Codes of Ethics on Termination in Psychotherapy and Counseling

Complete comparative list of different Codes of Ethics on a variety of topics

This paper focuses on the sections of the Codes of Ethics of the major professional organizations that deal with confidentiality as it pertains to therapists’ unexpected death or disability, or any other reason that therapists must close their practices. Additionally, it provides a summary of the codes stance on termination in psychotherapy and counseling.

The Following Codes Of Ethics Are Cited:

American Association of Marriage and Family Therapists, AAMFT
American Counseling Association, ACA
American Mental Health Counselors Association, AMHCA
American Psychological Association, APA
California Association of Marriage and Family Therapists, CAMFT
Canadian Psychological Association, CPA
National Association for Addiction Professionals, NAADAC
National Association of Social Workers, NASW
National Board for Certified Counselors, NBCC
Summary Of Codes Of Ethics On Termination

American Association for Marriage and Family Therapy Ethics Code, 2015
https://www.aamft.org/Legal_Ethics/Code_of_Ethics.aspx

1.9 Relationship Beneficial to Client. Marriage and family therapists continue therapeutic relationships only so long as it is reasonably clear that clients are benefiting from the relationship.

1.10 Referrals. Marriage and family therapists respectfully assist persons in obtaining appropriate therapeutic services if the therapist is unable or unwilling to provide professional help.

1.11 Non-Abandonment. Marriage and family therapists do not abandon or neglect clients in treatment without making reasonable arrangements for the continuation of treatment.

Standard II: Confidentiality
2.6 Preparation for Practice Changes. In preparation for moving a practice, closing a practice, or death, marriage and family therapists arrange for the storage, transfer, or disposal of client records in conformance with applicable laws and in ways that maintain confidentiality and safeguard the welfare of clients.

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American Counseling Association Code of Ethics and Standards of Practice, 2014
http://www.counseling.org/Resources/aca-code-of-ethics.pdf

A.2.b. Types of Information Needed
Counselors explicitly explain to clients the nature of all services provided. They inform clients about issues such as, but not limited to, the following: the purposes, goals, techniques, procedures, limitations, potential risks, and benefits of services; the counselor’s qualifications, credentials, relevant experience, and approach to counseling; continuation of services upon the incapacitation or death of the counselor; the role of technology; and other pertinent information. Counselors take steps to ensure that clients understand the implications of diagnosis and the intended use of tests and reports. Additionally, counselors inform clients about fees and billing arrangements, including procedures for nonpayment of fees. Clients have the right to confidentiality and to be provided with an explanation of its limits (including how supervisors and/or treatment or interdisciplinary team professionals are involved), to obtain clear information about their records, to participate in the ongoing counseling plans, and to refuse any services or modality changes and to be advised of the consequences of such refusal.

A.4. Avoiding Harm and Imposing Values
A.4.a. Avoiding Harm
Counselors act to avoid harming their clients, trainees, and research participants and to minimize or to remedy unavoidable or unanticipated harm.

A.11. Termination and Referral

A.11.a. Abandonment Prohibited
Counselors do not abandon or neglect clients in counseling. Counselors assist in making appropriate arrangements for the continuation of treatment, when necessary, during interruptions such as vacations, illness, and following termination.

A.11.b. Inability to Assist Clients
If counselors determine an inability to be of professional assistance to clients, they avoid entering or continuing counseling relationships. Counselors are knowledgeable about culturally and clinically appropriate referral resources and suggest these alternatives. If clients decline the suggested referrals, counselors should discontinue the relationship.

A.11.c. Appropriate Termination
Counselors terminate a counseling relationship when it becomes reasonably apparent that the client no longer needs assistance, is not likely to benefit, or is being harmed by continued counseling. Counselors may terminate counseling when in jeopardy of harm by the client, or another person with whom the client has a relationship, or when clients do not pay fees as agreed upon. Counselors provide pretermination counseling and recommend other service providers when necessary.

