Ethics Committee Chair — Katie (Wren) Busse, MS, Registered AMFT

Considerations for Termination

No matter what the reason is for someone seeking therapy or how long they stay in treatment, there will eventually be a termination process. Termination should be something a clinician has in mind at the onset of therapy, rather than something that comes into consideration halfway through the treatment process. The client should also be prepared for termination from the onset — with the guidance of their clinician. One way to ensure you’re thinking about termination from the beginning of therapy is by developing a treatment plan, or your guide to knowing when a client has met their goals in therapy. While there is no one right way to develop a treatment plan, developing both short- and long-term goals for therapy will help keep you mindful of the approaching termination (CAMFT, 2011, Sec 3.3).

Obviously, a preferable termination involves a client reaching their goals and no longer needing to continue therapy. However, we all know that not every situation can be wrapped up neatly; sometimes termination can be abrupt or against the wishes of the clinician or client.

Below are some common reasons therapy may be terminated early:

• Client refuses to continue treatment
• Client would benefit more from another specialized treatment (CAMFT, 2011, Sec 1.31)
• Insurance coverage limits session
  • Note: additional advocacy on behalf of your client may be warranted
• Client’s presenting issues are out of the therapist’s scope of competence (CAMFT, 2011, Sec 3.9)
• A conflict of interest arose for the therapist (CAMFT, 2011, Sec 1.31)
• The clinician is leaving a practice or treatment center
• Client has failed to pay session fees
  • Note: additional considerations not covered in this article should be examined prior to termination for non-payment of fees (CAMFT, 2011, Sec 1.3.4)
• Therapy is no longer beneficial to the client (CAMFT, 2011, Sec 1.7)
• Client has not made adequate progress over the course of treatment (CAMFT, 2011, Sec 1.31)
• Client “ghosts,” or abruptly stops communication with the therapist

Eventually, the day of termination arrives — either through thoughtful planning or by surprise. In an ideal world you would be able to plan ahead and have a termination session (or two) in person or by phone. If it has been determined that the client continues to need additional care, but you are not the best fit for their needs, provide the client with relevant referrals (CAMFT, 2011, Sec 1.32). So, what do you, as a clinician, need to do to ensure you have done your due diligence in making termination clear? You want to provide verbal or written notice to the client regarding the specific date therapy terminated and document this notice in your clinical records (CAMFT, 2011, Sec 3.1). Keep in mind, without adequate documentation of a specific termination date, it could be argued that you were still the treating clinician and responsible for that individual.

In short, always remember to:

1. Plan for termination at the start of therapy
2. Offer referrals for other relevant treatment providers, as needed
3. Document that a client was given notice of termination
4. Document the date of termination

Disclaimer: The preceding article does not constitute legal advice. Always consult with a CAMFT attorney or another legal professional for any legal or ethical questions you may have.

Reference:
California Association of Marriage and Family Therapists [CAMFT] (2011). CAMFT Code of Ethics. Retrieved from https://www.camft.org/Portals/0/PDFs/AssocDocs/CodeOfEthics.pdf?ver=2019-06-04-093935-577.

Katie Busse is a Registered Associate Marriage and Family Therapist 111673 in private practice under Kent Toussaint, LMFT 44685 at Teen Therapy Center in Woodland Hills. She works with preteens to adults and their families in addressing challenges such as anxiety, depression, anger, and family conflict. Learn more about Katie by visiting her website at www.katiebussetherapy.com. She can be reached at 747.217.2257 or katie@teentherapycenter.org.