Ending a therapeutic relationship can be difficult for both the therapist and client, whether you’re an in-person therapist or an online therapist. When a longstanding relationship has been built up, the two have mutual trust and respect for each other. On the other hand, some therapist-client relationships must end because of practical reasons, such as a client who never shows up.
The end of therapy can be a positive experience with a long-lasting impact on both the client and therapist. When successful, termination is an opportunity for closure. Together, the client and therapist take a step back and look at the personal growth that has slowly unfolded over the course of treatment—growth that may have gone unnoticed, had attention not been called to it.
In reality, termination starts long before the end of therapy. In the very first sessions, the therapist will begin to lay the groundwork for termination by setting clear goals for therapy and describing therapy as a time-limited process.
As the therapeutic relationship comes closer to an end, termination will be discussed more frequently. The therapist will highlight the growth made by the client, and help them create a plan to handle future problems. Here are some creative termination activities for therapy sessions, no matter how or why therapy is ending.
Once clients achieve the treatment goals they’ve set out to accomplish in counseling, it might be time to transition them out of therapy, or onto a new therapist. This is especially true for clients dealing with time-set or specific problems, like postpartum depression, or someone who has entered therapy for a specific reason, such as undergoing cognitive behavioral therapy. Often in these cases, therapists and clients agree it’s time to move on. That said, like any change, it’s still tough. Therapists should be supportive while setting clear boundaries – they’re not friends to seek advice from later, but paid professionals.
Therapy termination can come with a huge swell of emotions, from relief to feeling sadness to uncertainty and anxiety. Can the client deal with their issues without continuous care? What about the work they’ve done so far – is it enough for them to feel secure and able to cope? It can bring up all kinds of feelings for the client, especially if they’ve struggled with grief, rejection, or attachment issues. In these cases, therapists will want to be extra gentle in helping them navigate the termination.
As mentioned earlier, therapy termination is also hard for the therapist. They might feel insecure or as if they’ve done a bad job. Therapists want their clients to leave satisfied and having made progress, and some therapists might be afraid it’s their fault a client is ending sessions. However, counseling is there to support the client, not the therapists. Being defensive about reasons for termination is unhelpful.
When discussing the termination phase, therapists should be direct and compassionate. Don’t blame the client, even if the termination process is for less than pleasant reasons. Answer any questions about ending therapy, like where a client can go to seek additional help, or what they can do if another major life event happens that might require seeking therapy.
To ease the transition out of therapy, the therapist and client can reflect on growth, discuss strategies they’ve learned, talk about feelings of grief or anxiety about ending treatment, and offer guidelines for if and when it might be appropriate to return to a counseling session. Providing a sense of closure, as well as a review of strategies learned, boosts a client’s empowerment to leave therapy confident they’ve learned tools to help them outside of sessions. And again, if a therapist feels inclined, they can leave the door open so clients know they can always return.
Though a termination letter may seem too formal, particularly for therapists and long-term clients, it’s best to be cautious. Some therapists send a short letter to every client who leaves, while others only reserve them for certain situations. Termination letters signify the end of therapy, the reasons for ending it, and helps clarify why therapy is ending. To ethically terminate therapy with a client who doesn’t show up, a letter is needed, so that if the client later says you abandoned them, you can protect yourself with proof of their absence. No matter what, do not leave a client without warning them first. Not only is it likely prohibited by your state’s licensing board, but it’s unethical to do so. Avoid disciplinary procedures altogether by dealing with the termination in a mature manner. Have a final session, and refer your client to another therapist.
While adult clients know they can reflect on their experiences in therapy – or simply come back when needed – children and teens don’t necessarily have that ability yet, which can make the termination process harder. These clients may have also experienced numerous losses, and may not be able to understand why their therapeutic relationship with you needs to end.
Discuss termination at the beginning of therapy to prepare younger clients as far in advance as possible for the day when therapy needs to end. Explain to them, with the right appropriateness for their age, why therapy needs to end. You can encourage them by emphasizing how much progress they’ve made, so they no longer need you. Tell them how much you care about it, and that if they need help again, you can be there for them. Note: do not say this if you cannot follow up on it. If you’re moving to a new location and can no longer service them, it could do more damage than good. The same goes for if there is an issue with the parents
It also helps to plan termination activities that commemorate their time in therapy and showcase how much progress they’ve made. Therapists should let the client talk and process feelings, and talk to them about ways they can manage these emotions outside of therapy. Make a list of supportive adults they can turn to when they need help.
Sometimes, a client is simply unhappy with a therapist. They may object to how they run their practice, the worldviews of the therapist, or feel something is off. It’s a good opportunity to discuss what’s going on, and may not always lead directly to termination. To make it a productive conversation, avoid being defensive. It’s about the client, not your ego. Listen to what they say, and explain why therapy might need to end without accusing them or blaming them.
If you feel unqualified to help with a particular client’s issues, refer them to a specialist who can help. One therapist’s expertise isn’t going to always match up with a client's needs, and that’s fine. Alternatively, a client’s mental health issues may change. What started as therapy for general depression becomes something much deeper in need of extra help when it’s revealed they never recovered from an eating disorder. The goal is to find the client someone who is a good fit who can offer the best mental health care.
It’s also true that some clients and therapists are not a great fit. A staunch progressive may not take kindly to the conservative political views of their client, and vice versa. The same applies to religious reasons – pastoral counselors probably won’t vibe with atheists. Explain to the client that you don’t feel you can meet their needs. In other words, “it’s not them, it’s you.” Allow space for processing feelings, and again, always offer a referral.
The end of therapy can be seen as a huge milestone for the client, and should be celebrated as such. But knowing when to end therapy, and how to exit out of therapy, is important to protect and honor both the therapist and the patient.
If you’re a mental health professional looking for advice on how to run your practice, whether it be looking for therapist tools or wanting to know good strategies for private practice marketing, contact us today and Advekit can help support you so that you can know that you are running the best practice possible.
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