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By: Jeffrey E. Barnett, Psy.D.
This is an introductory article for the online course on Termination. This is the first of twelve papers that compose the course.
They say “All good things must come to an end.” So it is true with the professional services provided by mental health professionals. Termination may occur for a variety of reasons and in a wide range of situations. These include the following:
As you can see, the termination of the psychotherapy or counseling relationship can occur for a variety of reasons. Sometimes it is planned and anticipated. Other times it may come as a surprise to the clinician, and possibly to the patient/client. Sometimes it may be voluntary and desired. Other times it may be forced on the patient/client or the clinician. Ideally, the issue of termination should be addressed as part of the informed consent process. The clinician should share, as best can be done, her or his view on the likely outcome of treatment, any factors that may interfere with it, and how it is anticipated that termination will be addressed. Sometimes what we anticipate occurs and other times it does not. But, at a minimum, we will have had an open discussion on these important issues with our patient/client and their questions and concerns will have been addressed.
As will be seen in this course, termination actually is a phase of the treatment process; and an important one at that. Ideally, termination should not come as a surprise. Rather, it is a phase of treatment that should be planned for, anticipated, and worked toward. The successful termination of treatment is the goal of all treatment relationships. It’s goal is the successful, independent functioning of the former patient/client apart from the clinician. The goal of treatment is increased independence of the clinician over time and the healthy and effective functioning of the former patient/client.
But, the termination of treatment is not always a permanent ending of the professional relationship. For many, counseling and psychotherapy is an intermittently experienced treatment relationship that one comes back to periodically as new life challenges and difficulties are experienced. A patient/client may enter treatment at one point in time, work hard, and successfully end that course of treatment. Then, months or years later when a new life challenge is experienced s/he may return to treatment with the trusted clinician to continue their important work together for a period of time. The cycle can then be repeated several times over one’s life. Thus, termination does not always mean goodbye and it is not always a complete severing of the professional relationship. Additionally, when the patient/client is the family the clinician will frequently be providing clinical services to a family member in the next generation over time. Again, just because one phase of treatment has ended one should not assume that one’s professional role with that individual or family has ended. Despite the absence of actual treatment at any given time the professional role may continue for many years.
A related issue to termination is that of abandonment. As will be seen in the articles in this course mental health clinicians have an ongoing obligation to their patients/clients throughout the course of their professional relationship. Failure to meet this obligation of typically referred to as abandonment. The mental health professional’s responsibility to make appropriate arrangements so that each patient’s/client’s ongoing needs are met. Examples include accessibility between scheduled treatment sessions, arranging for professional coverage during periods of planned absence such as vacations, and making advanced arrangements for unanticipated interruptions of treatment such as through disability, illness, or death.
Each mental health clinician should be sure to address how patient’s/client’s may contact them in between treatment sessions as part of the informed consent process. Additionally, a reasonable attempt should be made to be accessible to patients/clients should a crisis or emergency occur between regularly appointments. While the clinician need not personally be available around the clock, some suitable arrangements should be made. Reasonable examples include having a pager or cell phone and providing patients/clients with the number so they may contact you if needed, hiring an answering service that contacts you when it is contacted by a patient/client, and sharing coverage with colleagues who are each “on-call” every few days, providing uninterrupted coverage throughout the week and weekend. Arranging for an appropriately trained colleague to provide coverage for you during vacations and other anticipated absences is essential. Just having patients/clients leave messages for you on an answering machine or voice mail system and then checking your messages periodically (when you remember to do so) does not seem adequate. Much greater accessibility to assistance may be needed than that. Finally, having a “professional will” is important for all mental health clinicians who are in private practice. In the event of your death or other situation that abruptly terminates your ability to provide clinical services your patients/clients they will need to be contacted, their treatment needs must be addressed, referrals must be made, records transferred, and your office closed with attention to respecting confidentiality and each patient’s/client’s treatment needed. Arrangements must be made in advance with a colleague who will carry out these duties on your behalf. Even if you are incapacitated, each patient’s/client’s treatment needs must be addressed in a sensitive, confidential, and competent manner so they will not feel abandoned.
Mental health professionals must each be familiar with the relevant guidelines and standards in their respective professions’ Codes of Ethics. The aspects of each mental health profession’s Code of Ethics that are relevant to termination and abandonment issues are highlighted and reviewed in this course in the section Codes of Ethics on Termination Psychotherapy and Counseling, available at http://www.zurinstitute.com/ethicsoftermination.html. Each mental health professional should be familiar with their profession’s standards that apply to these important issues. While there are general themes and standards of practice that exist across professions, the Codes of Ethics of each profession have unique features that practitioners must follow in order to be in compliance with their profession’s ethical standards.