One aspect of the counseling relationship that may be challenging for Counselors and Therapists is terminating therapy with a client. In many situations, counseling relationships are not intended to be long-term. Rather, we work to provide clients with the support needed to make changes that can help them live their best life. In this post, I review reasons when to terminate therapy with a client, ways to terminate therapy, and common client reactions after termination. Let’s dive in!
Why Terminate Therapy with a Client?
There are a variety of reasons that can lead to termination with clients in therapy. Termination is a process that should begin during your first session with clients. Your informed consent can lay the groundwork for reasons that can lead to terminating a client in therapy. By including these reasons in your informed consent, you are giving your client the opportunity to ask related questions and have a better understanding of what to expect from the counseling relationship.
Determining when to terminate therapy with a client can feel tricky or complicated if it is not something that you have done regularly. Let’s look at common reasons for terminating therapy with a client:
1. Not a Good Fit
As Counselors, we have learned when the counseling relationship does not feel right. This can mean that your client is in need of a counselor with different training or experience background, or that there is an aspect of the counseling relationship that is hindering their progress. If you notice that your client is not making clinically relevant gains while working with you, this may be a sign that you are not a good fit for them.
When we come to realize that we are not a good fit for the client, we are responsible for terminating therapy in an ethical fashion. This means that we do not abandon our clients, and work to provide them with appropriate referrals. Ideally, termination would occur in a final session that would allow the client to voice their thoughts and concerns about the termination.
When we explain the reason for terminating therapy with a client, it is important that we do so in a way that is not offensive, insulting, or judgmental. Rather, trying to have this be a factual conversation could be more effective. As an example, if you are trained in Cognitive Behavioral Therapy with a client who has been living with Posttraumatic Stress Disorder, you may terminate therapy when you see that they are not making the progress expected with this form of therapy. You can then explain that there are other therapeutic modalities that can be used to treat PTSD and refer them to a colleague who is trained and experienced in another treatment approach such as DBT, EDMR, or CPT. In this approach, you are not placing blame on the client or the work they have done with you in their sessions.
2. Needs a Different Level of Care
This situation can be similar to the above situation of not being a good fit. One example would be that you have been working with a client on an outpatient basis and feel as though they need inpatient treatment, or more intensive outpatient treatment options such as a day program. Hospitalization may be appropriate for clients that you feel are a danger to themselves or others, and individuals who would benefit from medication-assisted therapy on an inpatient basis for mental health concerns.
This is something that can be discussed briefly during your first session with your informed consent. If you begin to observe signs of increasing distress, or that a client is regressing back to unhealthy behaviors, you may want to begin talking about when a higher level of care would be needed. Talking about a higher level of care from the beginning of your work with a client, and again when you begin to see concerning changes can lead to an open discussion and can help decrease any stigma or resistance the client has about other levels of care.
3. Client has No-Showed
Most practicing Counselors have experienced no-show appointments. Forgetting an appointment, or running late for a session can occur, our clients are human after all. Repeated no-show appointments can have a negative impact on the client’s growth in therapy and your counseling practice.
Your informed consent from your initial session should clearly lay out your expectations for no-shows. As an example, your informed consent can explain that you excuse one or two no-shows, but on the third, you may choose to terminate counseling with the client. In reality, our lives are filled with shades of gray so you may choose to follow this rule with discretion.
Loss of contact would be a similar reason for terminating a client. This can occur when a client does not attend scheduled sessions and fails to respond to your outreach via approved methods.
4. Completed Treatment Goals
The ideal reason for terminating therapy with a client would be that they complete their goals. If this is the case, you would likely build up to their final session by reviewing their growth and allowing time for them to process any concerns or reactions that they have to end their time with you. Talking about termination throughout our time with a client can help reinforce that your relationship is not long-term, which can help clients process their emotions and reactions when this time comes.
Ways to Terminate Therapy with a Client
How to terminate therapy with a client will depend on the reason for termination. In a perfect world, we would be able to terminate with clients during a final, in-person session that gives them the time and space they need to process the ending of their therapeutic relationship.
There are situations, however, such as client no-shows and unexpected hospitalizations, that can make this difficult or impossible. It is necessary for us as Counselors to reach out and clearly explain that their therapeutic relationship with you has ended. In some situations, this occurs through a written letter that gets mailed to the client’s mailing address.
In a written letter, you would want to make sure that the language you use is easily understood, clear, and direct. You can include referral information for other treatment options if it is appropriate for the client’s situation. Professional resources, such as TherapyByPro, has client termination letter templates and a patient termination letter available online that can be used as a guide for your termination letters.
Common Client Reactions to Termination of Therapy
The client’s reaction to the termination of therapy can vary for each client. Let’s explore a few common client reactions to termination of therapy:
Anger
As an example, if you are terminating with a client because you feel as though you are not a good fit or they have no-showed, they may react with anger. This can include yelling, blaming, or being tearful. In a situation such as this, try to avoid becoming defensive.
Guilt
Another reaction that you may come across is clients feeling guilty. They may feel as though they were “bad clients” or didn’t “do enough”. In these situations, you may want to spend time clearly explaining what led up to the termination, and where the client can go from here. Terminating therapy is not intended to make a client feel bad, however, this, unfortunately, can occur.
Happiness
Individuals who are terminating therapy because they have completed their goals can exhibit mixed emotions as well. Some clients may be happy to end therapy and easily recognize the growth they have made. Others may struggle to see their progress or doubt their inability to cope with stressors without therapy.
Grief
Grief is another common reaction when clients are ending therapy. This can look different for everyone, and affect clients differently. It is okay for a client to feel sad about their termination, just as it is okay for you, as the counselor, to be sad that you’re terminating therapy with your client. The therapeutic relationship is an intimate, close relationship, so it is understandable that we may have reactions and emotions of our own when we have terminations.
The important thing to remember is keeping ourselves calm can help the client feel more comfortable with their own emotional reactions. Terminating sessions with clients who are angry and verbally aggressive can be challenging, which is why it is important for Counselors to take care of themselves. This includes our regular self-care routine and using supervision when needed for support.
Final Thoughts on Terminating Therapy with a Client
One of the comments that has stuck in my mind from my Master’s courses was that terminating begins in your first session. Having this mindset and expectation has made it a normal talking point in therapy sessions, especially when reviewing a client’s progress.
Our relationship with clients is a collaborative one which requires that we and the clients have a mutual understanding of some topics. This includes termination and factors that would lead to terminating therapy with them.
Because of the nature of our work, it is natural and normal for us as Counselors to have reactions when we terminate therapy with clients. You may feel a sense of relief when you terminate with a client who is not a good fit, or with someone whom you feel needs a higher level of care. This relief shows that there is a part of you that recognized that you would be better served by working with someone else.
Additionally, it is important for us as counselors to be familiar with ethical concerns that can arise during the termination period, as well as any legal requirements that may be relevant in your state. Utilizing supervision regularly can help you gain familiarity with concerns regarding termination.
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Author: Kayla VanGuilder, MA, LCMHC
Kayla is a Mental Health Counselor who earned her degree from Niagara University in Lewiston, New York. She has provided psychotherapy in a residential treatment program and an outpatient addiction treatment facility in New York as well as an inpatient addiction rehab in Ontario, Canada. She has experience working with individuals living with a variety of mental health concerns including depression, anxiety, bipolar disorder, borderline personality disorder, and trauma.
