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Termination with Clients, Therapists' Retirement & Therapist's Will:
Ethical & Clinical Considerations

Resources & References

Online Courses:
Termination in Psychotherapy: Ethical & Clinical Considerations
Retirement of Therapists: Ethical, Legal, Clinical and Psychological Considerations
Professional Will: What It Is and How to Write It

 

Termination with Clients

General Resources on Termination

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Closing a Psychotherapy Practice

Abandonment

Premature Termination, Client Dropout, & Clients' Responsibility

  • On Pre-Mature Termination or Dropout
    Many clients unilaterally decide to drop out of therapy. They may do that with a phone message or by simply not showing up to their next scheduled appointment. Therapists must remember that it is the client's prerogative and choice whether to continue in therapy or not. Except in extreme situations, such as when the client poses a danger to self or others, therapists need to respect their clients' choices. There is a myth or faulty belief that therapists must follow up premature termination with a letter. This is not always the case. There is no ethical, clinical or legal mandate to send a registered letter to client. Different clients and situations may require different actions and, at times, lack of action. This issue was addressed by Davis & Younggren in a 2009 PPRP article, where they clearly stated, "In ordinary circumstances, however, letters are typically unnecessary and potentially counterproductive to the natural dissolution of the relationship (Davis, 2008). For instance, the client might feel embarrassed or scolded for his or her oblique termination and be less inclined to return. The client might perceive the psychotherapist's actions as controlling and unnecessarily intrusive...It might seem that the psychotherapist is trying to break up with the client or get rid of him or her with such a formal action. Routine letters of closure not only present an unrealistic administrative burden on the provider, they add to the risk of negative client reactions." (Davis, D. D. and Younggren, J, N. (2009). Ethical competence in psychotherapy termination. Professional Psychology: Research and Practice, 40 (6), 572-578. p. 575)
  • On Clients' Duty
    "Patients also have a duty of compliance with treatment if they expect to get better and to have their psychotherapist remain in a relationship with them. This is because in psychotherapy the psychotherapist becomes a "fiduciary" in the treatment relation- ship. This type of fiduciary relationship is not simply a financial relationship but is actually much broader in both duty and obligation. It is a special type of relationship that requires that the patient have confidence and trust in the recommendations that are being made by the psychotherapist (Simon & Shuman, 2007). That is not to say that they have to agree with every suggestion the psycho-therapist makes but they, at a minimum, have to see value in cooperating with at least some of what is being offered. This begins with regularly attending treatment sessions. A psychotherapist's duty to treat patients is significantly reduced when they voluntarily fail to attend treatment sessions in a consistent fashion. Simply put, this lack of compliance on the part of patients is a violation of their responsibilities to the treatment alliance." From Younggren, J. N (2011). A Legal and Ethical Review of Patient Responsibilities and Psychotherapist Duties. Professional Psychology: Research and Practice, 2011, Vol. 42, No. 2, 160–168. P. 161.

Information for Clients/Consumers Regarding Therapy

Journal Articles: Psychoanalytic

Knafo, Danielle (2017). Beginnings and endings: time and termination in psychoanalysis. Psychoanalytic Psychology http://dx.doi.org/10.1037/pap0000125

McKamy , Elizabeth Herman (2015). Closed for business: reflections on a psychoanalytic psychotherapist's voluntary retirement. Contemporary Psychoanalysis, 51:4, 727-746.

Mendenhall, Susan (2009). From termination to the evolution of a relationship, Psychoanalytic Inquiry, 29(2),117-135