A.11.d. Appropriate Transfer of Services
When counselors transfer or refer clients to other practitioners, they ensure that appropriate clinical and administrative processes are completed and open communication is maintained with both clients and practitioners.

A.12. Abandonment and Client Neglect
Counselors do not abandon or neglect clients in counseling. Counselors assist in making appropriate arrangements for the continuation of treatment, when necessary, during interruptions such as vacations, illness, and following termination.

B.6.i. Reasonable Precautions
Counselors take reasonable precautions to protect client confidentiality in the event of the counselor’s termination of practice, incapacity, or death and appoint a records custodian when identified as appropriate.

C.2.h. Counselor Incapacitation, Death, Retirement, or Termination of Practice
Counselors prepare a plan for the transfer of clients and the dissemination of records to an identified colleague or records custodian in the case of the counselor’s incapacitation, death, retirement, or termination of practice.

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American Mental Health Counselors Association Code of Ethics 2020
http://www.amhca.org/learn/ethics

B. Counseling Process
5. Termination and Referral

CMHCs do not abandon or neglect their counseling clients.

  • a. Assistance is given in making appropriate arrangements for the continuation of treatment, when necessary, during interruptions such as vacation and following termination.
  • b. CMHCs may terminate a counseling relationship when it is reasonably clear that the client is no longer benefiting, when services are no longer required, when counseling no longer serves the needs and/or interests of the client, or when agency or institution limits do not allow provision of further counseling services.
  • c. CMHCs may terminate a counseling relationship when clients do not pay fees charged or when insurance denies treatment. In such cases, appropriate referrals are offered to the clients.
  • d. If CMHCs determine that services are not beneficial to the client, they avoid immediately terminating the counseling relationship. Instead, appropriate referrals are made. If clients decline the suggested referral, CMHCs may discontinue the relationship.
  • e. When CMHCs refer clients to other professionals, they will be collaborative.
  • f. CMHCs take steps to develop a safety plan if clients are at risk of being harmed or are suicidal. If necessary, they refer to appropriate resources and contact appropriate support.

C. Counselor Responsibility and Integrity
1. Competence

  • o. [CMHCs] develop a plan for termination of practice, death, or incapacitation by assigning a colleague or records custodian to handle transfer of clients and files.

B. Counseling Process
3. Multiple Clients

When working with multiple clients, CMHCs respect individual client rights and maintain objectivity.

  • b. If it becomes apparent that CMHCs are unable to maintain objectivity, resulting in conflicting roles, they must appropriately clarify, adjust, or withdraw from roles.

B. Counseling Process
7. Clients’ Rights

Clients have the right to be treated with dignity, consideration, and respect at all times. Clients have the right to:

  • c. Information such as time of sessions, payment plans/fees, absences, access, emergency procedures, third-party reimbursement procedures, termination and referral procedures, and advanced notice of the use of collection agencies.
  • k. A clearly defined termination process, and to discontinue therapy at any time.

B. Counseling Process
8. End-of-Life Care for Terminally Ill Clients

  • b. CMHCs are aware of their own competency as it relates to end-of-life decisions. When CMHCs assess that they are unable to work with clients on the exploration of end-of-life options, they make appropriate referrals to ensure clients receive appropriate help.

E. Record-Keeping, Fee Arrangements, and Bartering
1. Recordkeeping

  • b. CMHCs establish a plan for the transfer, storage, and disposal of client records in the event of withdrawal from practice or death of the counselor in a manner that maintains confidentiality and protects the welfare of the client.

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American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct 2016
http://www.apa.org/ethics/code/index.aspx

2.06 Personal Problems and Conflicts
(a) Psychologists refrain from initiating an activity when they know or should know that there is a substantial likelihood that their personal problems will prevent them from performing their work-related activities in a competent manner. (b) When psychologists become aware of personal problems that may interfere with their performing work-related duties adequately, they take appropriate measures, such as obtaining professional consultation or assistance, and determine whether they should limit, suspend, or terminate their work-related duties.

