Termination- I need this by 9pm tonight (3/4/18)

Peer 1 post

Terminations with Clients

 I think it is really important to consider the client’s needs when preparing for termination. Some clients have issues with abandonment and attachment and can have difficulties with transitions and terminations. It is important to keep that in mind when there is an upcoming transition. Since my clients know that I am an intern, they know that eventually I will be ended and transitioning them to either a new therapist or to end services.  The relationship and duration of the counseling experience can have an impact on the success of the therapy (Wong, Tabling, & Anderson, 2013). In my internship experience, there have been clients that have just stopped coming. This can happen in a counseling practice. I did not have the chance to process with them about why they stopped coming. If given the chance, I would have processed with them about the “next steps” to continue promoting success and well-being. Therapists should honor their inertial reaction to termination and explore why they believe the clients decided to stop coming and reflect on what the various variables are in the situation (Schaeffer & Kaiser, 2013).

Terminations in my Life

As a marine brat, I have had a lot of endings in my life. Every 2-3 years, I had to say good-bye to friends and move. I have become very good at good-byes unfortunately. I understand that it is a natural part of the process and one I am ready to do. There have been a few clients that I had at the inpatient program that I wanted to work with longer than just a few weeks and that made me sad. I felt like we started to do some really good work and I wanted to continue working with them. A lot of the clients have asked me where I will be practicing so they can find me and I have had to tell them that was many years away. A lot of them have shared that I made them feel comfortable and they normally did not connect with counselors. I encouraged them by telling them that now they know what to look for in a therapist and may find someone even better than me. As for rituals, I have been asking clients for feedback for me as an intern at the end of the last session. I think I am doing things a certain way, and it’s nice to get feedback from my clients that it is coming across the way I think I am. I was inspired by a podcast I listened to about new counselors who, as part of their internship, had their clients rate their qualities and how well they met those different qualities and needs. It is great feedback. It has been effective for me to hear that what I am doing and who I am (a lot of them talk about my unconditional accepting energy and also how I hold them accountable) is working.

Group

Today in supervision, it was great to hear the different experiences that everyone has. We have different sites and situations which create different transitions. Tisha was talking about a client who drains her energy and looking forward to eventually terminating him. I have had clients that I did not want them to leave and others where I could not wait for them to end. In the latter case, it was typically a personality disorder and our four weeks of treatment (2-3 sessions a week) was not enough to address and effect significant change. I think as counselors being aware of how clients can drain and/or invigorate us is a great skill.

References

SCHAEFFER, J. A., & KAISER, E. M. (2013). A Structured Approach to Processing Clients' Unilateral Termination Decisions. American Journal Of Psychotherapy, 67(2), 165-183.

Wong, A. G., Tambling, R. B., & Anderson, S .R. (2013). Treatment duration and termination status among clients in a university-based counseling center. The Family Journal, 21(4), 371–376.

PEER 2 POST

Some things that I consider is the trusting connection that the client and the counselor have in the beginning. I think it's important that the client also understands that this bond is not meant to last forever but is a necessary step towards they're here healing process. Termination on the other hand is the final stage of this counseling process. Some things that I consider is how the client will handle the conclusion of the counseling relationship and what follow-up procedures are necessary for the client at that time. Sometimes a lower level of care is very beneficial for the client meaning that they can be able able to access other outlets besides Counseling in order to maintain progress on previous goals. For instance joining the YMCA or joining a Counseling Group once or twice a month may be necessary for those that seek to continue some type of resource outside of Outpatient Therapy.

 Ethically the counselor is bond to communicate how long they will be in counseling services. It is important to discuss a timeline and make appropriate referrals or recommendations at the conclusion of the counseling relationship. Some ways that I would help prepare the client for termination would be to remind the client of the approaching ending dates. This will probably happen two or three sessions before the final one. I could probably space out the meetings as the client would like towards the end so that they feel more comfortable with not having to come to counseling every week. I can also continue to review the clients progress during the sessions before termination. This is a way in which I think can instill confidence and also make them more aware of their accomplishments during counseling which makes it more understandable that counseling will come to an end. I would also allow the client to talk about their feelings about determination and help them walk through those emotions and acknowledging that they are understanding the process or in acknowledging that they're having difficulty with the process. I would also consider having an open door policy once the termination has ended sometimes the clients want to return within a couple of months and do check ins with the counselor and I feel that that is perfectly fine. I had not considered any additional rituals or specific interventions that are part of the termination process but I would definitely want the client to fine-tune those skills that theyl learned during counseling and maybe have a journal of how counseling has helped them over this period of time and to continue journaling and processing their feelings about counseling weeks after it is over. With the Cognitive Behaviour therapy approach it will continue to allow the client to process thoughts feelings and behaviors related to termination of the counseling process.

The counselor has to be mindful not to do any harm during the termination process.

 

Premature termination can cause counselor distress and that they may feel like they contributed to or even calls to termination. The counselor may even believe they failed the patient and may not be as effective or confident in their counseling abilities because of this. They may even feel as if they have not helped the client or even harmed the client and in some way due to improper termination procedures.(Schaeffer & Kaiser, 2013).

 

A.11.c. Appropriate Termination Counselors terminate a counseling relationship when it becomes reasonably apparent that the client no longer needs assistance, is not likely to benefit, or isbeing harmed by continued counseling. Counselors may terminate counseling when in jeopardy of harm by the client or by another person with whom the client has a relationship, or when clients do not pay fees as agreed upon. Counselors provide pretermination counseling and recommend other service providers when necessary.

 

 A.11.d. Appropriate Transfer of Services When counselors transfer or refer clients to other practitioners, they ensure that appropriate clinical and administrative processes are completed and open communication is maintained with both clients and practitioners.(ACA,2014)

 

The group this week talked about client termination. We discussed how the clients processed the part of the counseling service. The group discussed issues that could possibly cause harm. We also talked about ethical issues when it comes to the termination process. I have personally seen both sides of termination. Those that are more willing to come to counseling were a little easier to terminate as opposed to those that were mandated by the courts for the substance abuse program. The termanation process is just as important as starting the counseling process because if not managed well it can possibly cause harm or other ethical issues.

 

Schaeffer, J. A., & Kaiser, E. M. (2013).  A structured approach to processing clients' unilateral termination decisions.  American Journal of Psychotherapy, 67(2) 165–183.

American Counseling Association. (2014).  2014 ACA Code of ethics [PDF].  Retrieved from http://www.counseling.org/Resources/aca-code-of-ethics.pdf