Termination: Clinical and Ethical Issues

 

Guidelines

• Each client’s treatment should ideally have a termination phase, even a very short one, regardless of the length of treatment.
• The process of termination requires thoughtful attention beginning with the process of informed consent.
• The process of termination should be articulated in the Informed Consent (or Office Policies) that each client must receive and sign before the first session (See Clinical Forms)
• When a client drops out of treatment or when treatment must be terminated due to managed care and insurance denials, lack of cooperation, failure to improve, and the like, simply tacitly condoning the termination sets the clinician up for ethical and legal difficulties.
• When a client drops out of treatment, if appropriate, follow up with letter respectfully offering to continue treatment, meet one more time for closure and/or to provide referrals.
• The main concern around termination is abandonment. Not only do not abundant your clients but also make sure that your records reflect that you indeed have not abandoned them.
• Arrange for appropriate coverage during periods of anticipated absence.
• Utilize a professional will to address any unanticipated incapacitation or absence from practice.
• Document all terminations. The records should include: Who initiated the termination, when and how it was conducted, which treatment goals were achieved, were referrals necessary and/or provided.
• Arrangements for clients to be able to have reasonable access to you between sessions are also important issues to address to prevent abandonment from occurring.
• If you are practicing Intermittent-Long-Term therapy, where clients and their families continuously come back to therapy throughout their lives, termination has a different meaning. Make sure you document your approach and how each ending of a phase of therapy is handled.