Informed consent represents the core of therapeutic work and should stand clearly at the outset. The patient in the case refused to permit her previous records to enter into the treatment.
It may ultimately be a deal breaker to continuation of treatment, especially when the patient calls attention to problems in previous treatment. Many ominous pitfalls and therapeutic errors or impasses may be revealed by the records of, or remarks about, even failed previous treatments.
Of course, great difficulty may attend locating previous treaters and obtaining records, assuming they kept records. This reciprocity may create the so-called magic bubble, 7 a conceptual sphere that begins with a mutual admiration society containing super-patient and wonder-doctor. The doctor then becomes impervious to consultation, supervision, good judgment, and common sense.
Consultee therapists often report fearing the anger of the patient if they were to suggest termination. The unneutralized rage of individuals with personality disorder has the apparent ability to intimidate even seasoned therapists. In addition to aggression, libido may play a role in delaying termination; gratifying erotic feelings and fantasies may account for the prolongation of some therapies beyond the appropriate point.
Some features in the case presented above are commonly encountered and merit particular focus. In this situation, therapist guilt about past boundary transgressions may be the driving force behind agreeing to continue. Conversely, threats of complaint about early boundary issues may frighten or coerce the treater into continuing or expanding the crossings.
Countertransference sadism. We suggest that the widely acknowledged decline in awareness and teaching of dynamic theory has left many therapists unfamiliar and uncomfortable with this common yet problematic countertransference response. Issues of power and control may also explain difficulty in terminating. Some therapists may be reluctant to give up a position of power over the patient and thus continue to hold on. Consultation phobia. Failure to maintain termination. While flexibility and willingness to negotiate are hallmarks of good therapy, a necessary and indicated termination should be sustained, even against psychological and other pressures from the patient to retract it, replete with promises to change, as in the case example.
Documentation issues. Appropriate documentation is extremely important in the charged situations described, but our experience is that the record can cut two ways. Inclusion in the record of all letters and e-mails to and from the patient avoids the appearance of concealing potentially damaging materials.
However, e-mails and letters from the therapist that display an inappropriate tone, excessive informality, hints of intimacy, and expressions of endearment are damaging rather than protective. The need to finish. The benefit of the doubt. Efforts should always be made first, in the service of informed consent, to negotiate an alliance-based, boundary-respecting therapeutic relationship.
Clear explanations of professional limits should be freely given. Counselors also experience many emotions when forced-termination occurs. Guilt is a very common emotion for counselors to feel when they initiate the termination stage. Forced-termination, by its very definition, means that the counseling relationship is ending prematurely. After spending so much time encouraging your client to be trusting, open and honest, one must now abruptly sever that connection.
This can leave counselors feeling as though they are abandoning their clients just as good progress could have been made, and can lead to a sense of feeling responsible for whatever might happen to the client as a result of the end of the relationship. Counselors-in-training often struggle with a sense of omnipotence, or the feeling that they are the only one who can understand or help the client. On the other hand, it is normal to feel a sense of impotence, or the feeling that the relationship was not at all helpful to the client and that the client will be helped more effectively by a different therapist.
When working with a client for only a short period of time, it can be difficult to see if any progress was made, especially if the client is not communicating any improvements to the counselor. And as a counselor, you may never know. Counselors may feel a sense of loss and sadness at not being able to see their clients anymore, and other may feel a sense of relief. This relief often leads to guilt about being glad to move on from the counseling situation.
It is very important to acknowledge your own feelings as you proceed through the termination stage of counseling. A client may initiate termination when it is determined that the goals that he or she set out to accomplish have been adequately met, or when he or she feels that problematic symptoms have been reduced or eliminated.
If the counselor agrees that goals have been met and the timing for termination is appropriate, termination can be a comfortable, pleasing experience for all involved. There may still be a sense of loss at not seeing the client on a regular basis, but this is often outweighed by a sense of happiness in knowing that the relationship was positive and productive and helped the client make progress.
Anticipated Reactions: In some cases, clients may initiate termination of the relationship if they do not feel comfortable with the counselor or do not feel that they are ready to fully engage in the counseling process. In this case, it is very important for counselors to process their own feelings about the end of the relationship and how it might affect future interactions with clients.
Counselor-Initiated Termination Definition: Counselor-Initiated Termination can occur when the counselor sees that the client has made progress toward achieving goals, notices a reduction in or elimination of symptoms, sees that the client has gained enough insight to deal with future recurring symptoms and has resolved transference issues, and determines that the client has the ability to work, enjoy life and play. Once the counselor has determined that there is little left to continue working on in therapy, it is time to introduce the reality of termination to the client.
If this is the case, it is your responsibility to make appropriate referrals and to obtain the professional training that would enable you to work with similar clients effectively in the future. Anticipated Reactions: Sometimes, clients will resist the termination process. After all, they have enjoyed success, in part, due to a relationship with their counselor. Ending that relationship can be frightening.
The client may insist that more time is needed to work on the issue s. A plethora of additional problems may suddenly arise, and sessions may be missed in an attempt to draw out the process or avoid termination.
The client may become suddenly angry at the mention of termination in order to create distance between client and counselor, and, in some cases, the client may prematurely end therapy of his or her own volition.
