The conclusion of treatment is a significant accomplishment when a client and therapist have a close and long-lasting relationship. Yet, addressing termination is much more crucial when a client and a therapist are not a good fit or when there is a problem in the relationship, such as persistent no-shows or therapeutic dissatisfaction.
Clients can end therapy anytime, for any reason, or without explanation. Knowing when to end therapy is a crucial skill for therapists since it can safeguard both the client and the therapist. If a client’s needs change or the therapist suddenly becomes unable to work, the relationship may end abruptly or after several discussion sessions. Understanding how this process can go and what it means to finish treatment can be helpful because all therapy relationships eventually end.
Different Reasons to Terminate Therapy
- Client’s Progress
Ideally, therapy should have definite objectives. It may be fair to switch clients to a new therapist or stop therapy entirely once they have reached their goals. For instance, a therapist working with a new parent experiencing postpartum depression may mutually decide to end therapy once the client’s depressive symptoms have subsided. The patient might discontinue therapy altogether or decide to find a therapist at GoodTherapy, who has experience in other problems.
The therapist and the client may experience mixed emotions when deciding it’s time to move on. The therapist and the patient have grown close and trustworthy, and the patient may even consider the therapist a friend. Hence, it’s crucial to be friendly and encouraging while establishing clear boundaries. The client should be aware that while they can return if they need assistance again, the therapist is not a friend with whom they can have a relationship outside therapy.
- Unhappy Client
Clients have the right to end their connection with their therapist if they are dissatisfied with their care, disagree with their philosophy, or believe the therapist has committed malpractice. If the patient doesn’t, the therapist must decide if the therapeutic partnership can go on.
Dissatisfaction with the therapist’s services might serve as a starting point for dialogue and personal development. The relationship must typically end when the therapist and client have substantial conflicts, or the client accuses the therapist of acting unethically.
- Client Repeatedly Cancels Appointments Or Raises Other Practical Concerns
Therapists have to address both practical issues and mental health issues. Therapist wastes time they could be spending with other clients when a client consistently cancels appointments. Also, a therapist might have to stop working with a client who makes unreasonable demands.
Send the client a termination notice if they refuse to attend therapy sessions using their preferred form of communication, ideally via many channels, such as email. Present any further practical concerns to the client in unbiased, non-stigmatizing words, and consider referring them to a different therapist if necessary.
- Other Reasons:
- The treatment progress will be hampered since the client or therapist feels they are not a good fit. Early in treatment, this frequently happens.
- Due to jurisdictional concerns, the therapist cannot continue providing services to the client because either the therapist or the client is relocating.
- To guarantee that the client receives the best care possible, the therapist recommends a different practitioner when the client experiences new symptoms outside the scope of their training.
- The client has been seeing their present therapist for a while, but they believe a new therapist may be able to address issues or advance their progress differently.
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The Following Are Some Causes For A Client To End Therapy Permanently
- Whether or not the client feels they have advanced, they still decide to stop going. Giving clients a voice in their treatment is crucial to ensuring they receive the proper care for as long as they need it. Prematurely leaving treatment can hinder them from receiving the proper support. 1
- The patient desires to discontinue therapy for any reason, to restart it later.
- When the client’s insurance coverage is lost, they cannot pay for services. (The therapist can frequently negotiate a sliding scale price when this happens, but some institutions won’t permit this.)
Ending Therapy With A Child
Children may find termination challenging, particularly if they do not have many reliable people or have suffered several losses. Early discontinuation of therapy should be discussed, and the child should be informed as much as feasible.
Give the child an age-appropriate explanation of the reason why therapy must halt. For instance, you might emphasize how far the youngster has come and how they no longer require your help. Emphasize your concern for the youngster and your commitment to being there for them if they ever need assistance again (but only if this is true; it might not be if there is a conflict with the parents or another reason for termination).
Experts’ Suggestions Regarding How To End Therapy.
- Early On, Bring Up Termination
When you start seeing someone, as part of your informed consent agreement, talk about how and when therapy will conclude. The idea and practice of termination shouldn’t be shocking.
Talk about how you’ll evaluate treatment goal progress as you introduce the process of terminating therapy. Before starting your treatment strategy, Eva Feindler, Ph.D., a psychology professor at Long Island University, advises gathering information about the baseline symptoms, reevaluating the symptoms periodically, and then bringing up the prospect of treatment termination based on change ratings.
