How does counseling end?
How does a counselor decide when to end counseling sessions or to terminate working with a client?
There are typically three reasons why therapy is terminated:
1) Client has met therapy goals
2) Client is not progressing
3) Therapist is not a good fit for client
In order to properly assess whether therapy is helping and what progress is being made, the therapist needs to have ways of consistently checking in with clients sessions-by-session to determine what is helping, what isn't, and where the client is at in relation to their original therapy goals. When a client has met their goals, that is a good time to end counselling sessions unless the client has new goals or simply wants to check-in periodically to make sure that they are still on track (sometimes referred to as relapse prevention).
When a client is not progressing, and feedback has been taken and attempts have been made to make the therapy more helpful for the client but to no avail, than it is considered unethical to continue to work with the client. In these circumstances, referring out to another therapist who may be a better fit is a good idea.
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Hello. The end of the counselor/client relationship is one of mutual respect and engagement. Counseling sessions can end for any number of reasons. Among them are the client's inability to make forward progress in therapy; the clinician's inability to help the client (for a variety of reasons); a mutually agreed upon time frame for a number of sessions to be provided; or the financial challenges of the client who decides that they need to put their resources elsewhere. In this last case, a counselor should never cancel sessions with a client simply on the basis of the client's inability to pay. That is traditionally seen as an unethical practice. Other arrangements can be made to provide care to the client, which in itself should be paramount.
When the client and therapist decide that services are done, it is best if there is at least one or two more sessions to allow a case file review to occur, and to bring an appropriate psychological sense of closure to the client (and vicariously to the clinician as well, those this is perhaps not as important). This transition gives both a sense of having reached the end of a journey...rather than some abrupt departure from it. (An abrupt ending in therapy can have a varying level of impact both emotionally and psychologically on the client and therapist). Sometimes the closure of therapy is the result of a program of therapy being formally completed, in which there is a mutually known (albeit perhaps approximate) date of when that program will be finished. In this case, the client is likely feeling that impending closure and has time to prepare mentally and emotionally from a place of being the client in therapy, to a place of healing, growth and situational resolution.
I have always worked in therapy with the following slogan (if you will), that I learned years ago during graduate school: "Not every therapist is good for every client, and not every client is good for every therapist." It is perhaps one of the most important guiding views I hold in working with clients. The therapeutic relationship is driven by mutuality - the desire of the client to get better at living life, and the therapist's desire to truly see the client heal and grow. When there is a block in this process from either side that prevents that synergy from occurring, the relationship that should be established may not be able to form. Or, if already formed, may at some point be unable to move forward. In these instances, referring the client to another type of service or clinician is appropriate. Usually, this can be seen pretty quickly by either party, though sometimes it is not always clear.
Ultimately, the client and counselor need to work together to discover if the needs of the client (which is paramount) are being met in the therapeutic engagement with their current counselor, or if other arrangements need to be made to go elsewhere. If both are observant in this process, they can work together to maintain that sacred space and continue to reach the goals that have been set. Eventually, therapy will end, but hopefully based on the client's successful journey to the place where they wanted to go, and thus opening the next chapters of their life to a space that is more whole and brighter.
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Hopefully both the client and counselor would together decide when to terminate counseling sessions. It's really helpful for the client to leave counseling with a solid sense of what he or she has accomplished in counseling, so it can be a good idea to spend some time acknowledging that in the last session or sessions. Sometimes, however, a client has needs beyond the scope of the counselor's expertise. That's a good time for a conversation about those needs and ideas of how best to meet them, whether by adding in care with an additional mental health professional or transferring care entirely to a new mental health provider.
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There are different reasons why a counselor may seek to terminate with a client and these will each have different processes by which the counselor will come to that decision. Here are a few examples.
The counselor may determine that the client's needs are outside what the counselor is competent to be able to work with. A person may have come to the counselor talking about a particular issue but either when they first met or as counseling progressed, it may become clear that the issue is in fact something different or that there is an additional related issue. If that issue is outside the competence of the counselor, the counselor should look for alternatives, the most common of which would be to terminate and refer. Beyond clinical issues, this could also come up around particular other related facts, such as the culture of the client or linguistic issues. This could also be the choice of the counselor if they know someone that they feel would be a better match for the client's issues.