3.12 Interruption of Psychological Services
Unless otherwise covered by contract, psychologists make reasonable efforts to plan for facilitating services in the event that psychological services are interrupted by factors such as the psychologist’s illness, death, unavailability, relocation, or retirement or by the client’s/patient’s relocation or financial limitations.

6. Record Keeping and Fees
(c) Psychologists make plans in advance to facilitate the appropriate transfer and to protect the confidentiality of records and data in the event of psychologists’ withdrawal from positions or practice.

10.09 Interruption of Therapy
When entering into employment or contractual relationships, psychologists make reasonable efforts to provide for orderly and appropriate resolution of responsibility for client/patient care in the event that the employment or contractual relationship ends, with paramount consideration given to the welfare of the client/patient. (See also Standard 3.12, Interruption of Psychological Services.)

10.10 Terminating Therapy
(a) Psychologists terminate therapy when it becomes reasonably clear that the client/patient no longer needs the service, is not likely to benefit, or is being harmed by continued service.
(b) Psychologists may terminate therapy when threatened or otherwise endangered by the client/patient or another person with whom the client/patient has a relationship.
(c) Except where precluded by the actions of clients/patients or third-party payors, prior to termination psychologists provide pretermination counseling and suggest alternative service providers as appropriate.

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California Association of Marriage and Family Therapists, CAMFT 2019
https://www.camft.org/Portals/0/PDFs/CAMFT_Code_of_Ethics.pdf

1.3 TREATMENT DISRUPTION:
Marriage and family therapists are aware of their professional and clinical responsibilities to provide consistent care to clients/patients and to maintain practices and procedures that are intended to provide undisrupted care. Such practices and procedures may include, but are not limited to, providing contact information and specified procedures in case of emergency or therapist absence, conducting appropriate terminations, and providing for a professional will.

1.4 TERMINATION:
Marriage and family therapists use sound clinical judgment when terminating therapeutic relationships. Reasons for termination may include, but are not limited to, the client/patient is not benefiting from treatment, continuing treatment is not clinically appropriate, the therapist is unable to provide treatment due to the therapist’s incapacity or extended absence, or due to an otherwise unresolvable ethical conflict or issue.

1.5 NON-PAYMENT OF FEES:
When terminating client/patient relationships due to non-payment of fees, marriage and family therapists do so in a clinically appropriate manner.

1.6 EMPLOYMENT AND CONTRACTUAL TERMINATIONS:
When terminating employment or contractual relationships, marriage and family therapists primarily consider the best interests of the client/patient when resolving issues of continued responsibility for client/patient care.

1.7 ABANDONMENT:
Marriage and family therapists do not abandon or neglect clients/patients in treatment. If a therapist is unable or unwilling to continue to provide professional services, the therapist will assist the client/patient in making clinically appropriate arrangements for continuation of treatment.

4.5 SEXUAL CONTACT:
Sexual contact includes, but is not limited to sexual intercourse, sexual intimacy, and sexually explicit communications without a sound clinical basis and rationale for treatment. Sexual contact with a client/patient, or a client’s/patient’s spouse or partner, or a client’s/patient’s immediate family member, during the therapeutic relationship, or during the two years following the termination of the therapeutic relationship, is unethical. Prior to engaging in sexual contact with a former client/patient or a client’s/ patient’s spouse or partner, or a client’s/patient’s immediate family member, following the two years after termination or last professional contact, the therapist shall consider factors which include, but are not limited to, the potential harm to or exploitation of the former client/patient or to the client’s/patient’s family, the potential continued emotional vulnerability of the former client/patient, and the anticipated consequences of involvement with that person.

3.8 CLIENT/PATIENT BENEFIT:
Marriage and family therapists continually monitor their effectiveness when working with clients/patients and continue therapeutic relationships only so long as it is reasonably clear that clients/ patients are benefiting from treatment.

3.12 DOCUMENTING TREATMENT RATIONALE/DECISIONS:
Marriage and family therapists document treatment in their client/patient records, such as major changes to a treatment plan, changes in the unit being treated and/ or other significant decisions affecting treatment.

