Termination in therapy (How to get it right)

In this brief blog, we will discuss the closure of therapy; termination, what happens when it ends abruptly, 4 ways to handle termination ethically and smoothly and some more important information.

No matter why it is coming to an end, the end of therapy can be difficult. When a client and therapist have mutual trust, termination is a major milestone for them both. 

But if one or both parties feel like the relationship has run its course, essentially reaching the end of their line, then making sure that they’re both taking this separation in stride is not only important but vital to handle the experience with grace.

Ideally, termination occurs when the goals that are mutually agreed upon by the client and counselor have been achieved or when the problem for which a client has entered into counseling has become more manageable or is resolved. 

Let’s understand what termination is and the reasons for it to occur.

What is termination?

“Termination” is a process that comes with closing your therapy session. For some, it might seem foreign or totally unnecessary, but this is the 4th and final phase of a successful therapy session. It’s a critically important time for both you and your counselor because it signifies the end of a long journey working together – filled with challenges and hope. 

Many times, our clients want to move on – they feel good after having dealt with their struggles and feel ready to dive into other things such as uncharted career paths or dating relationships. 

If termination is abrupt, it may leave both therapist and client with unanswered questions and feelings of “anxiety, sadness, and anger”. And yet, when the therapeutic relationship and outcome are seen as positive by the client, termination can be a healthy, valuable, and successful process; so much so that practitioners often report pride and a new sense of faith in the therapeutic process (Fragkiadaki & Strauss, 2012).

There are a variety of reasons why treatments may be terminated early. A therapist has the right to stop providing services when you are no longer benefiting from his skills or he feels there is little more he can learn about his patients’ ailments. 

When it comes down to ending therapies, ideally therapists will tell their clients about how they feel the therapeutic goals have been fulfilled or where progress has been made, but it’s also understood that they may decide to end treatments early without providing an explanation – as long as all legal requirements are met.

Some causes for treatment being stopped before they were supposed to are given below. Here is an example of what this content would look like in a template:

• Therapist is unable or unwilling to continue to give care for valid reasons (e.g., therapist is retiring/closing practise or client has threatened therapist with violence).

• Client fails to participate in therapy (e.g., non-compliance, no shows, or cancellations).

• The client has mental health needs that are outside the scope of the mental health practitioner’s competence. For example, the client may require a higher level of care (e.g., inpatient or crisis intervention) or specialised care (e.g., trauma or drug misuse) than the social worker can deliver in the office environment.

• Client fails to make adequate progress toward treatment goals or fails to comply with treatment recommendations.

• Conflict of interest is identified after treatment begins.

What happens when therapy ends abruptly?

Abandonment is a term that implies that the psychotherapist either ended the psychotherapy process in an inappropriate manner that does not adequately address the client’s ongoing treatment needs or the psychotherapist did not make necessary arrangements for the client’s treatment during the course of treatment (Younggren & Gottlieb, 2008).

Abandonment is a specific type of malpractice that can occur when a mental health professional’s services are terminated. Abandonment, sometimes known as ‘premature termination,’ happens when a social worker is absent or abruptly stops providing services to a client in need.

In an abandonment malpractice action, the client claims that the therapist was giving therapy when he or she arbitrarily discontinued it. The client must demonstrate that the desertion caused him actual harm and that the harm resulted in a compensable injury. 

The client’s displeasure with the result isn’t enough to prove the therapist’s carelessness. The client must also demonstrate that the termination was not his fault, such as by keeping all of his appointments, following treatment recommendations, and paying all of his fees.

It is important for both the client and Mental Health practitioner to clearly establish what will happen with their relationship before it is terminated abruptly. This way the client is aware of the reason why it ended and referral information pertaining to another professional in stake in case they feel that there are still things that they need help with in regards to their mental health or behavioral issues.

Ways to terminate therapy ethically and smoothly

• From the beginning, prepare clients for termination. 

Whenever a client begins a therapy session, it is important to remind them that they are there because they want change in their lives. 

The end goal should be a state of health and well-being that doesn’t rely on constant professional attention from a therapist. One way to do this is by telling the truth from the start about the time frame involved in working through difficulties. 

You can tell them that professional help should serve as a push in the direction of health and after a while, you should only need support once in a while or when new issues arise.

Knowing from the outset how treatment will end can be a vital piece of information for clients in making their decisions about participation in the proposed course of treatment (Davis & Younggren, 2009). 

• Come to an agreement on the treatment goals and the criteria for successful treatment completion.

It’s important for therapists to work together with their clients to create both short and long term goals. Without these types of goals, therapy can get out of hand, because it could start reaching for multiple targets – none of which you quite reach eventually. Even if each session results in some progress, without having a clear aim or direction, it’s hard to stay focused and to determine when exactly something has been completed. 

We also see that setting both short-term and long-term goals can help clients realize how their problems give them trouble in other areas of life, not only at the present moment but also in the future when they don’t address them now.

• Be Wary of Client-Initiated and Other-Initiated Treatment Interruptions.

As a psychotherapist, there are many different reasons why your clients might lose interest in visiting you. It could be that they are losing their motivation to change. 

This one seems pretty obvious but your job requires patience! Perhaps the client is experiencing financial hardships so they can no longer afford their fee for sessions. Perhaps the new mother has returned back to work and now she feels less of a need for treatment due to having more support from others around her during this time in her life. Or maybe there are insurance changes that may have occurred allowing your client to see someone else if they so choose. 

Whatever the reason, remember that it is just as important to know when to quit working with a client as it is to know when to represent them or even begin working with them in some cases!

• Be Clear on What Abandonment Is and Is Not

Abandonment occurs when the psychotherapist does not meet client treatment needs appropriately. Abandonment may occur when treatment endings are mismanaged as well as when clients’ ongoing treatment needs are not adequately addressed. The latter may include failure to make needed coverage arrangements during periods of anticipated absence such as vacations, attending a conference, or other times when client access to the psychotherapist may be limited.

The premature departure of a client from treatment is not necessarily abandonment, nor does it necessarily necessitate termination. It may also be unclear whether someone who misses multiple sessions in a row due to illness or other serious commitments has disappeared or whether they are just being compliant with treatment by making up lost time at the next available appointment. 

Ultimately, there are many ways in which termination can take place. Client’s leaving therapy prematurely does not automatically result in consequences for the therapist unless there are extenuating circumstances.

Keeping these points in mind should make the process of termination an insightful and important one. 

Conclusion 

Treatment termination is a crucial part of the therapeutic process. Termination should be handled appropriately by having conversations between the mental health worker and the client ahead of time and in a deliberate and sympathetic manner. 

For the interests of both the client and the mental health worker, it is preferable that clients do not feel abandoned. If the client requires prolonged care, the mental health worker must make every effort to help the client in getting ongoing services to ensure that their needs are met. The mental health workers’ efforts to me will be aided by proper documentation of the cessation of the treatment contact with the client.

Citations 

Barnett, J. E. (2016, October). 6 strategies for ethical termination of psychotherapy: And for avoiding abandonment.

Davis, D. D. (2008). Terminating therapy: A professional guide to ending on a positive note. Hoboken, NJ: John Wiley & Sons.

“Successful Therapy Termination (Guide) | Therapist Aid”. Therapist Aid, 2021, https://www.therapistaid.com/therapy-guide/successful-therapy-termination.