The ending of therapy can bring up a wide variety of feelings and tends to vary depending on the circumstances surrounding termination. It is recommended that therapists discuss termination of therapy at the very start of therapy as part of the informed consent process and check in on progress (and how things are feeling in therapy) through treatment. It is helpful to have a framework of what to expect when starting something new, as well as an idea of what the process with look like, and the end outcome.
Talking about ending relationships can be an uncomfortable topic. Too many times conversations are avoided. If you have ever been “ghosted” then you are likely on the receiving end! Sudden and unexpected endings are something that we want to avoid. Open dialogue and honest communication are important. While the therapist has the responsibility to talk about the process of starting and ending services, clients are encouraged to bring up the topic and advocate for their needs throughout the therapy process.
I am going to share seven different reasons when sessions end and use examples from my own experiences as a mental health professional. I will also share some next steps, with guidelines provided by the ACA Code of Ethics.
No Show/ No Response:
If a client shows up for their session but doesn’t show up to their next scheduled appointment, then the therapist will make two best attempts to reach out to offer to reschedule or provide additional referrals if needed before terminating services. Clients are encouraged to reach back out if they are ready to resume counseling. If multiple no-shows/ cancellations have been made, outside referrals are offered.
The unknowns of no-shows/ no responses can be challenging due to the unknowns. Did the client decide they were no longer interested in therapy? Did they find a new provider? Was it, not a good fit? Did their needs change? Were there barriers with insurance/ finances, technology, or transportation? Was one session all they needed? Perhaps none of the above! While no reason is needed, therapists greatly appreciate feedback which can be given on the main scheduling line, or directly to the therapist. I personally value the feedback and communication from clients when this is received.
Outside Scope of Practice
If a therapist is lacking the competency to be of professional assistance, then they are to avoid starting or continuing to provide therapy.
It is the responsibility of the therapist to be knowledgeable about culturally and clinically appropriate referral resources, discuss alternatives and provide referrals when what is clinically appropriate is outside the scope of the therapist. If referrals are declined, therapy is discontinued.
For example, If a new client meets with me for an initial appointment and shares that they are specifically seeking to receive eye movement desensitization and reprocessing (EMDR), I can complete their diagnostic assessment (as that is within my scope of practice) but I am not able to begin providing therapy for a modality that requires specialized training. Part of my responsibility would be to offer referrals and help connect to another provider who is trained in EMDR. Perhaps the client will work with me around goals to cope with trauma until they are connected to a specialized provider, and then my role ends.
Treatment Goals Are Met
If services are no longer needed due to treatment goals being met, then termination is the next step.
This is my favorite reason to end therapy, although it is bittersweet. It is recommended to gradually taper when getting ready for termination. Clients who are seen weekly may reduce to every other week and then perhaps monthly to ensure that they are maintaining progress. Having a session or two specially focused on the ending can help celebrate the progress, reflect on the journey, honor the client’s hard work, and share an appreciation for the relationship.
Counseling is No Longer Beneficial.
If it is reasonably apparent that services are no longer needed or the client is not likely to benefit from the continuation of services, then the therapist provides pre-termination counseling and recommended other providers, when appropriate.
Some examples I have seen are when clients hit a plateau in progress or may not find sessions helpful. This may look like not learning any new skills or no longer needing to utilize a space to process thoughts, feelings, or experiences. This could indicate the need for conversations around termination or possible transfer to another clinician who can build upon the work that was already done. It can also indicate the need to reevaluate how the client and therapist are utilizing the session.
Potential Harm to the Therapist is Present.
If a therapist is in jeopardy of harm by a client or someone who the client has a relationship with then safety needs to be prioritized.
It is important to feel that therapy is a safe place, and the safety of the therapist is included. One example from my personal life that illustrates this example is when a threat of harm is made to a therapist. My role was to assess the mental health of a client who was involved with juvenile probation. A specific threat was made towards me, duty to warn applied, and I was removed from the case to ensure safety from harm.
Payment is Not Being Made for Services
If services have been provided but payments are not being made as agreed upon, then counselors discuss alternatives such as payment plan options/ connect to billing, discuss free/ low-cost options, and then terminate services.
This is a challenging reason to end, and it is hard to be a therapist in this situation, Financial struggles, having several missed appointment fees (higher rate if not paid within a week/ no credit card on file), inconsistent employment/ loss of employment, and having a high deductible plan are some common reasons that quickly can accumulate fees.
Ending Due to Life/ Role Changes
If the client has a change such as moving out of state, getting a new job, and work hours changing or the therapist has a change for similar reasons such as a shift in work schedule/ availability, ending their job due to career change, or practicum ending sessions end. Other examples include temporary leaves. A client may go to a higher level of care and then transition back to outpatient therapy. A therapist may take a temporary leave related to medical reasons and then return. Options to transfer to another therapist are discussed in these situations, and the therapist can help facilitate the process.
Communicating any potential upcoming changes that will involve ending services as early as possible is recommended so that clients do not feel abandoned, and that continuity of care is provided.
Written By: Charlotte Johnson, MA, LPCC
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