Successfully ending the relationship between therapist and client – known as termination – is a crucial aspect of psychotherapy (Joyce, Piper, Ogrodniczuk, & Klein, 2007).
It may form part of a well-formed plan, indicating the next phase in the psychotherapy process, or it may occur hastily without careful consideration (Barnett, 2016).
Either way, it can be made easier by recognizing the boundary between the working phase and the termination phase and the shift toward the process of ending therapy (Joyce et al., 2007).
This article examines how to plan for termination and what questions and activities can help ensure we meet the client’s needs.
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Unlike our day-to-day relationships, we expect therapy to have a clear and definite ending.
That said, for the client, it can entail a sense of loss of attachment with the therapist and who they represent (Fragkiadaki & Strauss, 2012).
If termination is abrupt, it may leave both therapist and client with unanswered questions and feelings of “anxiety, sadness, and anger” (Fragkiadaki & Strauss, 2012).
And yet, when the therapeutic relationship and outcome are seen as positive by the client, termination can be a healthy, valuable, and successful process; so much so that practitioners often report pride and a new sense of faith in the therapeutic process (Fragkiadaki & Strauss, 2012).
Therapists should assess the client’s ongoing treatment needs before initiating termination. And where possible, the final phase of the relationship should occur when goals have been reached. Still, in reality, it sometimes happens when the time available for working has ended, insurance coverage has ceased, or the client no longer wishes to continue (Felton, 2019).
According to the American Psychological Association (2017), the psychotherapy relationship should end when the client is no longer receiving benefit from the treatment or has the potential for harm. Specific factors include (Barnett & Coffman, 2015):
The therapist and client should set boundaries and appropriate behavior early in the therapeutic process, and part of the planning should include provision for referral when termination is abrupt.
Concluding treatment should be a collaborative process between psychotherapist and client, when the latter is ready for treatment to end while leaving the “door open for a potential resumption of work” if required (Wachtel, 2002).
The Society for the Advancement of Psychotherapy suggests six strategies for the ethical termination of psychotherapy to avoid feelings of abandonment (Barnett, 2016).
The term ‘abandonment’ suggests therapy has ended before the client’s needs have been successfully addressed or the course of the treatment was inappropriate to meet them (Barnett, 2016).
Termination can be eased through early and ongoing planning, as summarized by the following six stages (modified from Barnett, 2016).
Clients need to know the intended duration of treatment from the start. If it is to be open ended based solely on the progress made during sessions, clients need to be aware that limitations may result from time available, client insurance, or other factors.
Only when the client has all the information can they make an informed choice and receive the maximum benefit from the treatment.
Ideally, when treatment ends, the therapeutic process will have met all treatment goals. But to do this, the therapist and client should agree on the intended outcome of therapy.
While changes in circumstances and insights experienced during treatment may transform goals, they should be set early to inform the “nature, focus, and scope of the treatment” and its intended duration (Barnett, 2016).
While not intentional, situations may occur that cause therapy to be ended by the therapist; for example:
While some interruptions can be anticipated, others are outside the control of the therapist. A professional will should be drawn up to identify who can access client records, perform an assessment, and arrange referral.
As with therapist-led interruptions, several factors could cause the client to end treatment, such as
The therapist should make a reasonable attempt to help address any ongoing treatment needs, even if only to connect the client with replacement treatment resources.
Goals set out at the beginning of the treatment will most likely not have been met if either the therapist or client withdraws early.
“Abandonment occurs when the psychotherapist does not meet a client’s ongoing treatment needs appropriately” (Barnett, 2016).
Yet, it is not abandonment if the client drops out or cannot meet their obligations, or if therapy ends through mutual agreement and appropriate notice.
Both parties must understand and accept what abandonment is and isn’t to avoid inappropriate behavior and get the best out of sessions.
In the ordinary course of events, termination should not be a surprise.
Instead, it should be planned and prepared for, working collaboratively toward the end of successful treatment.
Termination is a phase of treatment like any other. It should help the client prepare to build on what they have learned and move forward positively.
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Ending therapy is an integral part of the overall therapeutic process. If the termination process is begun early, with clear therapeutic goals, it can be a positive experience with a long-lasting impact (Barnett, 2016).
When clear treatment plans are drawn up early and goals and objectives are agreed upon from the outset, the finish line becomes clearer.
As therapy draws to a close, it is essential to assess the client’s readiness for termination through observation and discussion, watching out for (Bhatia & Gelso, 2017; Barnett & Coffman, 2015):
The client may now be better off with other forms of treatment, or based on the therapist’s knowledge and experience, therapy may no longer be required.
Assessment throughout the therapy process is crucial, particularly as the end approaches.
Ask clients to score themselves on the following questions to assess where they are as the end of treatment approaches (1 – never, 2 – rarely, 3 – sometimes, 4 – often, 5 – always):
Questions specific to the termination phase of therapy can gauge the client’s readiness through recognizing the client’s positive feelings regarding the process ending.
Ask the client the following questions:
| Some important changes have happened since our first meeting X weeks ago. |
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| What do you see as some of the key changes that have taken place? |
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| What have been some of the most significant impacts on your life as a result of the changes? |
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| What are your thoughts about no longer coming to therapy? |
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| What thoughts do you think you will have before the last time you come to see me? |
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| Do you have any concerns regarding ending therapy? |
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| For some, ending therapy can give a sense of loss. How do you feel you will handle it? |
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Activities and exercises can help clients and therapists get ready for termination in therapy and prepare for the last session.
The following activities can all be adapted and used for telehealth sessions.
When therapy comes to an end, it can be helpful for the therapist to write a letter to the client to remind them of the journey they have been on and the progress made.
Consider writing a letter or email to the client to encourage closure and as a reminder of their successes.
Consider the following points when writing the letter:
A client can also develop a healthy sense of closure from creating a letter for the therapist.
Children, in particular, may benefit from a structure/form. For example:
I remember when we:
It was fun when we:
This fun activity is beneficial for children but also valuable for adults.
For online/video sessions, the client chooses a number, and the therapist reads the associated card.
As a final session activity, it’s helpful to discuss the tools and skills the client will take with them following a successful series of therapy.
Ask the client to discuss each of the following, then add your thoughts regarding anything forgotten:
Afterward, it may be helpful to provide the client with a summary of what was said.
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With online, blended care, and virtual therapy becoming increasingly popular, it is important to ensure that termination remains collaborative.
Consider and discuss the following in the lead-up to therapy termination (Goode, Park, Parkin, Tompkins, & Swift, 2017):
