[AnnaBegins]

I had a really bizarre set of circumstances involving my T happen yesterday that got me thinking about Ts terminating with their patients. Is this something they get taught how to handle before they become Ts? Is there a proper, or preferred way for them to do it? And, is there a "good" way for them to do it or an approach you wish they had taken instead of the way they actually handled it?

Very confused...

[Perna]

T's can "quit" or clients can "fire" a T but I think of termination as something that is discussed and decided on by both T and client when they agree the client has benefited as much as they can from therapy/seeing that therapist. It is confusing when T's use the same words for "terminating" a client as client when it means they don't want to play anymore (so are quitting :-)

I am sure recognizing when a client has resolved most issues and have gone about as far as they can go in therapy is taught therapists but I don't know that there is always a good way for either party to quit before that happens, unless they talk about that, etc. T's don't have any control over if you leave, etc. and how you do it, just what they do when they want to end the relationship. Not like they can "leave" so it often has to look like the client has been "thrown out". It's like the work joke: "You can't fire me. . . I quit!"

[grimtopaz]

Therapists are trained in how to terminate and have terminated patients in the past. My understanding is that patients usually have a sense of when they've had gotten all they can out of therapy.

A therapist is not supposed to keep working with a client if the client is no longer benefiting/has nothing to work on. For example, my therapist looks down on therapists who meet with patients who just want to talk or recount their week. She thinks it's important to always be working on something (unless there are significant events, etc.) and have concrete goals

To be honest, as long as a therapist is not "abandoning" (as defined by their ethics code) a patient, they can terminate whenever they want as long as they provide the client with resources if they need continued care. They also need to provide a "good enough" rationale.

The common reasons to terminate are "I've done all I can with my training/therapeutic approach", in that case, they are required to someone who can provide the service she/he is unable to provide. They can also say a patient needs a "higher level of care" that they cannot provide. Or that they don't specialize in some issue the patient brings up (e.g., the issue of severe addiction/eating disorders come up and they don't have any training in that area). Obviously they can terminate if they are afraid of the patient/feel unsafe. Essentially, they can say "the patient is no longer benefiting from therapy with me."

[AnnaBegins]

Originally Posted by grimtopaz

To be honest, as long as a therapist is not "abandoning" (as defined by their ethics code) a patient, they can terminate whenever they want as long as they provide the client with resources if they need continued care. They also need to provide a "good enough" rationale.

Is there an actual ethics code that defines "abandoning" or is that more of an individual definition that each T decides on themselves?

[Crescent Moon]

Originally Posted by AnnaBegins

I had a really bizarre set of circumstances involving my T happen yesterday that got me thinking about Ts terminating with their patients. Is this something they get taught how to handle before they become Ts? Is there a proper, or preferred way for them to do it? And, is there a "good" way for them to do it or an approach you wish they had taken instead of the way they actually handled it?

Very confused...

Ideally, I don't think it's supposed to be unilateral. It's supposed to be something that is mutually agreed upon. However, if for some reason the therapist thinks they must stop working with a client, they should always, always, always discuss it face-to-face and provide referrals to another therapist, and hopefully a transition session or two.

[Crescent Moon]

Originally Posted by AnnaBegins

Is there an actual ethics code that defines "abandoning" or is that more of an individual definition that each T decides on themselves?

I think there is a conventional definition. Abandoning a client is cutting the client off without discussion and transition. A therapist is entitled to transfer a client to someone else. They may have countertransference going on that they know is going to interfere with their ability to be a good therapist for that client. Or the client's needs may exceed a therapist's skill and they are then obligated to transfer the client to someone competent in the skills the client needs. A therapist might also refer a client to someone else if the client has become threatening to the therapist.

Proper referral of a client to another therapist is not abandonment, although it certainly might feel like abandonment.

[AnnaBegins]

Originally Posted by Crescent Moon

Ideally, I don't think it's supposed to be unilateral. It's supposed to be something that is mutually agreed upon. However, if for some reason the therapist thinks they must stop working with a client, they should always, always, always discuss it face-to-face and provide referrals to another therapist, and hopefully a transition session or two.

Sadly, what I actually got was a text message from the friend who referred me to him asking if I got the form letter from the practice he used to work at informing us that he no longer works there. I'm honestly still in shock and don't know how to process this.

[grimtopaz]

Originally Posted by AnnaBegins

Is there an actual ethics code that defines "abandoning" or is that more of an individual definition that each T decides on themselves?

The term "abandonment" is a term used in the American Psychological Association ethics code. (The APA oversees licensed psychologists, I don't know about other mental health professions, but I suspect the codes are similar.) Essentially, a T cannot drop you without offering a proper termination session, and giving you a referral to other services (if they are needed). Of course, a patient may decline this against medical advice. Ideally, a T would tell you why they are terminating, but I know they are sometimes less than forthcoming and in some cases it's "okay" to lie if they can make a point it is for the benefit of the patient.

For example, some T's start working with a patient and they can't help but strongly hate them/dislike them. The ethical thing to do would be to give a referral and say something like "I think this person would be a better fit in terms of interpersonal style...blah blah."

The only exception is if the T feels unsafe/is threatened by the client or a client's family member - in that case, they are justified to sever all contact.

[Crescent Moon]

Originally Posted by AnnaBegins

Sadly, what I actually got was a text message from the friend who referred me to him asking if I got the form letter from the practice he used to work at informing us that he no longer works there. I'm honestly still in shock and don't know how to process this.

That really stinks. It sounds like it may be an unusual situation. He may have done something wrong? Said the letter encourage you to come in? I'd call them.

[Bentay]

Yep there are not so good ways & better ways. I don't sound too enthusiastic as termination is tough........well, at least I found it was for me

T's must receive training for it as its such an integral part of 'good' therapy. I think a staggered ending which has been agreed upon by both client and therapist is better than an abrupt ending...........I personally found 'fading away' so to speak, less difficult rather than going from 60 to 0 in one fail swoop!........I mean from one session per week to none.

Anyway, that worked better for me but everyone is different I guess.

[~EnlightenMe~]

Termination, when one-sided or forced, is excruciating at best.

[AnnaBegins]

Originally Posted by Crescent Moon

That really stinks. It sounds like it may be an unusual situation. He may have done something wrong? Said the letter encourage you to come in? I'd call them.

I still haven't gotten a letter myself, or so much as a phone call from the place he used to work letting me know he doesn't work there anymore. I checked their website and he's not on the staff list anymore so I'm assuming this isn't some cruel joke on my friend's part.

Shock is wearing off now...starting to feel panicky and really upset with myself...

Have you spoken directly to him about this? It could be he has left the practice, but perhaps he was able to take his patients with him. Or did it specifically say he would no longer be able to see former clients? It could vary depending on the business arrangement he had with the practice. You probably need to speak directly to him about the situation. Seems odd that the practice would send that kind of notice. Sounds almost like a disclaimer. Certainly need to get more detail. Did the letter provide instructions for contact or future care?