No matter the reason for termination, the end of therapy can be difficult. When a therapist and client have a long and trusting relationship, the end of therapy is a major milestone. But when a therapist is not a good fit for a client or there is an issue in the relationship—such as repeated no-shows or dissatisfaction with therapy—handling termination is even more important.
Clients can terminate therapy whenever they want, for any reason or for no reason at all. For therapists, knowing when to terminate therapy is an important skill that can protect both the client and the therapist. The following strategies can help you manage your therapy termination session no matter why therapy has ended.
Therapy Termination Activities: General Guidelines for Therapy Termination
Therapy termination can make both the therapist and client feel insecure. Therapists may wonder if they did enough to serve the client and may feel defensive if the client is unsatisfied. Clients may worry that termination is their fault or may fear leaving therapy means they will no longer have support.
These guidelines can aid the therapy termination discussion regardless of the reason for the termination:
- Remember that the purpose of therapy is to support the client, not the therapist. Therapists should not get defensive about the reason for termination, especially if the client is unhappy. Do not argue with the client or use the discussion to ease your own hurt feelings.
- Be clear, direct, and compassionate no matter why the client is leaving. Never blame the client, even if you must terminate therapy because the client is difficult or you are not a good fit.
- Be willing to answer questions about therapy termination, such as where a client can seek additional help if necessary.
- Do not abandon a client without warning. Your state licensing board may prohibit terminating therapy with no notice, without a final session, or without referring the client to another therapist. A clear understanding of your ethical duties and your state board’s rules can help you better serve your client and avoid disciplinary procedures.
- If at all possible, refer a client to a highly qualified therapist who specializes in their issues. This is particularly important if you terminate the relationship because of fit issues or because you are unqualified to treat the client.
Termination can offer opportunities for therapeutic intervention. Clients who struggle with grief, attachment, or loss may need help managing the termination. Termination may even be a bridge to resolving some of these issues.
When Should I Send a Therapist Termination Letter to the Client?
A termination letter memorializes the end of therapy as well as the reasons for termination. It can help clarify the nature of and reason for termination, especially if a client is emotional or angry during your termination meeting. And if a client repeatedly no-shows, a termination letter may be the only way to ethically terminate therapy. If a client later claims you abandoned them, the termination letter may offer some protection.
While a termination letter may feel needlessly formal, particularly in the case of a long-term client whom you like and trust, it’s wise to err on the side of caution. Some therapists send a brief termination letter to every client who leaves. If you don’t want to use a termination letter with every client, send one in the following scenarios:
- When terminating with a client who has no-showed and with whom you cannot meet in person.
- When terminating because you believe they are a danger to you or someone else, and you are therefore unwilling to meet with them in person.
- When terminating with a client who has a history of threatening to file licensing board complaints.
- When terminating with a client who has difficulty processing rejection.
- When terminating with a client because of a poor fit.
Terminating Therapy Due to Client Progress
Therapy should ideally have clear and specific goals. When a client achieves their goals, it may be appropriate to transition them to a new therapist or to terminate therapy altogether. For example, a therapist counseling a new parent with postpartum depression might mutually agree with the client to terminate therapy when depression symptoms go into remission. The client might stop therapy altogether or transition to a therapist with expertise in other issues.
When a therapist and client agree that it’s time to move on, both may have mixed feelings. The client has formed a trusting and close relationship with the therapist and may have even come to see the therapist as a friend. So it’s important to be warm and supportive, but also to set clear boundaries. The client should know they can come back if they need help again, but that the therapist is not a friend with whom the relationship can continue outside of therapy.
These strategies can help ease the transition:
- Reflect on the client’s growth and on how they plan to continue that growth.
- Discuss the therapeutic process—both what went well in therapy and what could have been better.
- Discuss any feelings of grief or anxiety about ending the treatment relationship.
- Talk about personal growth as an ongoing process and give the client guidelines for when it might be appropriate to return to therapy.
Laurie Leinwand, MA, a licensed professional counselor in Florham Park, New Jersey, shares how she helps foster a sense of closure at the end of therapy. "Together, we review all the tools the client now has at their disposal and how they feel equipped to handle what comes their way, " she explains. "We explore how they are already employing those strategies, so they are fully aware of how far they’ve come and feel empowered to move forward independently."
