Topic: professional-ethics

Question: How does counseling end?
How does a counselor decide when to end counseling sessions or to terminate working with a client?

Answer (from Jill Barnett KaufmanPsychotherapist):
There are several reasons for a counselor to decide to end counseling.  A major reason to end counseling is if the counselor feels that he or she does not have the skills or experience to work with the client.  This may happen during the intake process or after working with the client for some time.  If the clinician feels that the client is not benefitting from the therapy, it is ethical to suggest that the client terminate the therapy.  The process of termination must not injure the client and, if necessary, the clinician may need to refer the client to other treatment modalities.  Another reason to terminate working with a client is if the client needs a higher level of care.  If the client has a crisis or is at risk of hurting himself or someone else, he or she may need a higher level of care.  In this circumstance, the clinician may need to involve outside services such as a crisis unit.  A third reason to terminate with a client is if the clinician feels that he or she cannot remain professional with the client relationship.  For example, if the issues that the client is working on bring up something significant for the clinician and the clinician feels that he is unable to separate that from the professional relationship.  In this instance, the clinician should refer the client to another therapist.  Finally, if the client has reached her goals for therapy and no longer needs treatment, the clinician and client should terminate treatment.

Answer (from Catherine HodgeLicensed Mental Health Counselor):
Counseling ends when the client has received the maximum benefit from the therapist. Even if the therapist believes the client is not making progress, the client may feel they are improving and receiving a benefit. And the therapist may see a benefit and the client does not. It is best to have ongoing dialogue with the client to determine when termination is appropriate.

Answer (from Toni Teixeira, LCSWYour road to healing begins here):
Goodbyes can be hard.
Chances are most of the goodbyes you have experienced in your life have been
difficult. Saying goodbye to a therapist can be different. It can be an
opportunity to create a healthy ending in a positive relationship in your life.
If you work with a therapist who is skilled, then saying goodbye can be just as
transformative as the therapy itself. Ending therapy is also known
as “termination.” I know, “termination” doesn’t have a great ring to it!
However, it is what it is. It is an ending of the relationship as it existed.
It is reality cold and stark. Of course, when I talk to clients I don’t use the
word “termination,” I usually say “our goodbye.”  Under what circumstances does therapy usually
end? Therapy should end when a client does not need further assistance, is not
receiving any benefit from therapy, or might be harmed by continuing to work
with a particular therapist.In the best case scenario
the decision to move on from therapy and “say our goodbyes” happens when both
the therapist and the client feel like the client is ready to move on and move
up!  Ending the therapeutic relationship
should actually be worked on from the very first session. What I mean by that
is, there should be an understanding that the work we do together will have an
ending and that is a good thing because it means the client has gained the
skills to continue working on themselves independently. So the first session I
have with clients usually outlines a plan where the end goal is discussed and
we both have an understanding of the skills the client wants to learn or what
they hope to achieve. Now sometimes there are
situations where the therapist ends the relationship and the client may take
that personally, it is hard when any relationship ends and it might bring up
feelings of sadness, and fear or abandonment. Any good therapist will end the
relationship based on what is right for the client. What are some situations
where a therapist might end the relationship?If the situation the client
is dealing with is out of the therapist's scope of practice, the therapist may
end the relationship and refer the client to someone else. This is in the
client’s best interest. Another reason a therapist might end the relationship
is that the therapist is in a place in her life which prevents her from being
objective and helpful.  A therapist who
is going through a painful divorce may have difficulty working with a couple
that considering divorce. A good therapist may see that their judgement may be
clouded and want to refer the client to see someone else. This is good practice
and helps the client.If a client is actively
suicidal or actively using substances then the therapist may end the
relationship and refer out for a higher level of care. The client may need to
be hospitalized or may need an inpatient substance abuse treatment program.
Therapy may be terminated while they are being treated and may continue after
the intensive program is completed. 
Ending therapy should be a
time for connection and bringing together accomplishments, or reviewing the
next important step the client needs to take. It should not be an experience of
abandonment. A skilled therapist will help a client gain a new perspective on
closure. For some clients, it may be the one time in their lives when they get
a clean ending in a healthy relationship and they get to feel a sense of
control on creating that ending. Good luck to you!

Answer (from Dr. Bonnie HowellNow in St. Petersburg, Fl):
In the best case scenario, it's a mutual discussion and decision. If not,  I've had the discussion initiated both ways, by me, when I sense the client has gone has far as they want, by lack of interest in accepting or completing homework assignments, missing or cancelling appointments, usually at the last minute, lack of participation during sessions.  Client initiates by asking me pointed questions about why the need for homework assignments,, by forgetting their calendar, or their checkbook :) , by suggesting that we make appointments over longer intervals (once a week to once a month, for example).  I rarely have had to terminate a working relationship--that's why I don't charge for the first visit, so we know if we are a good fit before we start working together.  Then I periodically ask whether the client feels we are making progress, moving in the right direction, talking about the most relevant issues etc.

Answer (from Sherry Katz, LCSWCouples and Family Therapist, LCSW):
In my therapy practice the decision to end therapy is mutually made together with the patient.Otherwise, the person can end up with a sense of tremendous rejection and abandonment.The way you'll both know therapy is coming to a close is that the discussion will feel lighter and move easily.The person's mood will be better, they will smile more, sit in their seat in a more relaxed way, look more at ease, take better care of their appearance.One of the ways to end therapy is to gradually decrease the frequency of the sessions.Sometimes people who are in my practice start to come each three weeks, then monthly, then every three months.This gives a sense of security, friendliness, and casualness to the therapy, and de-medicalizes it as though the person was treated for a medical symptom and the symptom stops completely one day.Talk therapy is about life and life problems usually end gradually.I end my therapy in a way which mirrors the life process in which many interaction and situation problems show their effects gradually and show different effects over time.