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Canadian Psychological Association: Canadian Code of Ethics For Psychologists (3rd Edition)
http://www.cpa.ca/docs/File/Ethics/cpa_code_2000_eng_jp_jan2014.pdf

I.41 Collect, store, handle, and transfer all private information, whether written or unwritten (e.g., communication during service provision, written records, email or fax communication, computer files, video-tapes), in a way that attends to the needs for privacy and security. This would include having adequate plans for records in circumstances of one’s own serious illness, termination of employment, or death.

II.42 Be open to the concerns of others about perceptions of harm that they as a psychologist might be causing, stop activities that are causing harm, and not punish or seek punishment for those who raise such concerns in good faith.

Confidentiality
I.45 Share confidential information with others only with the informed consent of those involved, or in a manner that the persons involved cannot be identified, except as required or justified by law, or in circumstances of actual or possible serious physical harm or death. (Also see Standards II.39, IV.17, and IV.18.)

II.37 Terminate an activity when it is clear that the activity carries more than minimal risk of harm and is found to be more harmful than beneficial, or when the activity is no longer needed.

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National Association for Addiction Professionals (NAADAC) Code of Ethics, 2016
http://www.naadac.org/code-of-ethics

Principle I: I-24 Termination
Addiction Professionals shall terminate services with clients when services are no longer required, no longer serve the client’s needs, or the Provider is unable to remain objective. Counselors provide pre-termination counseling and offer appropriate referrals as needed. Providers may refer a client, with supervision or consultation, when in danger of harm by the client or by another person with whom the client has a relationship.

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National Association of Social Workers Code of Ethics (2017)
https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English

1.06 Conflicts of Interest
(a) Social workers should be alert to and avoid conflicts of interest that interfere with the exercise of professional discretion and impartial judgment. Social workers should inform clients when a real or potential conflict of interest arises and take reasonable steps to resolve the issue in a manner that makes the clients’ interests primary and protects clients’ interests to the greatest extent possible. In some cases, protecting clients’ interests may require termination of the professional relationship with proper referral of the client.

1.07 Privacy and Confidentiality
(t) Social workers should take reasonable precautions to protect client confidentiality in the event of the social worker’s termination of practice, incapacitation, or death.

1.15 Interruption of Services
Social workers should make reasonable efforts to ensure continuity of services in the event that services are interrupted by factors such as unavailability, relocation, illness, disability, or death.

1.16 Referral for Services
(a) Social workers should refer clients to other professionals when the other professionals’ specialized knowledge or expertise is needed to serve clients fully or when social workers believe that they are not being effective or making reasonable progress with clients and that other services are required.

(b) Social workers who refer clients to other professionals should take appropriate steps to facilitate an orderly transfer of responsibility. Social workers who refer clients to other professionals should disclose, with clients’ consent, all pertinent information to the new service providers.

1.17 Termination of Services
(a) Social workers should terminate services to clients and professional relationships with them when such services and relationships are no longer required or no longer serve the clients’ needs or interests.

(b) Social workers should take reasonable steps to avoid abandoning clients who are still in need of services. Social workers should withdraw services precipitously only under unusual circumstances, giving careful consideration to all factors in the situation and taking care to minimize possible adverse effects. Social workers should assist in making appropriate arrangements for continuation of services when necessary.

(c) Social workers in fee-for-service settings may terminate services to clients who are not paying an overdue balance if the financial contractual arrangements have been made clear to the client, if the client does not pose an imminent danger to self or others, and if the clinical and other consequences of the current nonpayment have been addressed and discussed with the client.

(d) Social workers should not terminate services to pursue a social, financial, or sexual relationship with a client.

(e) Social workers who anticipate the termination or interruption of services to clients should notify clients promptly and seek the transfer, referral, or continuation of services in relation to the clients’ needs and preferences.

(f) Social workers who are leaving an employment setting should inform clients of appropriate options for the continuation of services and of the benefits and risks of the options.

3.04 Client Records
(d) Social workers should store records following the termination of services to ensure reasonable future access. Records should be maintained for the number of years required by state statutes or relevant contracts.

