Research has shown that therapists view termination as a complex stage of psychotherapy (Gelso & Woodhouse, 2002, as cited in Hardy & Woodhouse, 2006), though client responses are variable.
As cited by Hardy and Woodhouse (2006) clients often report positive feelings regarding termination, to include: pride, health, a sense of accomplishment, independence, cooperative, calmness, alive, agreeable, friendly, good, healthy, thoughtful, and satisfied. Interestingly, Hunsely, Aubry, Verstervelt, and Vito (1999) reported that 38.6% of clients attributed termination as a successful achievement of goals. Thus, Hardy and Woodhouse (2006) note that therapists may underestimate client perception of growth.
It is important that therapists become aware of these positive reactions, as psychotherapists may attribute more negative emotional reactions to termination. Additionally, understanding the difference between termination and abandonment is essential to ethical practice. Termination is a clinical decision based on competent practice. Per the ethics code, termination becomes clear when the client no longer needs services, is not likely to benefit, or is being harmed by continued service (American Psychological Association [APA], 2010). The latter may occur when a psychologist is not working within his or her boundaries of competence. Abandonment is an inappropriate termination (Behnke, 2009). Again, sound clinical thinking and consultation/supervision may help guide the decision process to ensure ethical termination. Yet, unfortunately termination can be more abrupt, such as in forced termination for interns (end of rotation)?
Often with forced termination, the goals of therapy have not been met and the provider may not handle the termination in an appropriate manner. Such may be due to lack of training. For instance, Zuckerman and Mitchell (2004) found that pre-doctoral interns reported they felt less than adequately prepared for forced termination. Thus, Hardy and Woodhouse (2006) highlight the need for focused training, specific to forced termination. According to the ethics code, pre-termination counseling is recommended (APA, 2010). With forced termination, often the end of services is known, therefore one should be proactive and notify the client in an appropriate manner. In other words, with termination, preparation of the client is necessary. When it is appropriate and after sound clinical decision-making and supervision, all efforts should be made to ensure an ethical termination and transfer to another provider occurs. Taking such care will help minimize harm and promote ethical practice.
References
American Psychological Association. (2010). Ethical Principles of Psychologists and Code of Conduct. Retrieved from http://www.apa.org/ethics/code/
Behnke, S. (2009). Termination and abandonment: A key ethical decision. Retrieved from http://www.apa.org/monitor/2009/09/ethics.aspx
Hardy, J. A. & Woodhouse, S. S. (2008, April). How We Say Goodbye: Research on Psychotherapy Termination. Retrieved from http://societyforpsychotherapy.org/say-goodbye-research-psychotherapy-termination
Hunsley, J., Aubry, T. D., Verstervelt, C. M., & Vito, D. (1999). Comparing therapist and client perspectives on reasons for psychotherapy termination. Psychotherapy, 36, 380-388.
Zuckerman, A., & Mitchell, C. L. (2004). Psychology interns’ perspectives on the forced termination of psychotherapy. The Clinical Supervisor, 23, 55-70.
Dannie S. Harris, M.A., M.A., M.A.Ed., Ed.S.
WKPIC Practicum Trainee