Sunday, August 5, 2012
Termination in Counseling
According to Knapp (2007), the "termination phase of the therapeutic process is handled in a purposive and deliberate manner" (p. 3). This involves checking in with the client to see how he or she is doing in the present as well as helping the client acknowledge areas that may continue to need attention and awareness. Ward (1984) describes assessment areas important when ending a therapeutic relationship. Reviewing the client's progress and allowing the client to articulate the progressive changes during the therapy, acknowledging the most poignant insights gained by the client, recalling the client's initial presentation when starting therapy, and the use of formal assessments to demonstrate changes, and in some cases, it may be valuable for clients to seek the feedback of friends or colleagues to "related to his or her readiness to end counseling" (Ward, 1984, p. 23).
Patton (Laureate Education, Inc., 2010) used many of the above techniques and checked in with his client, Billie, as he reviewed her progress throughout the therapy. He discussed how she will continue to work on her issues that may surface in the future with an understanding that she can use him as a counseling resource in the future. Patton discussed how Billie felt about the completion of her therapy, and encouraged her to see the progress she had made during the course of their relationship. He empowered her by acknowledging her progress, pointing out the differences in her in the present compared to when she began therapy. He asked her how she perceives the differences as well, helping her to articulate her own perspective of personal change. He also asked her what her friends think about her progress.
I appreciated Patton's discussion of the personal meaning of the relationship to him. I like that he acknowledged his own growth through working with Billie. It seemed compassionate and human. He also asked what could have been different in their alliance that may have been more helpful. I liked both of those aspects of his style, or his theoretical approach. I also liked that Patton asked Billie what she will be doing differently on a daily basis. I thought this brought her into a present perspective of how she is going to continue to find her own strength.
Termination Circumstance #1
Because of my interest and plans to work in a hospice situation, I found London's (1982) article particularly poignant. I imagine in the hospice environment, there will inevitably be premature terminations because of the impending death of the client. Even when the termination is not the choice of the client or the therapist, it would be important to help clients have an adequate sense of closure with the relationship with their therapist. During this time for the terminally ill client, he or she is saying goodbye to friends and relatives and may experience pain, sadness, and anger in having these premature terminations, and it may be important to leave the client comfortable with the end of the therapeutic relationship. I had a friend who died several years ago and during the last few weeks of her life, it was important for her that we say goodbye and 'see you on the other side' every evening before I went home. She said this gave her some peace that our relationship was not one more thing left undone.
My take on this is that having things left undone is not good for the living or the dying. In a hospice situation, especially when the therapeutic relationship is tenuous depending on the life of the client, it may be important, for both the client and the therapist to seek closure in the relationship. It could be handled similarly to the way Patton sought closure with his client (Laureate Education, Inc., 2010). I believe when ending a series of sessions it is important to understand as Ward (1984) points out, "the therapeutic process never resolves all problems, removes all symptoms, or results in a complete cure" (p. 22).
Termination Circumstance #2
A second circumstance in which I would terminate a counseling relationship is when, after consideration, consultation, and supervision, I felt as if I were not experienced enough to help a client. For example, if I had a client who presented with an extreme case of dissociative tendencies, and a belief that her safety was in jeopardy, I would not feel competent. Terminating with this client could be difficult for the client, but I would want to make sure the client did, in fact, continue with someone more knowledgeable, perhaps a psychiatrist or someone who has knowledge of formal assessments and experience with the severe and persistent mental illness population. I would consider this case as somewhat of an emergency and might suggest in-patient care, depending on the client's experiences, but I would want to consult. It would be important to explain to the client that I cannot give proper care but will make a referral to someone more knowledgeable about his or her condition. I think in a case like this, providing for the client's safety would be a concern, especially if the client was fearful for his or her own safety.
Although under these circumstances, the procedure would be different in some ways, Ward's (1984) set of procedures could be modified. I would review with the client, the experiences they articulated with me, acknowledge any insights that may contribute to the client's understanding of his or her need for continued and possibly more intensive assistance. I think in this case it would be particularly beneficial to the client to acknowledge her initial decision to seek help, and the importance of following through on her decision.
Knapp, H. (2007). Therapeutic communication: Developing professional skills. Thousand Oaks, CA: Sage Publications, Inc.
Laureate Education, Inc. (Executive Producer). (2010). Techniques in counseling. Baltimore, MD: Author.
London, M. (1982). How do you say good-bye after you've said hello? Personnel & Guidance Journal, 60(7), 412–414.
Ward, D. E. (1984). Termination of individual counseling: Concepts and strategies. Journal of Counseling & Development, 63(1), 21–25.