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 Vivian D. Echevarria Guzman, MSC, LPC-S, NCCBilingual Licensed Professional Counselor):
To be able to identify a clear ending to a counseling relationship, we must have a clear understanding of the goals and limitations of treatment.  Usually, during the initial evaluation, I identify my client’s short term and long term therapy goals.  As therapy progress, we verify goals on a monthly to a quarterly basis, depending on the frequency of the appointments.  Once the therapy goals have been met, there is a closing session, the counseling relationship is ended, and the client can stop attending sessions.  In some cases, the client can also establish new goals and determine if I am a good fit for their therapy needs or if they need a new provider, in which case I provide multiple referrals.The counseling relationship could also end due to other factors like noncompliance= when a client is not committed to the agreed treatment process, or when the client’s or a counselor violates the counseling relationship.  Either the counselor or the client is able to end counseling.  Although, as mental health providers we need to provide a reason for terminating our therapeutic relationship and referral options, as a client no explanation is needed, a closing session is highly recommended.  ¿Cómo termina la terapia?¿Cómo un consejero decide cuando terminar las sesiones de consejería o terminar de trabajar con un paciente?Para poder determinar el final de la relación del consejero, debemos comprender las metas y parámetros de la terapia.  Usualmente durante la evaluación inicial se identifican metas a corto y largo plazo con el cliente, y se discute con el cliente como esas metas serán alcanzadas.  Durante el proceso de terapia el consejero revisa las metas mensual o trimestralmente dependiendo de la frecuencia de las citas.  Ya que las metas de terapia son alcanzadas, hay una sesión de cierre y el cliente puede terminar la terapia.   En algunos casos el cliente puede identificar nuevas metas para la terapia y determinar si el mismo consejero u otro consejero le pueden asistir. 
La relación de consejería también puede terminar por no conformar o violentar los parámetros  establecidos para la terapia.   Tanto el consejero como el cliente pueden terminar la relación de terapia.  Como proveedores de salud mental los consejeros estamos obligados a proveer un razón para la conclusión del tratamiento y proveer referidos según aplique, los clientes no necesitan proveer una explicación, aunque es recomendable discutirlo en una sesión de cierre.

Answer (from David KleinHumanistic, LGBT-Affirmative Psychotherapy for Individuals & Couples):
As a therapist who believes in client self-determination above most other elements of the process, I want to as much as possible leave it up to the client to determine when they are finished. In the case of a termination because a client's distress has resolved, I might periodically check in with the client about how therapy has been going, and if we want to re-evaluate where we are.The more unfortunate situation would come about if I felt that I wasn't the best fit for the client. I would offer that in words, and ideas of therapists (with names) of who I thought might be a better fit and why. It still is up to the client whether to continue, however should they want to keep seeing me, a part of the work would be about that want (to see someone who professionally doesn't believe they can help as much as someone else.)I also find it perplexing when I hear a client (or on a personal level) tell me that their therapist said they "didn't need therapy." I don't know that I buy into that scenario all that much, because I do believe that yes, not everyone NEEDS therapy, but that everyone CAN benefit from therapy and I don't believe it is the therapist's job to deter someone from ever seeking out help of any kind.

Answer (from Shy PorterSpecialist in couples & individuals):
Ideally, termination should be a mutual process. It's not that the therapist kicks the client out at some point and says, "Okay, you're done." Rather, over time the client will decrease the frequency with which he/she comes to session so that it may start off as weekly, then decrease to biweekly, then perhaps once every three weeks, then once/month and so on. Throughout this process, the therapist and client should have had regular check ins about progress toward goals. If the client feels good about where he/she is in life, he/she might decide to suspend therapy for now. That being said, the therapist should make it very clear that if the client ever decided to return for "maintenance" therapy or a check in, he/she would always be welcome. There is no hard and fast rule to ending or a particular time period in which it must end. What matters most is that the client feels good about it and knows that the therapist will always be there should he/she wish to return.

Answer (from Anna McElearneyHelping Couples Build Stronger Relationships):
For a therapist, deciding to end counseling sessions or terminate working with a client is a thoughtful and intentional decision. One that is not entered into lightly. While there are many considerations counselors take into account, to help answer this question, I'll offer an example of two areas that counselor's take into consideration when ending counseling sessions:Does the client need different or more specialized care than the current counselor can provide? This requires the counselor to determine whether referring the client to another therapist or health care provider is needed.And, has the therapeutic relationship reached treatment goal(s)? While this question is specific to the counselor, I'd like to also add that a client, at any time, can end counseling.

Answer (from Cory Ian Shafer LPCPsychotherapist, Jungian, Hypnotherapy):
In general, I usually let the client decide when this should occur, sometimes with some clients it will be a joint agreement, but even in that case it should weigh mostly on what the client feels. In short, therapy ends when you feel your done.C

Answer (from Chris McDonaldHolistic Counselor):
I will work with clients and continually review progress with them and determine if counseling is helping.  If a client appears to have less to talk about in sessions, appears more stable for a period of time and has reached therapeutic goals I will talk about termination.  Some clients however I may continue with on a monthly or bi monthly process to allow for check-ins to see how they are doing and if they need more help at that time.