How to terminate therapy with a client
How to terminate therapy with a client is a valid consideration for psychotherapists as therapy is not designed to go on forever. When the end occurs, it is usually because clients want to terminate therapy. They do this for a variety of reasons including expense, inconvenience, and poor fit.
But what about when the therapist wants to end therapy? What are acceptable reasons to terminate counseling and how can it be done in the best interests of the client? Let’s explore the rationale for terminating therapy and how to do so causing the least possible harm to the client and the therapeutic relationship.
When should you terminate therapy with a client?
There are many credible reasons for a therapist to want to terminate therapy with a client. Here are several of the most common.
Change of situation
Life changes happen for therapists, just as they do for clients. Maybe it is a move to another area, a change of job, or retirement. Whatever the case, the therapist will need to prepare the client for them to leave.
Goals achieved
The wish of every therapist is to have their clients meet their goals. If the client is ready to face their challenges on their own, it is probably time to conclude therapy. It is sometimes hard for therapists to make this decision as the client has not asked for termination—and therapy is a business—but, at the very least, a conversation about it needs to happen.
Client’s problems do not match therapist expertise
Sometimes, a client comes to therapy with a presenting problem that is within the therapist’s scope of practice but—as therapy advances—other difficulties come to the fore that are not within a therapist’s expertise.
If a therapist does not feel like they can sufficiently treat a client then they need to refer the person to another professional who they feel can better meet the client’s needs. This also includes when a client needs a higher level of care than outpatient therapy can provide. As much as you may want the business, you are under an ethical obligation to let a client go if you aren’t the right person for the job.
Client keeps crossing boundaries
Boundaries are crucial for the safety and protection of clients and therapists alike. At times, a client will not respect those boundaries and consistently attempt to breach them. For example, maybe they are calling you at all hours for non-emergencies or they keep attempting to have a personal, rather than professional, relationship with you. If a client does not respond to repeated attempts to maintain appropriate limits, it is time to put your well-being first and refer them to someone else.
Lack of client engagement
As a therapist, you can’t work harder than your client. Certain clients think they can just say they are going to therapy and everything will magically get better. These clients don’t do homework, resist your recommendations, and skip appointments. You can roll with their resistance and try to motivate them but if they show a consistent pattern of non-engagement in therapy over several months it may be time to end the therapeutic relationship.
Spinning your wheels
For whatever reason, sometimes you just don’t make progress with a client. You have tried different approaches and asked your colleagues for ideas, but nothing you do seems to work. You feel like the therapy is stuck and you are wasting your—and your client’s—time and money. If it has been several weeks of spinning your wheels, it is time to terminate therapy.
How do you terminate a patient in therapy responsibly?
You have determined that you need to terminate therapy. How do you do it? It is not ethical to say “see ya” and abandon your client. It is your responsibility to set your client up for success in their next phase of life. Here is what you need to keep in mind when terminating a client:
Termination starts at the beginning of therapy
Although it may appear counterintuitive, the groundwork for termination needs to be laid at the beginning of therapy. During the intake, you need to describe the course of therapy and how you would like to handle termination when it occurs. After intake, you can discuss termination as it applies to specific topics. This manages expectations and shows the client that termination is a collaborative process.
Provide referrals
You mustn’t leave your clients hanging on the next step of their mental health journey. Not only is it unethical, but it is also inappropriate to terminate someone and not give them a referral to another professional if they seek and/or need further help.
Review treatment progress
One useful aspect of termination is to review the progress (or lack of it) that the client has made thus far. This summarizes treatment and allows the client to see how far they have come and what work is left to accomplish.
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Explore termination feelings
When you review treatment progress, you are evaluating the content of therapy. It is also important to examine the client’s feelings about ending therapy. You don’t want to let the client walk out the door without processing complicated emotions they may have had about the therapeutic process.
Client feedback
Termination is also an opportunity to receive feedback about how the client viewed therapy and whether they found it a satisfying venture. This is a valuable aspect of termination but it is often skipped over because therapists are afraid to hear an evaluation that may not be flattering. Just remember, all feedback, whether it is good or bad, helps you become a better therapist.
Have a termination session(s)
Therapy is a relationship. As such, it is important to mark its ending appropriately. A termination session (or sessions) is a way to wrap up the therapeutic process and model a beneficial way to end a relationship. The termination session is a time to look back on what has been accomplished and look ahead to future concerns and plans. You can also elicit ideas from your client as to what they may want to discuss in a termination session.
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Aftercare
The termination session is not always the last contact you will have with a client. Depending on the client’s situation—and the setting—you may want to check in with your client after they have completed therapy. For instance, this may be done with higher-risk clients who you want to make sure are receiving the proper care. Aftercare is also required after discharge for certain agencies or institutions. While not always done in outpatient therapy, a discharge letter or report is often recommended to document the end of therapy
A therapist must understand when and how they should terminate therapy with a client. The termination process can have a lasting impact and must be done in a way that is most beneficial for the person (or people) involved.
Resources
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More resources
- Therapy resources and worksheets
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- The Ultimate Guide to Starting a Private Therapy Practice
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- Practice management tools
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References
American Psychological Association Practice Organization (2014). Transitions and Terminations: Legal and Ethical Issues When Discontinuing Treatment. https://www.apaservices.org/practice/good-practice/discontinuing-treatment-issues.pdf
Marschall, A. (2022, June 23). VeryWell Mind. What to Know About Therapy Termination. https://www.verywellmind.com/what-to-know-about-therapy-termination-5323830
