Preventing unplanned therapy termination
If only therapy would end neatly when the client reaches the desired goals! It is not always easy for the client or the therapist to determine when and how to end therapy. In a best-case scenario, treatment concludes on a positive note and the client leaves secure in the knowledge that they can return in the future if needed. Over time, most seasoned therapists experience a variety of unplanned terminations. Proactive planning can reduce the risk of unplanned termination.
Provide the FAQs
A frequently unasked question by clients prior to beginning therapy is “How long will this take?” Therapists can provide information such as, “Therapy usually lasts for six to 26 sessions meeting at least twice a month. Some clients may continue therapy on a maintenance basis with less frequently sessions.” It is reasonable to provide clients with a description of a typical course of treatment for their presenting problem.
Time-limited therapy
There are settings where forced termination is expected. Therapists working in clinic-based settings often have a limited number of sessions because demand for therapy far exceeds the supply of therapists. Time-limited therapy occurs in college counseling settings. Trainees have a finite amount of time treat clients before the rotation or internship ends. A clear, definitive, anticipated endpoint to therapy is beneficial in that it requires a sustained focus on the original therapeutic goal. Discussion of the time limit for therapy prior to beginning treatment allows the patient to have realistic expectations.
Ongoing assessment
Many therapists screen for depression and anxiety as part of the intake process. Repeating intake screening questionnaires at regular intervals throughout treatment provides a method for evaluating the success of therapy in terms of reducing symptom burden. Reviewing the questionnaire responses from the client helps to guide treatment decision-making.
Bad reasons for ending therapy
Therapy might conclude for logistical reasons because the therapist retires, dies, or the patient moves away. Financial reasons or changed insurance are common reasons to end therapy. If these situational factors are known in advance, it is optimal to explicitly discuss and frame the treatment with an anticipated endpoint in mind. When the client needs more time than is available, the course of treatment might be viewed as a first phase with an appropriate handoff, if warranted.
Long-term therapy
Clients do not reach their therapeutic goals in a linear fashion. Instead, the goals are redefined or forgotten. Therapy may continue indefinitely. The client, as the consumer, may want supportive therapy to cope with difficult and unchangeable circumstances. The patient may feel that therapy is a form of self-care. To the extent that the client does not harbor an unhealthy sense of dependence on the therapist, ongoing, long-term therapy is helpful to many people.
Revisit therapeutic goals
Premature or unplanned termination occurs when the client, for reasons unknown, abruptly ends therapy with or without notice to the therapist. This may occur because the client accurately judges that they are no longer deriving benefit or have reached a point of diminishing returns. A therapeutic rupture may cause the client to end therapy abruptly. Clients may worry about hurting the therapist’s feelings or feel uncomfortable discussing their wish to terminate. One way to avoid unplanned termination is to regularly revisit the patient’s goals for therapy. As consumers, clients should evaluate the cost/benefit of treatment and be transparent when they wish to terminate.
Challenging clients
As a therapist, it is difficult to admit that you do not like your client’s behaviors, personality traits, or psychological defenses. It is even more difficult to admit that you do not feel that you are able to help them. Sometimes this is evident at the onset of treatment. A client who is successfully treated for the presenting problem may reveal a deeper more intractable personality disorder or early developmental trauma after multiple sessions of therapy. If the patient will not benefit from additional therapy with you, it is ethically correct to terminate and aid in finding a referral to an appropriate provider. Seeking consultation with a colleague can ensure that the client’s best interests are served.
A good ending
A good ending results from planning. The therapist can begin treatment by asking the client, “If therapy could end in the best possible way, what might that look like for you?” A good ending is more likely when decision making is collaborative, and termination provides closure to a chapter of psychological work.