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 therapeutic goals 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.
In this guide, we outline a successful termination in two parts. “Laying the Groundwork for Termination” describes the role that termination plays throughout therapy. “The Termination Process” discusses the final sessions of therapy, when termination comes to the forefront of the conversation.
Laying the Groundwork for Termination
Prepare clients for termination from the start.
Begin laying the groundwork for successful termination from the very first session by describing therapy as a time-limited process. This means that therapy will not go on forever. The client’s goal is to develop the tools or make changes that allow them to lead a healthy life without therapy. This sets the expectation from the start that termination is a positive goal.
It is also helpful to set a rough timeline for treatment. Doing so reinforces the idea that treatment is time-limited. Of course, it’s impossible to know exactly how long a client will be in therapy, but it’s helpful for clients to have an idea of what to expect. Estimates can be based on therapeutic experience or suggestions from manualized treatments.
Set therapeutic goals to mark a “finish line” for therapy.
Treatment plans help guide therapy by outlining the client’s goals and objectives. Without such goals, therapy can become aimless as new problems arise each week, causing therapy to continue indefinitely. Goals create a clear “finish line” for therapy and give each session direction.
Collaborate with the client to establish specific, achievable, and measurable treatment goals. Create a copy of the treatment plan for your records and for the client to keep. Refer to the plan regularly to make sure therapy is on track and to reemphasize the structured nature of therapy. Remember that goals are not set in stone--they should be revised as needed to ensure they’re still relevant and attainable.
Tip: When a client has a new “fire” to put out each week, it can be difficult getting to treatment goals. If this becomes a distraction, make an agreement with the client to talk about that week’s problem for the first 10-15 minutes of each session. Afterwards, move on to the broader treatment goals.The Termination Process
As the client’s time in therapy draws to a close, termination becomes the focus of sessions. Termination is a time to review the client’s achievements and reinforce plans for maintaining good mental health. The information below will help you facilitate a smooth and successful termination process.
Gauge readiness for termination.
Generally, therapy is completed when a client has achieved the goals outlined in their treatment plan. However, this decision is a matter of professional judgment. When therapeutic goals are nearing completion, discuss the client’s readiness to terminate and their feelings--whether positive, negative, or ambivalent--related to ending therapy.
- The client maintains a significant reduction in symptoms or issues related to their presenting problem.
- It is the clinician’s professional judgment that the client is no longer in need of mental health counseling.
- Remaining symptoms or problems are better treated by other means (e.g. medication management or a support group).
Signs that a client may be ready for termination:
Sometimes, clients feel content with the progress they have made, and express that they are ready to end therapy. They may ask how much longer they need to be in therapy or how many sessions they have left. Other times, clients will offer subtle cues to their being ready for termination. These might include prioritizing other things over therapy, cancelling sessions, or not completing homework. Discuss whether these behaviors mean the client is avoiding working in therapy, or whether they are ready for termination but hesitant to say so.
If the clinician agrees with the client’s readiness for termination, this is an opportunity to begin collaborating on closure. If the clinician has concerns about the client’s readiness, this is an opportunity to discuss those concerns.
Some clients may be reluctant to end therapy. They might enjoy the routine of coming to regular sessions, or worry they won’t be able to maintain their achievements on their own. Explore the client’s reluctance and what can be done to help them feel ready for termination. In these cases, it’s often appropriate to use a “fading out” approach, where the frequency of sessions is gradually reduced.
Note: Sometimes it is appropriate to end a therapeutic relationship and refer the client to a provider who is better suited to their needs. This should happen when:- The client’s issues are outside the scope of the clinician’s areas of competency.
- Interpersonal differences between the clinician and client cannot be overcome.
- The client has been in treatment for a considerable amount of time and has shown no progress or a worsening of symptoms.
Review gains made in treatment.
Sometimes the positive changes that are fostered during therapy happen so gradually that they go unnoticed. Reviewing a client’s progress throughout treatment--and particularly at termination--will highlight these positive changes.
As a therapist, you might see positive changes in the client that they have yet to notice. When you compare the first few sessions to the most recent sessions, look for changes in the following areas:
- More positive body language
- Decreased symptom severity
- Improved relationships
- Positive outlook on the future
- Improved functioning at home, work, or school
Point out these improvements by sharing specific changes you’ve seen in the client. For example:
Example: "During your first sessions, it was terrifying for you to talk about your trauma. When you tried, your body shook, and you would try to change the subject. Now you’re able to tell the story almost matter-of-factly, without a single tear. Even though you still have painful feelings about the situation, and you still have some difficult moments, you have come a long way."Regular assessments are another tool for highlighting positive change. Choose an assessment that fits with a client's presenting issue, and ask that they complete it regularly. Over time, these assessments will begin to show trends in the client’s mood and functioning.
As therapy nears its end, these assessments will allow a client to clearly view their improvements, based upon their own self-report. If it makes sense for the particular assessment, the therapist may graph the results to further highlight the trends.
Finally, ask your client to review the changes they have noticed. Have they noticed improvements in their lives outside of therapy? What has been noticeably helpful? Below are some questions to begin exploring:
- Of what we’ve done so far, what has been the most meaningful or valuable to you?
- What have you learned or accomplished?
- What positive changes have you noticed in your life?
- How will you continue to use what you have learned?
- What do you want to remember from therapy?
- How do you think you will look back on our work?
Create a mental health maintenance plan.
Many issues that bring clients to therapy have a high risk of relapse and require ongoing maintenance. Because of this, it is important that clients have a plan for dealing with a recurrence of their presenting problem. Depending on the issue, this might mean returning to therapy.
A mental health maintenance plan helps clients recognize ongoing mental health needs by summarizing their triggers and warning signs. Additionally, it reminds them how to manage these needs by using self-care, coping strategies, and social support. These topics will be addressed throughout therapy but should be reviewed during the termination process.
Triggers are emotions, situations, people, places, or things that elevate the risk of the presenting problem recurring. For example, high levels of stress, interpersonal problems, and grief could all act as triggers. A mental health maintenance plan helps a client understand their triggers and how to avoid or manage them.
Warning signs are clues that the presenting problem might be returning or intensifying. For example, a client who presented with depression might note that their illness worsened after they isolated themselves from friends and family. When the client notices this behavior in the future, they will know to use an appropriate coping strategy or return to therapy.
For an outline of this process, try the Mental Health Maintenance Plan worksheet:
Conclusion
When it’s time to part with the client, the process may be straightforward and professional, or it may be more emotional. The client may experience a wide range of emotions, from sadness and a sense of loss, to pride, satisfaction, and a sense of independence. Allow the client to express their emotions, and validate their experience.
A therapist’s reactions may be just as varied. Commend the client for their hard work in therapy and take pride in what you and the client accomplished together.
To learn more about the termination process, check out this book:
