Reasons for therapy termination

The termination phase also includes discussions about how to anticipate and resolve future problems and how to find additional resources to call on as future needs indicate. Termination Types There are many reasons why therapy ends. A client may terminate at any time for any reason. Ideally, termination occurs once the client and therapist agree that the treatment goals have been met or sufficient progress has been made and/or the client improves and no longer needs clinical services.  However, there are many valid reasons that are discussed below as to why the therapist-client relationship may end the treatment before it is completed. • Client fails to make adequate progress toward treatment goals or fails to comply with treatment recommendations. • Client fails to participate in therapy (e.

g. , non-compliance, no shows, or cancellations). • Lack of communication/contact from the client. Social workers are to avoid abandoning clients, and take careful steps to minimize adverse effects to termination (Code of Ethics of NASW, 2008, p. This can be done through increased clinical competency, and through the exploration of termination. Termination occurs in all types of clinical social work practice. As a social worker, termination has and continues to be a time with mixed emotions. On the positive side, with some patients, as we discuss and review the work we have done together, I am being made aware of some amazing changes that have taken place and this is truly gratifying. Females reported more anxiety and willingness to conform to clients’ needs.

Analytic techniques of neutrality and emotional restraint appeared to aspire to culturally dictated male norms during termination. The findings were consistent among therapists in training and those who were more experienced, indicating that training does not eliminate sex-role bias (Greene, 1980). An effort to further educate clinicians on the experience of termination could allow for a better use of this phase so it does not fall prey to gender role stereotypes. Awareness of the emergence of unconscious processes could allow therapists to make better use of them. Quintana and Holahan (1992) and Marx and Gelso (1987) provide evidence that counters the perception that termination is always a difficult experience. A closer look at termination as a part of the therapeutic experience, and as a phase that is impacted by the therapeutic alliance, may provide data leading to greater clinical expertise.

Boyer and Hoffman (1993) collected data from 117 counsellors who responded to mail-in questionnaires about work with a client they had seen for at least 25 sessions and included a termination phase. The study found that both counsellor loss history and perceived client reactions to loss were related to counsellor experience during the termination phase. Results showed that past counsellor losses were more indicative of anxiety and depression than current counsellor losses. The interview method may have created socially desirable responses to questions, and there is a limitation in gathering clients’ experiences from the practitioners (Fortune, 1987). Fortune, Pearlingi, and Rochelle (1992) conducted a similar study, using the same structured interview, and yielded similar results. Pride and accomplishment were the most common practitioner responses, with loss and sadness at the midpoint of the scale.

Results indicated that the reasons for termination, the outcome of treatment, and the difficultly in termination were important factors in the termination experiences (Fortune, et. al, 1992). One student described being transferred a case in which termination was never processed with the original therapist and client. This set up a therapeutic relationship characterized by splitting, and a supervisor/supervisee relationship that quickly became damaged. Both client and MSW student experienced parallel negative transference toward the supervisor. The student described a resurgence of symptoms for the client when the next termination occurred and reported being unaware of this as a consequence of termination, therefore feeling guilty. Another student expressed guilt of abandonment while terminating with a client with serious mental illness and getting superficial supervision.

This project is a first step towards better conceptualizing termination by looking at clinicians’ experiences of termination as related to their attachment orientation. Outcome Analysis From the set objectives in the service plan, it can be deduced that termination can either be a rich or a missed opportunity as illustrated below. Termination as a “rich opportunity” “Rich opportunity” is an in-vivo code that emerged as a theme. The participant who coined the term referred to termination as an opportunity for innate, human communication and full emotional expression. With this, many other participants named specific opportunities that termination provides. ” This quote describes the impact of missing the opportunity for a termination process, and that the missed opportunity impacts both client and clinician.

The inherent ambivalence associated with termination was shown in the data that described both the rich–and missed- opportunities that make up termination. Although some participants spoke a great deal about how they use termination, others spoke about what is missing when a termination process is foreclosed. Many participants mentioned drop-outs, sessions running out, or rushed terminations as frequent experiences. One said, “There is no process, clients just stop coming. ” Participants also noted that if they felt it was not time, or if they felt that more issues needed to be addressed, then their own experience of the termination was more difficult. Another component of the missed opportunity theme was missed opportunities regarding training, education and overall preparedness. One participant reported, “I feel I wasn’t adequately trained [to deal with termination].

” In all, these data suggest that clinicians have awareness of the termination process, and the opportunities that it presents are sometimes used and other times missed. Service plan LONG Term Goal Short-term Objectives Intervention Outcome • To achieve effective termination of services with the patients at the end of treatment process after meeting the set goals of the treatment. Proper documentation of the termination of the therapeutic relationship with the client will provide support for the social workers’ effort to meet the clients’ needs as treatment ends. References Walsh, J. Endings in clinical practice: Effective closure in diverse settings. Chicago, Ill: Lyceum Books. Cooper, M. B. ( 2003) NASW Social Work Dictionary 336, 433, 5th ed. American Nurses Association. Code of ethics for nurses with interpretive statements.