AMERICAN ART THERAPY ASSOCIATION (AATA) ETHICS DOCUMENT, 2003:
1.0 RESPONSIBILITY TO CLIENTS
1.8. Art therapists terminate therapy when it becomes reasonably clear that the client no longer needs the service, is not likely to benefit, or is being harmed by the continuing service.
1.10. Art therapists, prior to termination, provide pre-termination counseling and suggest alternate service providers as appropriate, except where precluded by the actions of clients or third-party payers.
2.0 CONFIDENTIALITY
2.6. Art therapists maintain client treatment records for a reasonable amount of time consistent with state regulations and sound clinical practice, but not less than seven years from completion of treatment or termination of the therapeutic relationship. Records are stored or disposed of in ways that maintain confidentiality.
13.0 REFERRAL AND ACCEPTANCE
13.3. Independent practitioners of art therapy terminate art therapy when the client has attained stated goals and objectives, or fails to benefit from art therapy services.
13.4. Independent practitioners of art therapy communicate the termination of art therapy services to the client.
AMERICAN COUNSELING ASSOCIATION (ACA) CODE OF ETHICS AND STANDARD OF PRACTICE, 2005:
http://www.zurinstitute.com/aca_code_of_ethics_2005.pdf
A.11. Termination and
Referral
A.11.a. Abandonment Prohibited
Counselors do not abandon or neglect
clients in counseling. Counselors
assist in making appropriate arrangements
for the continuation of
treatment, when necessary, during interruptions
such as vacations, illness,
and following termination.
A.11.b. Inability to Assist Clients
If counselors determine an inability
to be of professional assistance to
clients, they avoid entering or continuing
counseling relationships.
Counselors are knowledgeable about
culturally and clinically appropriate
referral resources and suggest these
alternatives. If clients decline the suggested
referrals, counselors should
discontinue the relationship.
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 is being harmed by continued
counseling. Counselors may
terminate counseling when in jeopardy
of harm by the client, or 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.
A.5.a. Current Clients
Sexual or romantic counselor–client
interactions or relationships with current
clients, their romantic partners, or
their family members are prohibited.
A.5.b. Former Clients
Sexual or romantic counselor–client
interactions or relationships with
former clients, their romantic partners,
or their family members are
prohibited for a period of 5 years
following the last professional contact.
Counselors, before engaging in
sexual or romantic interactions or
relationships with clients, their romantic
partners, or client family
members after 5 years following the
last professional contact, demonstrate
forethought and document (in
written form) whether the interactions
or relationship can be viewed as
exploitive in some way and/or
whether there is still potential to harm
the former client; in cases of potential
exploitation and/or harm, the
counselor avoids entering such an interaction
or relationship.
Standard of Practice Seven (SP-7):
Termination. Counselors must assist in making appropriate arrangements for the continuation of treatment of clients, when necessary, following termination of counseling relationships. (See A.11.a.)
AMERICAN ASSOCIAION FOR MARRIAGE AND FAMILY THERAPISTS (AAMFT) CODE OF ETHICS, 2001
http://www.aamft.org/resources/LRM_Plan/Ethics/ethicscode2001.asp
1.9 Marriage and family therapists continue therapeutic relationships only so long as it is reasonably clear that clients are benefiting from the relationship.
1.10 Marriage and family therapists assist persons in obtaining other therapeutic services if the therapist is unable or unwilling, for appropriate reasons, to provide professional help.
1.11 Marriage and family therapists do not abandon or neglect clients in treatment without making reasonable arrangements for the continuation of such treatment.
1.5 Sexual intimacy with former clients is likely to be harmful and is therefore prohibited for two years following the termination of therapy or last professional contact. In an effort to avoid exploiting the trust and dependency of clients, marriage and family therapists should not engage in sexual intimacy with former clients after the two years following termination or last professional contact. Should therapists engage in sexual intimacy with former clients following two years after termination or last professional contact, the burden shifts to the therapist to demonstrate that there has been no exploitation or injury to the former client or to the client's immediate family.
AMERICAN MENTAL HEALTH COUNSELORS ASSOCIATION (AMHCA) CODE OF ETHICS 2000
http://www.amhca.org/code
Section 1.
H) Former Clients:
Counselors do not engage in sexual intimacies with former clients within a minimum of two years after terminating the counseling relationship. The mental health counselor has the responsibility to examine and document thoroughly that such relations did not have an exploitative nature based on factors such as duration of counseling, amount of time since counseling, termination circumstances, the client's personal history and mental status, adverse impact on the client, and actions by the counselor suggesting a plan to initiate a sexual relationship with the client after termination.
