Westmacott, R, Hunsley, J, Best, M, Rumstein-McKean O & Schindler, D (2010). Client and therapist views of contextual factors related to termination from psychotherapy: A comparison between unilateral and mutual terminators, Psychotherapy Research, 20 (4), 423-435

Journal Articles: Psychoanalytic

Dewald, P.A. (1982). The clinical importance of the termination phase, Psychoanalytic Inquiry, 2(3), 441-461

Firestein, SK (1982). Termination of psychoanalysis: Theoretical, clinical, and pedagogic considerations, Psychoanalytic Inquiry, 2(3), 473-497

Mendenhall, Susan (2009). From termination to the evolution of a relationship, Psychoanalytic Inquiry, 29(2),117-135

Wharff, E.A. (1993). Termination dreams, Journal of Analytic Social Work, 1(3), 81-103

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Additional References

  • Bamford, J., & Akhurst, J. (2014). 'She's not going to leave me'–counsellors' feelings on ending therapy with children. British Journal of Guidance & Counselling, 42(5), 459-471. http://dx.doi.org/10.1080/03069885.2014.907867
  • Barnett, J. and Zur, O. (2009). Termination guidelines. The Central Valley Therapist, 8-9. Retrieved from http://www.zurinstitute.com/terminationguidelines.html
  • Bhatia, A., & Gelso, C. J. (2017). The termination phase: Therapists' perspective on the therapeutic relationship and outcome. Psychotherapy, 54(1), 76-87. http://dx.doi.org/10.1037/pst0000100
  • Butler, J. (2015). 'The unexamined death': Patients' experiences of the premature termination of analysis due to the sudden death, or terminal illness of the analyst (Doctoral Dissertation). Retrieved from http://repository.essex.ac.uk/15292/
  • Dawson, D., & Akhurst, J. (2015). 'I wouldn't dream of ending with a client in the way he did to me': An exploration of supervisees' experiences of an unplanned ending to the supervisory relationship. Counselling and Psychotherapy Research, 15(1), 21-30. doi:10.1002/capr.12003
  • Firestein, S. K. (2001). Termination In psychoanalysis and psychotherapy. Madison, CT: International Universities Press.
  • Gans, J. S. (2016). "Our time is up": A relational perspective on the ending of a single psychotherapy session. American Journal of Psychotherapy, 70(4), 413-427.
  • Gil, E., & Crenshaw, D. A. (2015). Termination challenges in child psychotherapy. New York, NY: Guilford Publications.
  • Goode, J., Park, J., Parkin, S., Tompkins, K. A., & Swift, J. K. (2017). A collaborative approach to psychotherapy termination. Psychotherapy, 54(1), 10-14. http://dx.doi.org/10.1037/pst0000085
  • Jordan, J., McIntosh, V. V., Carter, F. A., Joyce, P. R., Frampton, C., Luty, S. E., & Bulik, C. M. (2014). Clinical characteristics associated with premature termination from outpatient psychotherapy for anorexia nervosa. European Eating Disorders Review, 22(4), 278-284. doi:10.1002/erv.2296
  • Joyce, A. S., Piper, W. E., Ogrodniczuk, J. S., & Klien, R. H. (2007). Termination in psychotherapy: A psychodynamic model of processes and outcomes. Washington, DC: American Psychological Association.
  • Jurek, J., Janusz, B., Chwal, M., & de Barbaro, B. (2014). Premature termination in couple therapy as a part of therapeutic process. Cross case analysis. Archives of Psychiatry and Psychotherapy, 2, 51-59. Retrieved from http://archivespp.pl/uploads/images/2014_16_2/51Jurek_ArchivesPP2_2014.pdf
  • Lutz, W., Hofmann, S. G., Rubel, J., Boswell, J. F., Shear, M. K., Gorman, J. M., & Barlow, D. H. (2014). Patterns of early change and their relationship to outcome and early treatment termination in patients with panic disorder. Journal of consulting and clinical psychology, 82(2), 287-297. http://dx.doi.org/10.1037/a0035535
  • Maples, J. L., & Walker, R. L. (2014). Consolidation rather than termination: Rethinking how psychologists label and conceptualize the final phase of psychological treatment. Professional psychology: Research and practice, 45(2), 104-110. http://dx.doi.org/10.1037/a0036250
  • Norcross, J. C., Zimmerman, B. E., Greenberg, R. P., & Swift, J. K. (2017). Do all therapists do that when saying goodbye? A study of commonalities in termination behaviors. Psychotherapy, 54(1), 66-75. http://dx.doi.org/10.1037/pst0000097
  • Olivera, J., Challú, L., Gómez Penedo, J. M., & Roussos, A. (2017). Client–therapist agreement in the termination process and its association with therapeutic relationship. Psychotherapy, 54(1), 88-101. http://dx.doi.org/10.1037/pst0000099
  • Owen, J., Drinane, J., Tao, K. W., Adelson, J. L., Hook, J. N., Davis, D., & Fookune, N. (2017). Racial/ethnic disparities in client unilateral termination: The role of therapists' cultural comfort. Psychotherapy Research, 27(1), 102-111. http://dx.doi.org/10.1080/10503307.2015.1078517
  • Råbu, M., Binder, P. E., & Haavind, H. (2013). Negotiating ending: A qualitative study of the process of ending psychotherapy. European Journal of Psychotherapy & Counselling, 15(3), 274-295. http://dx.doi.org/10.1080/13642537.2013.810962
  • Rubin, A., Dolev, T., & Zilcha-Mano, S. (2016). Patient demographics and psychological functioning as predictors of unilateral termination of psychodynamic therapy. Psychotherapy Research, 1-13. http://dx.doi.org/10.1080/10503307.2016.1241910
  • Schlesinger, H. J. (2013). Endings and beginnings: On terminating psychotherapy and psychoanalysis. New York, NY: Routledge.
  • Vidair, H. B., Feyijinmi, G. O., & Feindler, E. L. (2017). Termination in cognitive–behavioral therapy with children, adolescents, and parents. Psychotherapy, 54(1), 15-21. doi:10.1037/pst0000086
  • Weil, M. P., Katz, M., & Hilsenroth, M. J. (2017). Patient and therapist perspectives during the psychotherapy termination process: The role of participation and exploration. Psychodynamic Psychiatry, 45(1), 23-43. doi: 10.1521/pdps.2017.45.1.23

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