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Termination
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Page Contents: Introduction / Reasons for a Client to Terminate Treatment / The Manner of the Termination / Termination by the Psychotherapist / Legal Aspects of Termination

 

 
IN ORDER to appreciate—and understand—life fully, 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 a Client to Terminate 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!”

Nevertheless, regardless of what your psychotherapist thinks, you can do whatever you want. It’s your life.
 

  

Then there are pragmatic reasons for terminating psychotherapy, exemplified by 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, and decides to go back to school—but no longer has the time for psychotherapy. Or maybe financial issues prevent the treatment from continuing. These are not necessarily “foolish” decisions, even though there may be psychological conflicts still unresolved. The point here is that not everyone wants to, or can afford to, pursue psychotherapy to the point of deep unconscious healing. For some persons, “good enough” may be good enough.

Finally, there are unfortunate reasons for terminating psychotherapy, such as when a psychotherapist performs his or her job incompetently. When a client believes that trust has been broken despite efforts to speak about the problem within the treatment, there may be no other option than for the client to terminate treatment for his or her own psychological safety.

 
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 get angry at your psychotherapist and quit psychotherapy rather than deal with your feelings (known as transference) within the psychotherapy, that’s bolting, not terminating.

The only way to terminate psychotherapy honestly is to talk about it.

  

Notice, however, that if you try to “talk about it” with an incompetent psychotherapist and you get criticized or belittled, then you have found an unfortunate reason (see above) to terminate. Give yourself credit, though, for having made the attempt to be honest.

  

But, aside from unfortunate reasons, take at least one or two sessions to review your treatment before leaving. 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.

Then, having terminated the treatment 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.

  

If your psychotherapist does something illegal or unethical—such as try to have sex with you, or try to have a relationship with you outside psychotherapy, or bring his or her personal issues into your treatment—then you would be well advised to terminate psychotherapy and make a consumer complaint to the psychotherapist’s licensing board.

  

 
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 psychotherapist 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.
 

  

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.

Sometimes a managed-care company will decide that treatment must be terminated. This is usually done for practical business reasons that have nothing to do with the client’s welfare, but the psychotherapist on the case can lose his or her job for not following orders, even if it is not in the client’s interest to terminate the treatment. Any psychotherapist in such a position should seek legal advice immediately, lest his or her licensing board take action if the client files a complaint.

Regardless of the reasons for the psychotherapist 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.

  

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.

 
 


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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
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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
 
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