Leaving the door open can also be a powerful way to help clients feel secure in their decision. "I do, however, let them know that if down the road they need a 'tune-up' or are faced with new, unusual challenges, that my door is always open," continues Laurie. "Knowing that can ease the discomfort clients may feel in ending their treatment."
Terminating Therapy with an Unhappy Client
When a client is unhappy with the therapist’s services, objects to the therapist’s philosophy, or accuses the therapist of wrongdoing, the client may terminate the relationship. If the client does not, the therapist must assess whether the relationship can continue.
Displeasure with the therapist’s services can be a springboard for discussion and growth and does not necessarily warrant termination. When there are serious disagreements between the therapist and client, or the client accuses the therapist of unethical behavior, the relationship usually must end.
The following strategies may help:
- Avoid defensiveness. The client is the customer, and the goal of therapy is to help and support them—not defend yourself or protect your ego.
- Listen to the client’s feedback, since it may help you be a better therapist.
- Explain why therapy must end without accusations or blame.
- If the client accuses you of wrongdoing, take careful notes about the incident and consider memorializing the termination in a letter.
Termination of Therapy When the Therapist Is Not a Good Fit
Sometimes a therapist is just not a good fit for a client. An evangelical Christian pastoral counselor may not be able to help a committed atheist, for example. In other cases, a therapist may become a less good fit as a client’s needs change. A client who originally sought help from an eating disorders specialist may need a different therapist when the eating disorder is in remission, and their new challenges involve work or parenting. To terminate the relationship:
- Explain to the client that your job is to ensure they get excellent care and that you do not feel you can meet their needs.
- Give the client space to process their feelings. Some clients will feel rejected, particularly if they felt therapy was going well.
- Offer a referral to a therapist who might be a better fit.
Therapy Termination When a Client Repeatedly No-Shows or Poses Other Practical Concerns
Therapists must deal with both practical and mental health concerns. When a client repeatedly no-shows, a therapist loses time they could spend with other clients. A therapist may also need to terminate therapy with a client who makes unreasonable demands, whose insurance will not pay for therapy, or who otherwise presents practical or logistical concerns.
If the client will not come to therapy sessions, send them a termination notice using their preferred method of communication—such as email or U.S. mail—and ideally, via several communication channels. If there is another practical issue, present it to the client in objective, non-stigmatizing terms and consider referring them to another therapist.
Terminating Therapy with a Child
Termination can be difficult for children, especially when the child does not have many stable adults in their life or when the child has experienced numerous losses. It is important to discuss termination at the beginning of therapy and to prepare the child as far in advance as possible.
Explain to the child, in age-appropriate terms, why therapy must end. For example, you might emphasize that the child has made so much progress, they no longer need you. Highlight that you care about the child, and that if they need help again, you will be there for them (but only if this is true; it might not be if there is conflict with the parents or another reason for termination). Some other strategies include:
- Talk about termination in the last session. Encourage the child to share their feelings.
- Plan a termination activity to memorialize therapy and the progress the child has made.
- Talk to the child about strategies for managing painful emotions when they are no longer in therapy. Help the child develop a list of supportive people, especially adults, whom they can contact when they need help.
- Discuss termination with the parents. Identify strategies for helping the child adjust, and develop criteria for returning to therapy.
References:
- Hardy, J. A., & Woodhouse, S. S. (2018). How we say goodbye: Research on psychotherapy termination. Retrieved from https://societyforpsychotherapy.org/say-goodbye-research-psychotherapy-termination
- Many, M. M. (2009). Termination as a therapeutic intervention when treating children who have experienced multiple losses. Infant Mental Health Journal, 30(1), 23-39. doi: 10.1002/imhj.20201
- Gutheil, T. G. (2012, June 30). Breaking up is hard to do: Terminating therapy before things get out of hand. Psychiatric Times, 29(6). Retrieved from https://www.psychiatrictimes.com/risk-assessment/breaking-hard-do-terminating-therapy-things-get-out-hand
- The termination checklist [PDF]. (n.d.). International Center for Clinical Excellence. Retrieved from https://www.scottdmiller.com/wp-content/uploads/2017/11/Termination-Checklist.pdf
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