Another reason for discharge (and possible referral) would be if the relationship does not seem to be a good fit. No counselor is the right person to work with everyone. If the right level of connection is not happening, the counselor will often look first at what they are doing, might talk about it with the client and ultimately will admit that things don't seem to be working to allow the desired therapeutic process to work. A similar process would be followed if the counselor determined that the client might not yet be ready for counseling as evidenced by lack of engagement such as frequent cancellations, not doing any agreed on work between sessions, showing up late or being really guarded in session.
The easiest situation to decide on is when a person has met their counseling goals and have nothing new that they are working on. While this is the easiest one to determine, it is also probably the hardest one for the counselor as they may be like the client in not wanting the relationship to come to an end. However, counselors know that this is part of the process. They will also determine this by regularly reviewing the treatment plan or by sending in the sessions that the work has come to an end. This type of termination maybe final or may be with the intent that the client will return later to address other things that have been identified but for which they are not ready to move into.
All of these (and other) situations involves the counselor being open to the relationship ending, to monitoring how things are going, then engaging in self reflection, possibly talking with the client and then coming to a conclusion on which the counselor follows through.
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From the very beginning of counseling sessions I emphasize that the work will and must end at some point.
In counseling there is an arc to the process. A beginning, middle and end.
I am always digging, searching and exploring.
There comes a point where things come to there natural ending.
I always leave an opening for continuing counseling in the future. At least as a check in.
- 796 views
Counselors should consider ending counseling sessions or terminating therapy under several different circumstances. Here are a few of the most common:
If the client has developed the coping skills for which they came to therapy, counselors should encourage clients to decrease sessions to less often to begin practicing maintaining progress on their own. Clients are often nervous about decreasing sessions when they are doing well for fear of relapsing. This is a crucial step in helping clients to build confidence in their coping skills and decrease the feeling that they must forever continue therapy in order to be well. Most clients experience some difficulties and slip ups during this step down process, but these are important to identify and address while still in therapy where clients can get help coming up with a plan. This is also the point at which counselors should be helping clients come up with a relapse prevention plan so they can safely terminate therapy and maintain the progress on their own.
If the counselor determines the client's needs are outside of their scope of practice, they should refer them out. For example, if the counselor determines that the client has an eating disorder and the counselor is not knowledgable or trained in the treatment of eating disorders, they should refer them to another provider who specializes in this issue.
If the client is in need of a higher level of care, counselors should refer them to the lowest level that is likely to be effective for the client. Most of what we think of as "therapy" is often on session every week or two with a therapist at a local practice. For some clients, however, the therapist may find they are unable to manage their symptoms and emotions between sessions and need to be seen more frequently. For outpatient therapy, clients with more severe symptoms are typically seen twice a week. For clients who need more than that, counselors should refer them to other programs for more intensive treatment such as intensive outpatient (groups and individual therapy several times per week), partial hospitalization (groups and individual therapy several hours per day plus medication), or inpatient (residential treatment with groups, individual therapy, and medication for 30 days).
If the client is in need of substance abuse treatment before therapy can be effective with other concerns, the counselor should refer clients for a substance abuse evaluation. People commonly use substances to cope with unwanted emotional pain and mental health symptoms. Over time, this pattern often develops into substance abuse. Research has shown therapy to be ineffective in treating mental health conditions without FIRST addressing any substance abuse. For example, someone with a history of trauma who is drinking to cope with unwanted memories would need to be able to maintain sobriety for a period of time before therapy for trauma can have any significant impact.
My goal as a therapist is always to start people off with the lowest frequency of sessions possible for them to actually make progress (typically once a week or once every other week). Then we work to teach them the skills they came in for and encourage them to practice outside of sessions. Next, once they've gotten the hang of the skills and are feeling better, we start encouraging them to space out sessions and "take the training wheels off". Finally, we come up with a relapse prevention plan to make sure they can keep it going on their own and identify any impending relapses long before they get bad so they can course correct on their own.
For more information about the process of CBT therapy, visit: "From Start to Finish: What does cognitive behavioral therapy look like?"
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For most: When the money/insurance runs out.
When best: When the job is done... and you're feeling much better.
