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

Resources

This resource page is part of three 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

CE Credits for Psychologists. CE Credits (CEUs) for LMFTs, Social Workers, Counselors and Nurses.
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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

Dewald, P.A. (1982). The clinical importance of the termination phase, Psychoanalytic Inquiry, 2(3), 441-461

Firestein, SK (1982). Termination of psychoanalysis: Theoretical, clinical, and pedagogic considerations, Psychoanalytic Inquiry, 2(3), 473-497

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

Wharff, E.A. (1993). Termination dreams, Journal of Analytic Social Work, 1(3), 81-103

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Additional 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 http://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
  • Brady, JL, Guy, JD et. al (1996). Difficult good-byes:A national survey of therapists' hindrances to successful terminations, Psychotherapy in Private Practice,14 (4), 65-76
  • 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
  • Firestein, S. K. (2001). Termination In psychoanalysis and psychotherapy. Madison, CT: International Universities Press.
  • 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
  • Guy, J.D., French, R.J., Poestral, P & Brown, C.K (1993). Therapeutic terminations: how psychotherapists say good-bye, Psychotherapy in Private Practice, 12(2), 73-82

  • Hopwood, C, Ambwani, S & Morey, L (2007). Predicting nonmutual therapy termination with the personality assessment inventory, Psychotherapy Research, 17 (6), 706-712
  • 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
  • Joyce, A. S., Piper, W. E., Ogrodniczuk, J. S., & Klien, R. H. (2007). Termination in psychotherapy: A psychodynamic model of processes and outcomes. Washington, DC: American Psychological Association.
  • 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
  • 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.
  • 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
  • Tryon, G.S. & Kane, A.S. (1995). Client involvement, working alliance, and type of therapy termination, Psychotherapy Research, 5(3), 189-198
  • 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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Retirement of the Therapist

General Legal Issues

Retirement Issues from Professional Organizations

    CAMFT
  • Rutzky, J. (2000) Taking Care of Business: Writing a Professional Will, The California Therapist Vol. 12 (4), p. 44.
  • Steiner, A. (2002) The Emergency Response Team: A Back Up Plan Every Clinician Needs, The California Therapist, April/May, p. 69-77.
  • Steiner, A. (2001) When the Therapist Has to Cancel, The California Therapist, Jan/February, p. 52-54.

Additional References on Retirement

  • American Psychiatric Association. (2007) Closing a Practice on Short Notice
  • Blakelee, M. (2014) Retiring as a Psychologist Ethically. National Psychologist, July.
  • Bogie, M. A. (2001). Retiring from Practice. NASW Assurance Service. 2/1
  • Chernin, P. (1976) Illness in a Therapist—Loss of Omnipotence, Archives General Psychiatry, Vol. 33, Nov., p. 1327.
  • Coleman, M. (2009). When a clinical social worker in solo or group practice dies. Clinical Social Work Practice Update. NASW.
  • DeWald, P. (1982) A Serious Illness in the Analyst: Transference, Countertransference, and Reality Reponses, Journal of Psychoanalytic Association, Vol. 30, No 2, p.347.
  • Draper, B., Winfield, S. & Luscombe G. (1997) The older psychiatrist and retirement, International Journal of Geriatric Psychiatry, 12, 233 -239.
  • Drentea, P. (2002) Retirement and mental health, Journal of Aging and Health, 14, 167 -194.
  • Eagles, J, Addie, K & Brown, T (2005). Retirement intentions of consultant psychiatrists, The Psychiatric Bulletin, Psychiatric Bulletin,29: 374-376
  • Eliot, Thomas Sterns. (1971). Four Quartets. New York: Harcourt Brace/Jovanovich. 202 Women & Therapy
  • Encyclopedia of Practice and Financial Management: Legal Responsibilities when you close a Practice. Chapter 15:6.
  • Gerson, B. (1996) The Therapist as a Person: Life Crises, Life Choices, Life Experiences, and Their Effects on Treatment, The Analytic Press.
  • Gold, J.H., Nemiah, J.C. (eds) (1993) Beyond Transference: When the Therapist's Real Life Intrudes, American Psychiatric Press, Inc. Washington, D.C.
  • Griffin, M. (2010). Closing a Psychotherapy Practice: Further Considerations. The Therapist, March/April
  • Guy, J., Souder, J. (1986) Impact of Therapist's Illness or Accident on Psychotherapeutic Practice: Review and Discussion, Professional Psychology: Research & Practice, Vol. 17(6) p. 509.
  • Halpert, E. (1983) When the Analyst is Chronically Ill or Dying, Psychoanalytic Quarterly, 1.1.
  • Holloway, J.D. (2003) Shutting down a practice: Psychologists face legal, ethical and emotional issues when they close their practice doors. Monitor on Psychology, 34/2, 32
  • Ireland, M. (1998) Plan for a Professional Will in the Event of Illness, Disability, or Death, unpublished manuscript.
  • Junkers, G, ed. (2013). The taboo of aging and retirement in psychoanalysis, New York: Routledge.
  • Leslie, Richard, R. S. (2010) Closing a Practice, The Therapist, January.
  • Levin, D. (1998) Unplanned Termination: Pain and Consequences, Journal of Analytic Social Work, Vol. 5(2) p. 35.
  • Marine, E. Are you taking risks that will affect your retirement? from a bulletin of The American Professional Agency
  • McGee, Thomas F. (2003) Observations on the retirement of professional psychologists. Professional Psychology: Research and Practice, 34, 388-395.
  • Moffic, S (2012). Mental boot camp: today is the first day of your retirement, Psychiatric Times, (June 25, 2012).
  • NASW (2001). Retiring from practice. NASW Insurance Trust. Practice Pointers.
  • Pollack, G (ed., 1992) How psychiatrists look at aging, Connecticut: International Universities Press, Inc.
  • Rauch, E. (1998) A One Session Memorial Group Following the Death of a Therapist, International Journal of Group Psychotherapy, 48 (1) p 99-104.
  • Salokangas, R. K. & Joukamaa, M. (1991) Physical and mental health changes in retirement age, Psychotherapy and Psychosomatics, 55, 100 -107.
  • Samuels, L. (1992) When the Analyst Cannot Continue, The San Francisco Jung Institute Library Journal, Vol. 10, No. 4, pp. 27-38.
  • Schad-Somer, S. (1985) Situational Countertransference, Journal of Contemporary Psychotherapy, Vol. 15(2) pp.156.
  • Schwartz, H., Silver, A. Eds., (1990) Illness in the Analyst: Implications for the Treatment Relationship, Madison, CT, International Universities Press.
  • Spayd, C. S. Closing professional practice: Clinical, ethical and practice considerations for psychologists throughout the life span. (Slide presentations).
  • Stein, G. Betting on Life: A Psychologist's Guide to Making Retirement and “Bucket List" Plans. Blog
  • Theriault, Jocelyne. (1994). Retirement as a psychosocial transition: process of adaptation to change. Int'l Journal of Aging and Human Development, 38, 153-170.
  • Thomas, J.T. (2015). Closing your practice: Practical, Clinical and Ethical Dimensions. National Psychologist, March.
  • Weiss, Stanley, & Kaplan, Eugene. (2000). Inner obstacles to psychoanalysts' retirement: personal, clinical, and theoretical perspectives. Bulletin of the Menninger Clinic, 64, 443-461.

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Therapists' Will

Resources

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