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References on Termination

  • Bamford, J., & Akhurst, J. (2014). 'She's not going to leave me'–counsellors' feelings on ending therapy with children. British Journal of Guidance & Counselling, 42(5), 459-471. http://dx.doi.org/10.1080/03069885.2014.907867
  • Barnett, J. and Zur, O. (2009). Termination guidelines. The Central Valley Therapist, 8-9. Retrieved from https://www.zurinstitute.com/terminationguidelines.html
  • Bartle-Haring, S.et. al (2012). Alliance and termination status in couple therapy: A comparison of methods for assessing discrepancies, Psychotherapy Research, (Apr 5, 2012), 1-13
  • Bhatia, A., & Gelso, C. J. (2017). The termination phase: Therapists' perspective on the therapeutic relationship and outcome. Psychotherapy, 54(1), 76-87. http://dx.doi.org/10.1037/pst0000100
  • Butler, J. (2015). 'The unexamined death': Patients' experiences of the premature termination of analysis due to the sudden death, or terminal illness of the analyst (Doctoral Dissertation). Retrieved from http://repository.essex.ac.uk/15292/
  • Connell, J.,Grant, S., & Mullin, T (2006). Client initiated termination of therapy at NHS primary care counselling services, Counselling and Psychotherapy Research, 6(1), 60-67
  • Dawson, D., & Akhurst, J. (2015). 'I wouldn't dream of ending with a client in the way he did to me': An exploration of supervisees' experiences of an unplanned ending to the supervisory relationship. Counselling and Psychotherapy Research, 15(1), 21-30. doi:10.1002/capr.12003
  • Gans, J. S. (2016). "Our time is up": A relational perspective on the ending of a single psychotherapy session. American Journal of Psychotherapy, 70(4), 413-427.
  • Gil, E., & Crenshaw, D. A. (2015). Termination challenges in child psychotherapy. New York, NY: Guilford Publications.
  • Goode, J., Park, J., Parkin, S., Tompkins, K. A., & Swift, J. K. (2017). A collaborative approach to psychotherapy termination. Psychotherapy, 54(1), 10-14. http://dx.doi.org/10.1037/pst0000085
  • Griffin, M. (2017). Parting ways; Anticipating and avoiding problems which commonly occur during termination.  The Therapist, Sept/Oct. 72-77.
  • Hyman, M. &, Robert C. Lane, R.C. (1997). Special Section on Termination: A Special Issue of psychoanalytic Psychology. Psychology Press.
  • Jordan, J., McIntosh, V. V., Carter, F. A., Joyce, P. R., Frampton, C., Luty, S. E., & Bulik, C. M. (2014). Clinical characteristics associated with premature termination from outpatient psychotherapy for anorexia nervosa. European Eating Disorders Review, 22(4), 278-284. doi:10.1002/erv.2296
  • Jurek, J., Janusz, B., Chwal, M., & de Barbaro, B. (2014). Premature termination in couple therapy as a part of therapeutic process. Cross case analysis. Archives of Psychiatry and Psychotherapy, 2, 51-59. Retrieved from http://archivespp.pl/uploads/images/2014_16_2/51Jurek_ArchivesPP2_2014.pdf
  • Knox, S., Adrians, N., Everson, E., Hess, S., Hill, C. & Crook-Lyon, R (2011). Clients' perspectives on therapy termination, Psychotherapy Research, 21 (2), 154-167
  • Lampropoulos, G.K. (2010). Type of counseling termination and trainee therapist-client agreement about change, Counselling Psychology Quarterly, 23(1),111-120
  • Leslie, Richard, R. S. (2010) Closing a Practice, The Therapist, January.
  • Lutz, W., Hofmann, S. G., Rubel, J., Boswell, J. F., Shear, M. K., Gorman, J. M., & Barlow, D. H. (2014). Patterns of early change and their relationship to outcome and early treatment termination in patients with panic disorder. Journal of consulting and clinical psychology, 82(2), 287-297. http://dx.doi.org/10.1037/a0035535
  • Maples, J. L., & Walker, R. L. (2014). Consolidation rather than termination: Rethinking how psychologists label and conceptualize the final phase of psychological treatment. Professional psychology: Research and practice, 45(2), 104-110. http://dx.doi.org/10.1037/a0036250
  • Norcross, J. C., Zimmerman, B. E., Greenberg, R. P., & Swift, J. K. (2017). Do all therapists do that when saying goodbye? A study of commonalities in termination behaviors. Psychotherapy, 54(1), 66-75. http://dx.doi.org/10.1037/pst0000097
  • Olivera, J., Challú, L., Gómez Penedo, J. M., & Roussos, A. (2017). Client–therapist agreement in the termination process and its association with therapeutic relationship. Psychotherapy, 54(1), 88-101. http://dx.doi.org/10.1037/pst0000099
  • Owen, J., Drinane, J., Tao, K. W., Adelson, J. L., Hook, J. N., Davis, D., & Fookune, N. (2017). Racial/ethnic disparities in client unilateral termination: The role of therapists' cultural comfort. Psychotherapy Research, 27(1), 102-111. http://dx.doi.org/10.1080/10503307.2015.1078517
  • Piselli,A., Halgin, R.P., & MacEwan, G.H (2011). What went wrong? Therapists' reflections on their role in premature termination, Psychotherapy Research, 21(4), 400-415
  • Råbu, M., Binder, P. E., & Haavind, H. (2013). Negotiating ending: A qualitative study of the process of ending psychotherapy. European Journal of Psychotherapy & Counselling, 15(3), 274-295. http://dx.doi.org/10.1080/13642537.2013.810962
  • Rubin, A., Dolev, T., & Zilcha-Mano, S. (2016). Patient demographics and psychological functioning as predictors of unilateral termination of psychodynamic therapy. Psychotherapy Research, 1-13. http://dx.doi.org/10.1080/10503307.2016.1241910
  • Schlesinger, H. J. (2013). Endings and beginnings: On terminating psychotherapy and psychoanalysis. New York, NY: Routledge.
  • Sean B. Hall, Nina W. Brown & J. Ryan Humphries (2018) Premature Termination From Outpatient Psychotherapy in a University-Based Counseling Center, Counseling Outcome Research and Evaluation, 9:1, 28-41, DOI: 10.1080/21501378.2017.1302786
  • Taylor, L, Kaminer, D & Hardy, A (2011). Risk factors for premature termination of treatment at a child and family mental health clinic, Journal of Child & Adolescent Mental Health, 23(2), 155-164
  • Vasquez M. J., Bingham R. P. & Barnett, J.E. (2008) Psychotherapy Termination: Clinical and Ethical Responsibilities. Journal of Clinical Psychology in Session, 64(5), 653-665.
  • Vidair, H. B., Feyijinmi, G. O., & Feindler, E. L. (2017). Termination in cognitive–behavioral therapy with children, adolescents, and parents. Psychotherapy, 54(1), 15-21. doi:10.1037/pst0000086
  • Weil, M. P., Katz, M., & Hilsenroth, M. J. (2017). Patient and therapist perspectives during the psychotherapy termination process: The role of participation and exploration. Psychodynamic Psychiatry, 45(1), 23-43. doi: 10.1521/pdps.2017.45.1.23
  • Westmacott, R, Hunsley, J, Best, M, Rumstein-McKean O & Schindler, D (2010). Client and therapist views of contextual factors related to termination from psychotherapy: A comparison between unilateral and mutual terminators, Psychotherapy Research, 20 (4), 423-435
  • Younggren, J. N., Fisher, M. A., Foote, W. E., & Hjelt, S. E. (2011). A legal and ethical review of patient responsibilities and psychotherapist duties. Professional Psychology: Research and Practice, 42(2), 160-168.

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Therapist's Retirement

General Legal Issues

References on Retirement

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Therapists' Will

Resources on Therapists' Professional Will

Therapists' Professional Will Bibliography

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