Termination of Services
Rachel Ruskamp
Walden University
NURS 6650: Psychotherapy Adolescents and Groups
January 22, 2020
Termination by the Psychotherapist
There are many reasons a therapist may terminate services for a client. A psychotherapist who works in may leave the current organization at the cease of an internship, and treatment with all of his or her consumers thus terminating services with the consumers, once in a while prematurely ("Termination of Psychotherapy: Reasons, Manner, and Legal Issues," 2019). Other times a psychotherapist will have countertransference issues that can intervene with the treatment. The psychotherapist may also have to consult with a peer professional to talk about the case, and it can also be decided that instances ethically require the termination of treatment to protect the Client's quality interests ("Termination of Psychotherapy: Reasons, Manner, and Legal Issues," 2019). The termination of the psychotherapy relationship is a difficult phase of therapy at times for the Client, so ensuring resources are available to facilitate healthy coping is imperative, and ensuring the resources are available to provide support are necessary at this transition of care.
The termination note must contain the following ("Termination of Psychotherapy: Reasons, Manner, and Legal Issues," 2019).
Demographic-
JA is a 27-year-old Divorced Caucasian male. He is being treated for PTSD and anxiety related to flashbacks from a deployment in 2008 to Iraq for approximately 15 months.
Chief Complaint- The Client is receiving Group interpersonal- CBT to facilitate relief of PTSD symptoms associated with a deployment to Iraq in 2007. The Client was deployed for 15 months and witnessed countless acts of violence and death.
Treatment Goals-MET. The Client desired to obtain anxiety relief related to flashbacks and voiced interest in discontinuing benzodiazepines, which he reported made him tired and unable to function throughout the da.
Diagnosis: PTSD
Treatment Modality and Interventions- The Client received 12 weeks of intensive at 60 minutes in duration, Group CBT therapy. At week 6, the Client reported a decrease in medication use to manage symptoms of anxiety. Therapy session length throughout the protocol was 60 minutes of face to face intervention weekly with 15 minutes of journaling and reflection nightly. At the end of therapy client has decreased medication use for anxiety and reports that he is sleeping well. He reports uninterrupted sleep nightly lasting 6-8 hour nightly. This sleep that he reports has improved substantially as he is no longer awakened in the night without being able to fall back to sleep, due to flashbacks of his time in Iraq. CBT methods used for flashbacks were EMDR and reflection of past events that the Client described he continued to have vivid memories of certain times he felt he was vulnerable and sad during the deployments. Deep breathing exercises in a session facilitated relief of physical symptoms related to the flashbacks.
Treatment Goals and Outcome
Treatment goals discussed at the beginning of therapy indicated the Client wanted to improve sleep and anxiety related to the events that he experienced during his time deployed. The Client voiced interest in discontinuing the frequency of the prescribed benzodiazepine to facilitate anxiety relief.
Prognosis.
The Client has been engaged in treatment as evidenced by missing zero scheduled therapy appts and completing all necessary homework to obtain symptom management. Healthy coping mechanisms were voiced by the Client in the form of deep breathing and continuing to support groups with peers as he recognizes that the PTSD symptoms, while manageable, he recognizes the importance of peer support.
The probability of completing the treatment and symptom relief is dependent on mutually agreed to treatment objectives and the individual committed to CBT. Thus they receive the greatest benefit of treatment (Institute for Quality Health, 2016).
Supports in place: The Client plans to attend a weekly PTSD Veteran group that meets Friday evening at the VFW in Eagle River, AK, to continue to heal and gain new coping strategies from peers. The Client has attended the group therapy for two months and states that it is a huge support network that provides him hope and friendship.
Follow-up- The Client agreed to this plan and was given the number to the crisis line in the event of a Psychiatric Emergency.
The Client denies SI/HI and has voiced an understanding of the plan in place. The Client is scheduled with his Psychiatrist in two weeks to discuss discontinuing the medication regimen he once used to manage his anxiety related to the PTSD. .
Medications were discussed and no questions or concerns were voiced by the client related to medication and use of the medications.
There are no upcoming appts for group psychotherapy.
The Client voiced an understanding of this plan.
Rachel Ruskamp RN-BC/CCM
References
Cognitive Behavioral Therapy.” PubMed Health. 8 Sep. 2016. Institute for Quality and
Efficiency in Health Care. 19 Dec. 2017. Retrieved July 30, 2019, from
https://www.ncbi.nlm.nih.gov/pubmedhealth/pmh0072481.
Termination of Psychotherapy: Reasons, Manner, and Legal Issues. (2019).
Retrieved 30 July 2019, from http://guidetopsychology.com/termin.htm
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