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To be able to identify a clear ending to a counseling relationship, we must have a clear understanding of the goals and limitations of treatment. Usually, during the initial evaluation, I identify my client’s short term and long term therapy goals. As therapy progress, we verify goals on a monthly to a quarterly basis, depending on the frequency of the appointments. Once the therapy goals have been met, there is a closing session, the counseling relationship is ended, and the client can stop attending sessions. In some cases, the client can also establish new goals and determine if I am a good fit for their therapy needs or if they need a new provider, in which case I provide multiple referrals.
The counseling relationship could also end due to other factors like noncompliance= when a client is not committed to the agreed treatment process, or when the client’s or a counselor violates the counseling relationship. Either the counselor or the client is able to end counseling. Although, as mental health providers we need to provide a reason for terminating our therapeutic relationship and referral options, as a client no explanation is needed, a closing session is highly recommended.
¿Cómo un consejero decide cuando terminar las sesiones de consejería o terminar de trabajar con un paciente?
Para poder determinar el final de la relación del consejero, debemos comprender las metas y parámetros de la terapia. Usualmente durante la evaluación inicial se identifican metas a corto y largo plazo con el cliente, y se discute con el cliente como esas metas serán alcanzadas. Durante el proceso de terapia el consejero revisa las metas mensual o trimestralmente dependiendo de la frecuencia de las citas. Ya que las metas de terapia son alcanzadas, hay una sesión de cierre y el cliente puede terminar la terapia. En algunos casos el cliente puede identificar nuevas metas para la terapia y determinar si el mismo consejero u otro consejero le pueden asistir.
La relación de consejería también puede terminar por no conformar o violentar los parámetros establecidos para la terapia. Tanto el consejero como el cliente pueden terminar la relación de terapia. Como proveedores de salud mental los consejeros estamos obligados a proveer un razón para la conclusión del tratamiento y proveer referidos según aplique, los clientes no necesitan proveer una explicación, aunque es recomendable discutirlo en una sesión de cierre.
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It is usually time to end counseling sessions when it is clear to both the client and the counselor that therapeutic goals have been reached and enough improvement has been made that the client can continue without that support. There are exceptions to this rule, but for the most part this is when counselors begin termination. For some clients, this is an easy process that marks the achievements they have made in working through their emotions and difficulties. For some other clients, however, this is a difficult process in which they are losing a valuable support and are understandably anxious about what life will be like without the frequent meetings. Ultimately, termination is different for everyone, and there are many ways that termination can be healthy and helpful.
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As a therapist who believes in client self-determination above most other elements of the process, I want to as much as possible leave it up to the client to determine when they are finished. In the case of a termination because a client's distress has resolved, I might periodically check in with the client about how therapy has been going, and if we want to re-evaluate where we are.
The more unfortunate situation would come about if I felt that I wasn't the best fit for the client. I would offer that in words, and ideas of therapists (with names) of who I thought might be a better fit and why. It still is up to the client whether to continue, however should they want to keep seeing me, a part of the work would be about that want (to see someone who professionally doesn't believe they can help as much as someone else.)
I also find it perplexing when I hear a client (or on a personal level) tell me that their therapist said they "didn't need therapy." I don't know that I buy into that scenario all that much, because I do believe that yes, not everyone NEEDS therapy, but that everyone CAN benefit from therapy and I don't believe it is the therapist's job to deter someone from ever seeking out help of any kind.
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Ideally, termination should be a mutual process. It's not that the therapist kicks the client out at some point and says, "Okay, you're done." Rather, over time the client will decrease the frequency with which he/she comes to session so that it may start off as weekly, then decrease to biweekly, then perhaps once every three weeks, then once/month and so on. Throughout this process, the therapist and client should have had regular check ins about progress toward goals. If the client feels good about where he/she is in life, he/she might decide to suspend therapy for now. That being said, the therapist should make it very clear that if the client ever decided to return for "maintenance" therapy or a check in, he/she would always be welcome.
There is no hard and fast rule to ending or a particular time period in which it must end. What matters most is that the client feels good about it and knows that the therapist will always be there should he/she wish to return.
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- Does the client need different or more specialized care than the current counselor can provide? This requires the counselor to determine whether referring the client to another therapist or health care provider is needed.
