CFN9885 - SECTION 13: TERMINATION
Termination as a Process
Termination is typically not accomplished in one or two final sessions, rather termination is best seen as a process. Ideally, termination occurs by mutual agreement when the goals developed by the client and the clinician are achieved. This would include not only addressing the specific problems or goals the client wanted to work on in counseling, but additionally when clients have deepened their self-understanding and broadened their problem-solving and coping skills to be able to apply them in different and new situations.
Some clinicians have stated the principle that it should take about as many sessions to terminate counseling with a client as it took to build rapport with the client. Whether not this is literally true, successful termination using takes place over a number of sessions and it must be done with forethought and sensitivity. Termination is not so much an ending, but a transition in the client’s growth process.
With many clients, readiness for termination is not difficult to assess. Clients report a clear sense of having acquired what they wanted from the counseling experience and they show clear signs of being ready to end counseling. Clients report that family, friends, and associate have noticed positive changes.
Clients’ assessment of their situation is consistent with the clinician’s observations. The clinician and the client may then decide that ending counseling is the best option. They may decide to decrease the frequency of sessions working toward complete termination, and/or they may decide to have follow-up sessions as needed. The final sessions are then devoted to reviewing what has taken place in the counseling process, preparing the client for future developments, and saying goodbye.
Some clients terminate therapy because they feel dissatisfied with the clinician or the counseling process and they want to explore other options. In some situations there may be a disagreement between the clinician and the client where the client feels they have obtained what they need from the counseling, but the clinician feels the client needs to do some more work.
The goal of most counseling is for clinicians to become obsolete and unnecessary to their clients. The very needs that motivate people to become clinicians may prevent some clinicians from wanting to terminate relationships with clients, especially clients with whom they have developed strong attachments.
In these situations, the clinician and the client need to discuss the situation and see if changes can be made to more meaningfully address the client’s concerns. If this does not resolve the situation, then the clinician should give the client a list of appropriate referrals. It is important for clinicians to explore the reasons why they feel some clients terminate counseling with them prematurely and, with the help of good supervision or consultation, seek to address any areas that need improvement.
Sometimes clients end - or are forced to end - their sessions with a clinician prematurely. Some clients are forced to end counseling because of limits on insurance reimbursement. In these situations, it is important for clinicians to know beforehand how many sessions will be reimbursed by the client’s insurance company or third-party payee and tailor the number and type of counseling sessions accordingly.
Clinicians can also make adjustment in their fees to accommodate continued counseling or they can make an appropriate referral to another counseling option. Some clients end or interrupt counseling because of unexpected personal situations that prevent them from continuing. In these situations, it is important for clinicians to communicate to clients in these situations that they are welcome to return to counseling when they are in a better situation.
There may be other situations where the clinician feels the client no longer needs counseling, but the client wants to continue working with the clinician. Clinicians in this situation need to examine why they feel that they no longer need to work with this client, that the true reason is that the goals have been accomplished and not that the clinician has tired of working with a client. If the clinician feels that the counseling goals have been realized, then the client and the clinician need to examine the source of the insecurity and work toward a mutually agreed upon separation.
Sometimes gradually reducing the number of sessions or scheduling follow-up sessions can ease client insecurity. Effective termination provides a positive closure to the counseling experience and encourages clients to continue to use what they have learned in counseling.
In conclusion, these stages are not separate, rather they overlap. For example, early assessment often begins while the relationship is still being developed, early goal-setting often beings during the assessment stage, relationship building is an ongoing process, and treatment goals may change as the counseling progresses. (Hackney & Cormier, 2005)