Termination in Therapy: The Art of Gently Letting Clients Go

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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When Is the Right Time to End Therapy?

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 does not have the skills or competencies to meet the client’s needs.
• A situation arises that could negatively affect the therapist’s judgment or objectivity, for example, when an inappropriate secondary relationship forms.
• If the client is behaving threateningly, and the therapist feels endangered.

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.

How to Smoothly End Therapy: Quick Guide

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).

1. Agree on how the therapy will end from the outset

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.

2. Agree on treatment goals and what success looks like

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).

3. Prepare for therapist-led interruptions to the treatment

While not intentional, situations may occur that cause therapy to be ended by the therapist; for example:

• The client is not benefitting from the treatment.
• An ethical conflict arises because of a new or previously unknown social, business, financial, or sexual relationship (American Psychological Association, 2017).
• For reasons of safety. For example, if the therapist has been threatened or feels endangered.
• Illness, retirement, family circumstances, retirement, or even death.

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.

4. Client-led interruptions to the treatment

As with therapist-led interruptions, several factors could cause the client to end treatment, such as

• Illness
• Financial changes (e.g., insurance coverage)
• Dissatisfaction with the psychotherapist or treatment direction
• Job loss or relocation

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.

5. Clarify what abandonment is and is not

“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.

6. Plan for termination

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.

15 Questions to Ask Your Clients

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):

• Reduced symptoms or issues concerning the problem presented
• Improvement in relationships
• More positive body language
• A better outlook regarding the future
• Improvements in functioning at work, school, or home

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.

Client wellbeing questions

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):

• Have you felt happy?
• Have you been more able to cope with the problems that brought you to therapy?
• Have you felt good about yourself?
• Has your home life been better?
• Have you been sleeping better?
• Have you been satisfied with your relationships?
• Have you been living more healthily (diet, exercise, etc.)?
• Have you been able to focus?
• Have you been able to attend and cope at work/school?

Client’s readiness to end therapy

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:

4 Activities & Exercises for Your Last Sessions

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.

End of therapy letters

From the therapist to the client

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:

• Thank the client for the opportunity to work together.
• Outline the focus of the therapy.
• Describe the problem the client presented at the outset.
• Remind the client how you approached or unpacked the problem.
• Discuss patterns of behavior, feelings, and thinking.
• Describe some changes made and coping strategies adopted by the client.
• Remind the client of the improvements you have seen in them.
• Discuss some of the changes the client has made to their life.
• Point out that you will miss the regular sessions but are available if needed.

From the client to the therapist

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:

Dear:

I remember when we:

It was fun when we:

I feel we:

I hope:

Thank you for:

Signed:

5-second rule

This fun activity is beneficial for children but also valuable for adults.

• The therapist creates a set of cards with one instruction on each, for example:
  • Name three negative feelings
  • Name three positive feelings
  • Name three new coping skills for anger/stress, etc.
  • Name three people you can talk to
• The client selects one instruction and has five seconds to respond (this can be performed in a group).

For online/video sessions, the client chooses a number, and the therapist reads the associated card.

What I will take with me

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:

• Coping strategies
• Positive affirmations
• Visualization techniques
• Stress relieving tools, for example, breathing and mindfulness
• Support in the form of people, contact numbers, online resources, etc.
• Skills learned, such as handling stress and managing anger
• Reasons to be positive and hopeful
• Goals met and progress made

Afterward, it may be helpful to provide the client with a summary of what was said.

4 Activities for your telehealth sessions

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):

1. Revisit the agreed-on goals and assess progress toward their completion. An online tool like Quenza can help review each goal’s status and target areas needing increased focus.
2. Return to and review the online contract.
3. Summarize the lessons learned and the progress the client has made.
4. Confirm the date of the final session and any resources required after termination.

Helpful Termination Worksheets and Assessments

Use the following worksheets to assist you with the termination process.

Termination checklists

A termination checklist can be helpful as both therapist and client begin to consider the end of the therapeutic relationship (modified from Norcross, Zimmerman, Greenberg, & Swift, 2017):

Termination worksheet

Children and adults can benefit from writing what they would like to achieve in their last sessions.

Ask the individual or group to answer the following, verbally or in writing:

These forms can be completed over email or using an online tool.

3 Closing Rituals for Group Therapy

While the above questions and activities are equally appropriate for group therapy sessions, there are a few additional questions and approaches that can also be helpful (Terry, 2011):

Group termination questions

Ask each person to answer the following questions either in private or within the group:

• What has it been like being part of the group?
• What has been the most/least helpful aspect?
• What did you learn about yourself or how others see you?
• What were the most significant moments?
• Is there anything you regret not saying or sharing?
• How are people feeling regarding the group coming to an end?
• How are you feeling regarding the group coming to an end?

Discuss group fears

Ask each person to discuss the following prompts either in private or within the group:

• My fear is that …
• My hope is that …
• What I’d like to take away from these sessions most is …

Gift exercise

Write down something that each person in the group has given you.

Perhaps they made you laugh, gave you hope, or understood your perspective.

Below each description, describe a humorous (imaginary) gift you could give each person, such as a superpower, magic mirror to see themselves as they truly are, or a talking animal.

Read the gifts out in one of the last sessions to each person who has volunteered to receive feedback.

PositivePsychology.com’s Relevant Resources

Throughout our blog, you’ll find many tools you can pass on to clients to help ensure they continue in a positive direction following the termination of the therapeutic relationship.

Here are just a few that can help:

• Simple Thought Diary Worksheet
  This simple thought diary template can help clients systematically link experiences and situations to thoughts and emotions, serving as a useful tool to review one’s commonly adopted mindset.
• Willingness, Goals, and Action Plan
  This planning template helps clients identify their most valued life goals, anticipate psychological obstacles, and implement a practical plan.
• Behavior Contract
  This worksheet helps clients engage the support of trustworthy friends or family via a contract to encourage adaptive behaviors and habits and avoid reinforcing negative ones.
• One Hour Stress Plan
  This worksheet provides a 60-minute action plan for dealing with intense demands, helping clients work systematically through a list of tasks that require their most urgent attention.
• Building New Habits
  This worksheet succinctly explains how habits are formed and includes a space for clients to craft a plan to develop a new positive habit.
• 17 Positive Psychology Exercises
  If you’re looking for more science-based ways to help others enhance their wellbeing, this signature collection contains 17 validated positive psychology tools for practitioners. Use them to help others flourish and thrive.

A Take-Home Message

Ending therapy well is crucial to the overall therapeutic process.

Termination should be recognized as a valuable part of the therapeutic process, likely to bring up emotions in both the therapist and the client (Fragkiadaki & Strauss, 2012).

If managed and planned from the outset, termination that considers ethical and clinical implications will be a positive phase of treatment.

Termination should not be a surprise unless unusual circumstances prevail.

A strong “working alliance during the treatment phase” predicts overall treatment outcome (Bhatia & Gelso, 2017). It is crucial to form a solid therapeutic relationship during therapy with regular and open communication.

Clear therapeutic goals and beginning termination early can have positive, long-lasting impacts, consolidating learnings and readying the client to “move forward positively when treatment ends” (Barnett, 2016).

Agree on the goals and how the therapy will end in earlier sessions. Regularly assess whether the client is progressing toward their desired outcomes and begin planning early for the end of treatment.

The questions and worksheets within this article highlight issues that should be considered before termination while reminding the client of their work and success in reaching their goals.

We hope you enjoyed reading this article. Don’t forget to download our three Positive Psychology Exercises for free.