- A Sudden End Should Be Avoided.
Too abruptly terminating treatment—whether you conclude your patient has achieved their goals or they decide they are ready to be done themselves—leaves patients feeling abandoned and missing a vital chance to maintain therapeutic progress.
There is no strict deadline. If a patient regularly attends therapy every week, you can think about reducing the frequency over time—for instance, moving to biweekly, then monthly sessions, until termination. According to research, termination concerns account for around 12% of the time psychotherapists spend treating patients.
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- Know When To Refer.
Inform your patient immediately if you cannot provide continued therapy. Even though it could be challenging to admit that a patient’s demands fall outside your competence, it is a psychologist’s ethical responsibility to make the proper recommendations.
Even though the patient’s symptoms are within your expertise, you can discover they are not heading toward their objectives. Decide on a finite number of sessions for the termination phase in that situation, and then work with the patient to find a better fit.
- Creating A Professional Will
Primarily if you operate in private practice, it’s critical to develop a plan for your patients in the case of your illness or death. Information like your meeting schedules, how to access your patient records, and where you store the keys to your office may be included in a professional will, a document that acts as a backup plan for your patients if you cannot. Also, it names a coworker who your loved ones can get in touch with in an emergency.
- Consult Professionals.
Several theoretical orientations offer recommendations for consolidating patient progress. However, relying solely on your theory may not produce the best therapy results. For instance, in the tradition of cognitive behavioral therapy, a therapist may be more likely to talk about behavioral goals than a psychodynamic therapist, who could place more emphasis on the therapeutic alliance. Both elements are crucial.
John Norcross, Ph.D., professor and chair of psychology at the University of Scranton in Pennsylvania, advise basing your treatment on a pantheoretical consensus of psychologists to prevent limiting patient growth during the termination period.
- Profit From The Patient’s Response.
Your patient may show grief, disappointment, or even feelings of abandonment, even if you and your patient agree it’s time to end treatment. Termination may feel like a repetition of the entire course of treatment. For instance, your patient’s anxiety about not feeling good enough might have increased, but termination might bring those feelings back.
For instance, if your patient brings up past sentiments of abandonment, examine those thoughts and remind them of the coping mechanisms they have learned through your work together.
- Look Back On Positive Growth
Reminding patients of their accomplishments is essential for solidifying their achievements since it can inspire pride and future confidence. Looking back can assist patients in consolidating their progress and making the therapeutic benefits permanent, so they can carry them with them and remember their accomplishments, according to Woodhouse.
Consider the good aspects of the therapy relationship and how it grew or developed through time, in addition to thinking back on instances of goals being met.
- Anticipate Potential Difficulties.
Discuss how patients might use the lessons they’ve learned from the previous sessions to overcome problems they may face and advance their progress. This may entail anticipating problems or symptom remission and reassuring the patient that they can deal with these problems thanks to their newly developed abilities or sense of self.
Plan what the patient should do if they subsequently require assistance. For instance, you could present the option for future treatments or sporadic booster sessions. Inform the patient upfront if you are unavailable and offer alternative alternatives, such as support groups or other therapists.
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- Prepare the Farewell.
Have a plan for your breakup before the last session. Choose a strategy you both feel comfortable with by asking the patient what they hope to achieve from the final session. You might elect to shake hands or hug each other after the session, write a note to one another, or exchange a moments that symbolizes the patient’s creative endeavors. In any event, the exchange needs to be scheduled, so the patient isn’t taken aback.
- Manage your feelings.
Once you part ways with a patient, you could experience a range of emotions, such as pride in all they’ve accomplished, grief for the breakup of the relationship, or even shame if you feel you weren’t able to support them as much as you would have liked. Be mindful of tending to and working through your experience.
When Not to Terminate a Contract
It is acceptable to disclose this if the client is not prepared for termination when the therapist brings up the subject. You can choose the best course of action with your therapist moving forward.
Some clients decide to hold sessions only occasionally, as needed, or once every few months, depending on how much stress they are experiencing.
The process of parting ways with a client can be either simple and professional or more emotional. The client could feel various things, from pride, satisfaction, and a sense of independence to melancholy and loss. Confirm the client’s feelings by allowing them to express themselves.
The responses from a therapist could differ just as much. Reward the client for their diligence in therapy and be proud of your two’s progress.