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National Board For Certified Counselors (NBCC) Code Of Ethics, 2016
http://www.nbcc.org/Assets/Ethics/NBCCCodeofEthics.pdf

7. NCCs shall not engage in any form of sexual or romantic intimacy with clients or with former clients for two years from the date of counseling service termination.

62. NCCs shall not solicit testimonials from current clients or their families and close friends. Recognizing the possibility of future requests for services, NCCs shall not solicit testimonials from former clients within two years from the date of service termination.

76. NCCs shall discuss service termination with clients when there is a reasonable belief that the clients are no longer benefiting from or are unlikely to benefit from future services. NCCs shall not abruptly terminate counseling services without good cause or significant justification, and in such cases, shall provide appropriate referrals.

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Summary Of Codes Of Ethics On Termination

These Codes of Ethics provide a detailed review of the principles and standards to be followed by mental health professionals in each of the professions indicated. Despite there being a broad range of professions (Counselors, Marriage and Family Therapists, Psychiatrists, Psychologists, and Social Workers) a great deal of agreement is seen in how each mental health profession view the clinician’s responsibilities regarding termination. It is clear that each profession regards the informed consent process as essential for addressing termination and abandonment issues from the outset. Each mental health clinician must inform clients/patients how to contact him or her in between sessions should an emergency or crisis arise, each must make appropriate arrangements for coverage by a competent professional during periods of absence, and each must address the termination process as an essential phase of treatment.

While some of the Codes of Ethics provide a detailed review of the principles and standards to be followed in the event that a therapist abruptly dies or becomes disabled or must close their practice unexpectedly, other codes do not attend to such cases. Only the CAMFT Code of Ethics mentions the term “professional will.”

For termination to be handled in a clinically effective and ethical manner discussions between clinician and client/patient should occur, when possible, in advance and be addressed in a thoughtful and sensitive manner in anticipation of it occurring. Clients/patients should not be abandoned and should treatment need to end and ongoing treatment needs remain, efforts must be made to assist clients/patients to obtain needed services through help with the referral process prior to ending the present therapeutic relationship. In fact, the Codes of Ethics of the mental health professions are consistent in requiring that clinicians assess each client’s/patient’s ongoing treatment needs prior to initiating termination. This is essential so that the clinician may ensure that any ongoing treatment needs are adequately addressed through the referral process.

Several Codes of Ethics make it very clear that mental health professionals do not terminate professional relationships for the purpose of pursuing a personal, social, business or sexual one. It is clear throughout the mental health professions that the focus is on the client’s/patient’s needs and not on the clinician’s. Around the issues of termination, like with any other clinical concern, mental health professionals do not engage in exploitation or abuse of the power inherent in their role in the professional relationship. The Codes of Ethics make it clear that treatment termination motivated by gratification of the clinician’s needs is a form of exploitation. Terminations of treatment should be determined by each patient’s/client’s clinical needs.

It is also acknowledged in several of these Codes of Ethics that at times mental health professionals may need to terminate the professional relationship without the opportunity for advanced notice. It is stated that this is done only in the most unusual circumstances such as “when threatened or otherwise endangered by the client/patient or another person with whom the client/patient has a relationship” as stated in Psychologists’ Ethics Code (see above). It is also made clear that mental health professionals terminate treatment services at times to promote the best interests of their clients/patients. Examples include when providing further treatment likely would prove harmful, when the client/patient is not benefiting from treatment, when the client’s/patient’s treatment needs no longer remain within the mental health professional’s areas of professional competence, and when a multiple relationship that is either inappropriate or incompatible with on going treatment is discovered or initiated.

Regardless of whether the notion of therapists’ abrupt disengagement from practice is mentioned in the code, it is clear that each professional code alludes to the fact that therapists must attend to such eventualities. One can easily argue that the injunction against harm by itself is a mandate to have a professional will so issues of continuity of care and appropriate handling of records are carried out in accordance with the codes of ethics and the law.

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