- And, has the therapeutic relationship reached treatment goal(s)?
While this question is specific to the counselor, I'd like to also add that a client, at any time, can end counseling.
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In general, I usually let the client decide when this should occur, sometimes with some clients it will be a joint agreement, but even in that case it should weigh mostly on what the client feels. In short, therapy ends when you feel your done.
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I will work with clients and continually review progress with them and determine if counseling is helping. If a client appears to have less to talk about in sessions, appears more stable for a period of time and has reached therapeutic goals I will talk about termination. Some clients however I may continue with on a monthly or bi monthly process to allow for check-ins to see how they are doing and if they need more help at that time.
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There are several reasons for a counselor to decide to end counseling. A major reason to end counseling is if the counselor feels that he or she does not have the skills or experience to work with the client. This may happen during the intake process or after working with the client for some time. If the clinician feels that the client is not benefitting from the therapy, it is ethical to suggest that the client terminate the therapy. The process of termination must not injure the client and, if necessary, the clinician may need to refer the client to other treatment modalities. Another reason to terminate working with a client is if the client needs a higher level of care. If the client has a crisis or is at risk of hurting himself or someone else, he or she may need a higher level of care. In this circumstance, the clinician may need to involve outside services such as a crisis unit. A third reason to terminate with a client is if the clinician feels that he or she cannot remain professional with the client relationship. For example, if the issues that the client is working on bring up something significant for the clinician and the clinician feels that he is unable to separate that from the professional relationship. In this instance, the clinician should refer the client to another therapist. Finally, if the client has reached her goals for therapy and no longer needs treatment, the clinician and client should terminate treatment.
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Counseling ends when the client has received the maximum benefit from the therapist. Even if the therapist believes the client is not making progress, the client may feel they are improving and receiving a benefit. And the therapist may see a benefit and the client does not. It is best to have ongoing dialogue with the client to determine when termination is appropriate.
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Goodbyes can be hard. Chances are most of the goodbyes you have experienced in your life have been difficult. Saying goodbye to a therapist can be different. It can be an opportunity to create a healthy ending in a positive relationship in your life. If you work with a therapist who is skilled, then saying goodbye can be just as transformative as the therapy itself.
Ending therapy is also known as “termination.” I know, “termination” doesn’t have a great ring to it! However, it is what it is. It is an ending of the relationship as it existed. It is reality cold and stark. Of course, when I talk to clients I don’t use the word “termination,” I usually say “our goodbye.” Under what circumstances does therapy usually end? Therapy should end when a client does not need further assistance, is not receiving any benefit from therapy, or might be harmed by continuing to work with a particular therapist.
In the best case scenario the decision to move on from therapy and “say our goodbyes” happens when both the therapist and the client feel like the client is ready to move on and move up! Ending the therapeutic relationship should actually be worked on from the very first session. What I mean by that is, there should be an understanding that the work we do together will have an ending and that is a good thing because it means the client has gained the skills to continue working on themselves independently. So the first session I have with clients usually outlines a plan where the end goal is discussed and we both have an understanding of the skills the client wants to learn or what they hope to achieve.
Now sometimes there are situations where the therapist ends the relationship and the client may take that personally, it is hard when any relationship ends and it might bring up feelings of sadness, and fear or abandonment. Any good therapist will end the relationship based on what is right for the client.
What are some situations where a therapist might end the relationship?
If the situation the client is dealing with is out of the therapist's scope of practice, the therapist may end the relationship and refer the client to someone else. This is in the client’s best interest. Another reason a therapist might end the relationship is that the therapist is in a place in her life which prevents her from being objective and helpful. A therapist who is going through a painful divorce may have difficulty working with a couple that considering divorce. A good therapist may see that their judgement may be clouded and want to refer the client to see someone else. This is good practice and helps the client.
If a client is actively suicidal or actively using substances then the therapist may end the relationship and refer out for a higher level of care. The client may need to be hospitalized or may need an inpatient substance abuse treatment program. Therapy may be terminated while they are being treated and may continue after the intensive program is completed.
