In order to fully appreciate—and understand—life,
you must come to terms with
death.
And, just as beginnings and endings are integral to life, they are also central
to human psychology. Consequently, once
psychotherapy
begins, its ending—its termination—becomes a vital presence
in the psychotherapy.
In regard to
the termination of psychotherapy, you might be surprised to discover that
the critical issue, however, is not the reason for termination but
the manner in which the termination occurs.
Reasons for
Terminating Treatment
Unless psychotherapy
begins under a specific legal contract, such as the purchase of a complete
treatment program, we can state one general principle about the course of
treatment:
If you begin
treatment voluntarily, you may terminate treatment at any time, for any
reason.
The best reason
to terminate psychotherapy, of course, would be that you have come to understand
your life and its unconscious motivations to such an extent that you no longer
need a psychotherapist to guide you. If you began psychotherapy feeling as
if your psychotherapist were almost a god, you end psychotherapy
realizing—as the psychoanalyst Jacques Lacan taught—that your
psychotherapist is no more necessary to you than a scrap of paper
in the gutter. This isn’t an insult; it just means that you have more
or less “dissolved” all your illusions about finding your
identity
in other persons.
There can also
be less admirable reasons for terminating psychotherapy. For example, a person
might come to psychotherapy because she is unemployed and feels depressed.
After a few sessions she might find a job and decide to quit psychotherapy.
Maybe she didn’t really come to terms with the
unconscious
basis of her depression, but if she wants to stop psychotherapy, she has
the right to do so. Period.
The psychotherapist
might not think it’s a good idea for her to leave psychotherapy and
might even note in her
chart
that the client terminated psychotherapy Against Medical Advice (AMA).
But AMA is just a legal device to protect the psychotherapist in case of
a future lawsuit, so that the psychotherapist can say to the court, “But
I warned her!”
So, regardless
of what your psychotherapist thinks, you can do whatever you want, however
foolish. It’s your life.
And then there
are those cases when a client, having been in psychotherapy for a while and
having done good hard work, receives a job offer in another city or state
and decides to move. Or maybe the client has made good progress in psychotherapy,
feels more confidence in himself, and decides to go back to school—but
no longer has the time for psychotherapy. These are not necessarily
“foolish” decisions, even though there may be psychological conflicts
still unresolved. The point here is that not everyone pursues psychotherapy
to the point of deep
spiritual
healing. For some persons, “good enough” may be good
enough.
The Manner of
the Termination
Even though you
may leave psychotherapy for any reason—or even for no reason, if you
choose—it can only be hoped that you leave honestly.
If you simply
stop coming to sessions and don’t return your psychotherapist’s
phone calls, for example, that’s hiding, not
terminating.
If you get involved
with a new “lover,” for example, and find psychotherapy to be
inconvenient for your schedule, that’s running, not
terminating.
If you feel angry
at your psychotherapist and quit psychotherapy rather than deal with your
feelings (known as
transference)
within the psychotherapy, that’s bolting, not
terminating.
 |
Of course, if
your psychotherapist does something illegal, such as try to have sex with
you, or try to have a relationship with you outside psychotherapy, then you
would be well advised to terminate psychotherapy and make a
consumer
complaint to the psychotherapist’s licensing board. |
|
The only way
to terminate psychotherapy honestly is to talk about it. Regardless of the
reason for terminating, at least take one or two sessions to review your
treatment. Remember how bad your life once was. Recognize what you’ve
learned and how you’ve grown. Recognize also what still needs to be
done. Assess your weaknesses. And then look ahead to anticipate future problems
and plan strategies to cope with them.
Of course, having
terminated honestly and politely, you also have the option to return to treatment
again in the future—either for a one- or two-session “tune up”
or to work on deep issues still unresolved.
Termination by
the Psychotherapist
There can also
be times when a psychotherapist must terminate treatment.
A psychotherapist
in training who works in an agency may leave the agency at the end of an
internship, and treatment with all of his or her clients will have to be
terminated, sometimes prematurely.
Sometimes a
psychotherapist who works for an agency will decide to leave the agency to
go into private practice. Things can get sticky here because if the
psychotherapist tries to take any clients from the agency into the private
practice, the agency might claim that the psychotherapist is
“stealing” its clients. So the psychotherapist has to be very careful
about how everything is presented to the client. Of course, in the end the
client is free to do what he or she wants.
