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 Christopher SmithPresident and Clinical Director, Seeking Shalom):
There are different reasons why a counselor may seek to terminate with a client and these will each have different processes by which the counselor will come to that decision. Here are a few examples. The counselor may determine that the client's needs are outside what the counselor is competent to be able to work with. A person may have come to the counselor talking about a particular issue but either when they first met or as counseling progressed, it may become clear that the issue is in fact something different or that there is an additional related issue. If that issue is outside the competence of the counselor, the counselor should look for alternatives, the most common of which would be to terminate and refer. Beyond clinical issues, this could also come up around particular other related facts, such as the culture of the client or linguistic issues. This could also be the choice of the counselor if they know someone that they feel would be a better match for the client's issues. Another reason for discharge (and possible referral) would be if the relationship does not seem to be a good fit. No counselor is the right person to work with everyone. If the right level of connection is not happening, the counselor will often look first at what they are doing, might talk about it with the client and ultimately will admit that things don't seem to be working to allow the desired therapeutic process to work. A similar process would be followed if the counselor determined that the client might not yet be ready for counseling as evidenced by lack of engagement such as frequent cancellations, not doing any agreed on work between sessions, showing up late or being really guarded in session. The easiest situation to decide on is when a person has met their counseling goals and have nothing new that they are working on. While this is the easiest one to determine, it is also probably the hardest one for the counselor as they may be like the client in not wanting the relationship to come to an end. However, counselors know that this is part of the process. They will also determine this by regularly reviewing the treatment plan or by sending in the sessions that the work has come to an end. This type of termination maybe final or may be with the intent that the client will return later to address other things that have been identified but for which they are not ready to move into. All of these (and other) situations involves the counselor being open to the relationship ending, to monitoring how things are going, then engaging in self reflection, possibly talking with the client and then coming to a conclusion on which the counselor  follows through.

Answer (from Frank WalkerI help couples manage the bumpy road called marriage. Whether your marriage needs a tune up, a major overhaul or just a flat tire changed. I can help.):
From the very beginning of counseling sessions I emphasize that the work will and must end at some point.In counseling there is an arc to the process. A beginning, middle and end. I am always digging, searching and exploring. There comes a point where things come to there natural ending.I always leave an opening for continuing counseling in the future. At least as a check in.

Answer (from Dr Traci KochendorferTime for you to " Claim IT" with over 15 years in health and wellness, Ph.D Psy.D D.D. F.P.L.C. recognized on TV and Magazines,):
There can be many reasons why?Client has reached their goals they hired the coach/ counselor forClient is not progressing or taking a path forward.Client is not a good fit

Answer (from Candice Conroy, LMHCFind relief from anxiety, depression, and trauma.):
Counselors should consider ending counseling sessions or terminating therapy under several different circumstances. Here are a few of the most common:If the client has developed the coping skills for which they came to therapy, counselors should encourage clients to decrease sessions to less often to begin practicing maintaining progress on their own. Clients are often nervous about decreasing sessions when they are doing well for fear of relapsing. This is a crucial step in helping clients to build confidence in their coping skills and decrease the feeling that they must forever continue therapy in order to be well. Most clients experience some difficulties and slip ups during this step down process, but these are important to identify and address while still in therapy where clients can get help coming up with a plan. This is also the point at which counselors should be helping clients come up with a relapse prevention plan so they can safely terminate therapy and maintain the progress on their own.If the counselor determines the client's needs are outside of their scope of practice, they should refer them out. For example, if the counselor determines that the client has an eating disorder and the counselor is not knowledgable or trained in the treatment of eating disorders, they should refer them to another provider who specializes in this issue.If the client is in need of a higher level of care, counselors should refer them to the lowest level that is likely to be effective for the client. Most of what we think of as "therapy" is often on session every week or two with a therapist at a local practice. For some clients, however, the therapist may find they are unable to manage their symptoms and emotions between sessions and need to be seen more frequently. For outpatient therapy, clients with more severe symptoms are typically seen twice a week. For clients who need more than that, counselors should refer them to other programs for more intensive treatment such as intensive outpatient (groups and individual therapy several times per week), partial hospitalization (groups and individual therapy several hours per day plus medication), or inpatient (residential treatment with groups, individual therapy, and medication for 30 days).If the client is in need of substance abuse treatment before therapy can be effective with other concerns, the counselor should refer clients for a substance abuse evaluation. People commonly use substances to cope with unwanted emotional pain and mental health symptoms. Over time, this pattern often develops into substance abuse. Research has shown therapy to be ineffective in treating mental health conditions without FIRST addressing any substance abuse. For example, someone with a history of trauma who is drinking to cope with unwanted memories would need to be able to maintain sobriety for a period of time before therapy for trauma can have any significant impact.My goal as a therapist is always to start people off with the lowest frequency of sessions possible for them to actually make progress (typically once a week or once every other week). Then we work to teach them the skills they came in for and encourage them to practice outside of sessions. Next, once they've gotten the hang of the skills and are feeling better, we start encouraging them to space out sessions and "take the training wheels off". Finally, we come up with a relapse prevention plan to make sure they can keep it going on their own and identify any impending relapses long before they get bad so they can course correct on their own.For more information about the process of CBT therapy, visit: "From Start to Finish: What does cognitive behavioral therapy look like?"

Answer (from Dr. Timothy Paul'man'; Online - "Natural Health Consultant and Coach"):
For most:  When the money/insurance runs out.When best:  When the job is done... and you're feeling much better.

Answer (from Laura Cassity, LMSW, LMACAffiliated Family Counselors):