Ending therapy should be a time for connection and bringing together accomplishments, or reviewing the next important step the client needs to take. It should not be an experience of abandonment. A skilled therapist will help a client gain a new perspective on closure. For some clients, it may be the one time in their lives when they get a clean ending in a healthy relationship and they get to feel a sense of control on creating that ending.
Good luck to you!
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In the best case scenario, it's a mutual discussion and decision. If not, I've had the discussion initiated both ways, by me, when I sense the client has gone has far as they want, by lack of interest in accepting or completing homework assignments, missing or cancelling appointments, usually at the last minute, lack of participation during sessions. Client initiates by asking me pointed questions about why the need for homework assignments,, by forgetting their calendar, or their checkbook :) , by suggesting that we make appointments over longer intervals (once a week to once a month, for example). I rarely have had to terminate a working relationship--that's why I don't charge for the first visit, so we know if we are a good fit before we start working together. Then I periodically ask whether the client feels we are making progress, moving in the right direction, talking about the most relevant issues etc.
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In my therapy practice the decision to end therapy is mutually made together with the patient.
Otherwise, the person can end up with a sense of tremendous rejection and abandonment.
The way you'll both know therapy is coming to a close is that the discussion will feel lighter and move easily.
The person's mood will be better, they will smile more, sit in their seat in a more relaxed way, look more at ease, take better care of their appearance.
One of the ways to end therapy is to gradually decrease the frequency of the sessions.
Sometimes people who are in my practice start to come each three weeks, then monthly, then every three months.
This gives a sense of security, friendliness, and casualness to the therapy, and de-medicalizes it as though the person was treated for a medical symptom and the symptom stops completely one day.
Talk therapy is about life and life problems usually end gradually.
I end my therapy in a way which mirrors the life process in which many interaction and situation problems show their effects gradually and show different effects over time.
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There are a number of reasons why a therapeutic relationship might end including, but not limited to the client reaching their goals, the client reaching a place of acceptance where they wish to remain or even a breach within the relationship. The last aspect should likely be taken to supervision in order to be fully processed. All of these things could happen, and usually happen organically (again, except for the last example).
Your question, however, was about the counselor ending treatment. This is a bit more difficult and can be very nerve-wracking. It may be beneficial to take this with you to supervision, as well. It's important to understand why you feel the need to end or terminate with the client, as well. Do you feel that they would be better suited for another therapist, have they achieved their goals or is it something else?
In regular, open-ended sessions, I try to make a point of checking in with the clients fairly frequently. In these check-ins, I use the time to ask the client how they feel about the sessions and if there is anything they wish to focus on more astutely. I also ask if they have any immediate goals that they would like to prioritize. In goal-oriented sessions, I check in more frequently to ensure that both the client and I remain focused and, should they wish to shift their focus, that they recognize it is part of my responsibilities to make sure we move back to the desired goal.
Often, especially in longer term therapeutic relationships, we as clinicians can see that the client has reached their goal, however they are apprehensive about ending therapy. This is actually a great place to go with them; why would they feel unable to handle issues in their external or internal environment without you? Often, having this open discussion can increase empowerment and mastery. That said, it could also highlight other issues which the client may have been apprehensive about going into within therapy and now, as the relationship seems to be ending, feels more confident in bringing these up.
In the case where the relationship is a toxic one, terminating with a client may be the best option for both of you. It's a difficult conversation, but recall that part of the role of the therapist is to model that these discomforts can be managed.
I hope that this brief response can assist you going forward!
- 104 views
This is a question that is very specific to each person. There are definitely some variables, but I can give you some general ideas for when counseling might end:
- When a client has met all of their goals, at least to a degree when they feel that they no longer need to work on them with the assistance of a counselor
- Sometimes a decision is made that a client is no longer benefiting from counseling at a certain time
- Sometimes clients have to remain in counseling in order to receive medication. This depends on agency policy, but sometimes it is a requirement. If the medication is necessary and cannot be prescribed by a primary care physician, frequency of sessions is usually decreased greatly
I'm not sure why you are asking this question, but it is also something that is often discussed at the beginning of treatment. Oftentimes "discharge goals" change as treatment progresses because more is known about clients, their goals, changes in their goals, and many other things. Changes are normal, but your counselor probably has discharge goals in mind, at least generally, from the beginning. I strongly encourage you to ask about it!
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