Sometimes a
psychotherapist will have
countertransference
issues that can interfere with the treatment. The psychotherapist may have
to consult with a peer professional to discuss the case, and it may be decided
that circumstances ethically require the termination of treatment to protect
the client’s best interests.
|
Countertransference
problems will be minimized if the psychotherapist has had intense training
in psychodynamic psychotherapy or
psychoanalysis. For example, a client and
psycotherapist may have opposing political views, and the client may have
a tendency to argue politics; but if the psychotherapist has the expertise
to keep the treatment focused on the underlying
emotional issues—rather than get caught up
in surface arguments—then the psychotherapist’s personal feelings
need not become a problem. |
|
And sometimes
a psychotherapist will realize that the psychotherapy has moved into an area
that requires expertise he or she does not have, and trying to continue
psychotherapy without proper training or supervision would be an ethical
violation.
Regardless of
the reasons for needing to terminate the treatment, a psychotherapist is
bound by ethics to treat a client with due respect and consideration in all
things, including termination. The reasons for termination should be discussed
fully and honestly. This should be done in the office, face to face. The
client should be given enough advance notice (if possible) so that the
client’s emotional reactions can be processed. (Of course, if the
client-psychotherapist relationship is an issue contributing to the need
for termination, then any block to the client and psychotherapist working
together effectively may prohibit a full processing of the termination itself.)
Finally, a suitable referral to another psychotherapist should be made, if
possible.
Legal Aspects
of Termination
If your psychotherapy
was not entirely voluntary—that is, if it were court-ordered, for
example—then premature termination will be a violation that will cost
you dearly. But in any other case there shouldn’t be any legal problems.
Just remember these points:
•
|
Even
after psychotherapy has terminated, you still hold the
privilege
of confidentiality. Your psychotherapist
cannot reveal anything about your treatment without your permission. Your
psychotherapist will also have the legal obligation to retain your treatment
records (or “chart”) for quite a while, according to state law.
For example, California law (Health and Safety Code section 123145) requires
that records be kept for a minimum of seven years, but this law does NOT
APPLY to private practice settings. Hence psychologists in CA are referred
to the Specialty Guidelines for the Delivery of Services by the American
Psychological Association which recommends that full records be maintained
for three years after termination and that summary records be maintained
for an additional 12 years. |
• |
You
may request that your treatment records be sent to another qualified
professional. Note that your original
psychotherapist has a legal right to the chart itself, so only copies of
the information in your chart will be sent. |
• |
If a
person dies while in psychotherapy, or after psychotherapy,
privilege—including
the right to see the psychotherapy records—usually passes to that
person’s estate. In such a case,
professional legal advice may be needed. |
Clinical questions
about the termination of psychotherapy can be found
on the Questions and Answers About Psychotherapy
page.
No
advertising—no sponsor—just the simple truth . . .
|
|
DID MY WORK help you? Have you found
insight into your behavior? Have you found information unlike anywhere else?
Then why not make a Quick & Easy donation to this freewill website
to express your gratitude for my labor in creating something substantial,
something that can change your life for the better?
|
|
 
Additional
Resources
CA Law:
Legislative Council
Website —the official site for California legislative information.
Search their database for any law you can think of.
CALIFORNIA CIVIL CODE —Table of Contents
CALIFORNIA HEALTH AND SAFETY CODE —Table of
Contents
CALIFORNIA EVIDENCE CODE —Table of Contents
CALIFORNIA PENAL CODE —Table of Contents
CALIFORNIA WELFARE AND INSTITUTIONS CODE —Table
of Contents
Related pages within A Guide to Psychology
and its Practice:
Choosing a
Psychologist
Confidentiality
Consumer Rights and
Office Policies
Fear of
Psychotherapy
Legal Issues
Psychology: Clinical
or Counseling or ...?
Psychology and
Psychiatry
Questions and Answers
about Psychotherapy
Reasons to Consult
a Psychologist
Types of Psychological
Treatment
CONTACT ME
INDEX of all subjects
on this website
SEARCH this
website
A Guide to Psychology
and its Practice
www.GuideToPsychology.com
Copyright © 1997-2008 Raymond Lloyd Richmond, Ph.D. All rights
reserved.
San Francisco, California USA
|