Counselors may also resist the process. If a client has enjoyed success, in which you have played a part, it is easy to want to maintain that relationship. As a counselor, you are receiving positive feedback, feeling needed and appreciated, all of which provides you with confidence and a sense of self-worth.
Letting go of that to allow your client to function independently can be difficult. It is important to recognize the positive work you do as a counselor, but this should not lead to your maintaining a relationship that is no longer serving the client. Termination of Group Counseling Many of the same skills necessary for termination of individual counseling relationships are necessary for terminating counseling groups.
Some of the things that group leaders can do to increase the chances of ending a group successfully include: Reinforcing the progress that was made during the course of the group. Offering suggestions to group members about ways in which they can successfully incorporate what they have learned into their daily lives.
Helping group participants brainstorm and anticipate problems that may arise when the group has concluded. Allowing time for constructive feedback from group members. This includes feedback for the leader as well as feedback for other group members. Assisting participants in processing their feelings about termination and helping them resolve any unfinished business.
Educating participants about additional resources that are available to them as supports once the group has ended.
Making oneself available should the need for individual counseling or consultation with group members arise. Tips for Successful Termination To increase the likelihood of successful termination with your clients, take heed of the following suggestions: Discuss termination with your clients early on in the counseling process.
Establish clear goals with your clients so that progress toward those goals can be recognized and completion of those goals is apparent. Your email address will not be published. Submit Comment. Facebook Twitter RSS.
Web-only Feature. And for Avoiding Abandonment. Address Termination Issues from the Outset. Include in the Informed Consent Discussions and Agreement The process of informed consent is intended to share all relevant information with clients so that they can make decisions about participation in the treatment services being offered Barnett, Have a Professional Will Psychotherapy can end for a variety of reasons.
Concluding Thoughts How the psychotherapy relationship and process end has important implications for our clients. Cite This Article Barnett, J. References American Psychological Association. Rose Reed on May 7, at pm. Rosemary Holt on October 25, at am. Please advise.
Jeffrey Barnett on October 28, at pm. Ofer Zur on February 1, at pm. Cindy Clark on May 29, at pm. I need to know, What a Closed Counselor means. This is not regarding their business hours Reply. Submit a Comment Cancel reply Your email address will not be published. What About the Words? Society for the Advancement of Psychotherapy uses cookies to provide you with a great user experience.
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Out of these cookies, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website.
We also use third-party cookies that help us analyze and understand how you use this website. These cookies will be stored in your browser only with your consent. You also have the option to opt-out of these cookies. But opting out of some of these cookies may have an effect on your browsing experience. Clients can write effective coping skills, memorable counseling experiences, or other notable takeaways on the flowers. Next, punch a hole in each flower and thread them along the string.
Family members or caregivers can also be involved in the process with client consent , adding their own flowers to the lei. The lei can then be given to the client as a parting gift. This intervention involves creativity and metaphor in a way that summarizes the counseling experience while actively involving the client. Building blocks: This activity can be tailored to clients of any age. During the final session, counselors can bring a number of building blocks, Legos, Jenga blocks, or other toy blocks to session.
Clients can then construct a tower or creation of their choosing. Each block in the creation can represent a powerful moment in counseling, a coping skill clients now possess, or another skill clients have learned during counseling.
As the height of the tower increases, clients may become anxious, especially as the tower begins to lean. This intervention is a tactile and empowering activity for the end of counseling.
Goodbye letter: There are many variations of a goodbye letter that can be used as the counseling process comes to a close. Counselors can provide a letter template with certain blanks to be filled in, or they can simply provide a blank piece of paper on which clients can write their own letter. Adding prompts or sentence stems for clients to complete can add a degree of structure to the letter.
Goodbye letters can be written from client to counselor, from counselor to client, or even from the perspective of the process of counseling itself being personified. It is also important to keep the activity strengths-based as is the case with any termination activity.
Survivor tree: Survivor trees can serve as a creative intervention to foster and celebrate resilience in the final stage of the counseling relationship.
As the tree grows and expands on the paper, the counselor can weave in the idea that trees survive multiple seasons every year.
Some seasons leave barren branches, whereas other seasons are rife with leaves and buds. Nevertheless, the tree survives and continues to bloom, even after a cold or barren season.
Clients can then reflect how their resilience has allowed them to overcome previous barren seasons. They might also reflect on how the skills they learned in counseling can help engender resilience during future difficult seasons of life. Taking the example of the tree eventually blooming despite the adversity of winter, clients can explore how they can go forth in life and bloom beautifully, no matter the adversities they face.
Client autonomy can be reinforced by allowing clients creative license in decorating and designing their cases. Clients can be encouraged to include various objects in the box that they find important and valuable to the counseling process e. Furthermore, clients can create decorative scraps of paper to add to the box. These papers can include notable moments in counseling, emotions surrounding the counseling process, skills learned, or other tools with which the client can face the future trials and travails of life outside of the counseling relationship.
This intervention is relatively open to interpretation and can include myriad creative avenues to help clients gain closure. Regardless of the specific intervention used, termination is a vital part of the counseling process.
During termination, counselors should convey a great deal of warmth and compassion to clients, while simultaneously aiming to empower them and promote their self-worth. To reiterate, it is important to understand that semantics matter. The word termination conjures up brutal images of loss.
In truth, the end of counseling is really the start of a new beginning; it is as if one chapter is closing and counselors are handing the pen off to clients to write their own next chapters.
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