P) Termination and Referral:
Mental health counselors do not abandon or neglect their clients in counseling. Assistance is given in making appropriate arrangements for the continuation of treatment, when necessary, during interruptions such as vacation and following termination.
Q) Inability to assist clients:
If the mental health counselor determines that their services are not beneficial to the client, they avoid entering or terminate immediately a counseling relationship. Mental health counselors are knowledgeable about referral sources and appropriate referrals are made. If clients decline the suggested referral, mental health counselors discontinue the relationship.
R) Appropriate Termination:
Mental health counselors terminate a counseling relationship, securing a client's agreement when possible, when it is reasonably clear that the client is no longer benefiting, when services are no longer required, when counseling no longer serves the needs and interests of the client, when clients do not pay fees charged, or when agency or institution limits do not allow provision of further counseling services.
Principle 7
D) Mental health counselors and practitioners recognize that their effectiveness depends in part upon their ability to maintain sound and healthy interpersonal relationships. They are aware that any unhealthy activity would compromise sound professional judgement and competency. In the event that personal problems arise and are affecting professional services, they will seek competent professional assistance to determine whether they should limit, suspend or terminate services to their clients.
E) Mental health counselors have a responsibility both to the individual who is served and to the institution within which the service is performed to maintain high standards of professional conduct. Mental health counselors strive to maintain the highest level of professional services offered to the agency, organization or institution in providing the highest caliber of professional services. The acceptance of employment in an institution implies that the mental health counselor is in substantial agreement with the general policies and principles of the institution. If, despite concerted efforts, the member cannot reach an agreement with the employer as to acceptable standards of conduct that allows for changes in institutional policy conducive to the positive growth and development of counselors, then terminating the affiliation should be seriously considered.
Principle 14
F) Establishing the On-Line Counseling Relationship
Counseling Plans Mental health counselors develop individual on-line counseling plans that are consistent with both the client's individual circumstances and the limitations of on-line counseling. Mental health counselors who determine that on-line counseling is inappropriate for the client should avoid entering into or immediately terminate the on-line counseling relationship and encourage the client to continue the counseling relationship through a traditional alternative method of counseling.
THE PRINCIPLES OF MEDICAL ETHICS WITH ANNOTATIONS ESPECIALLY APPLICABLE FOR PSYCHIATRY, AMERICAN PSYCHIATRIC ASSOCIATION (ApA) 2001 EDITION
http://www.psych.org/MainMenu/PsychiatricPractice/Ethics/ResourcesStandards.aspx
While termination is not specifically mentioned in the American Psychiatric Association Code of Ethics it has a number of standards that are relevant:
5. Psychiatric services, like all medical services, are dispensed in the context of a contractual arrangement between the patient and the physician. The provisions of the contractual arrangement, which are binding on the physician as well as on the patient, should be explicitly established.
One must assume that the issues of termination, access to the psychiatrist between sessions, and coverage arrangements during periods of unavailability must be included in the informed consent agreement to be able to uphold the standards of professionalism of the medical and psychiatric professions.
ETHICAL PRINCIPLES OF PSYCHOLOGISTS AND CODE OF CONDUCT, American Psychological Association (APA) 2002:
http://www.apa.org/ethics/code2002.html
10.10 Terminating Therapy
(a) Psychologists terminate therapy when it becomes reasonably clear that the client/patient no longer needs the service, is not likely to benefit, or is being harmed by continued service. (b) Psychologists may terminate therapy when threatened or otherwise endangered by the client/patient or another person with whom the client/patient has a relationship. (c) Except where precluded by the actions of clients/patients or third-party payors, prior to termination psychologists provide pretermination counseling and suggest alternative service providers as appropriate.
3.12 Interruption of Psychological Services
Unless otherwise covered by contract, psychologists make reasonable efforts to plan for facilitating services in the event that psychological services are interrupted by factors such as the psychologist's illness, death, unavailability, relocation, or retirement or by the client's/patient's relocation or financial limitations.
10.09 Interruption of Therapy
When entering into employment or contractual relationships, psychologists make reasonable efforts to provide for orderly and appropriate resolution of responsibility for client/patient care in the event that the employment or contractual relationship ends, with paramount consideration given to the welfare of the client/patient.
10.06 Sexual Intimacies With Relatives or Significant Others of Current Therapy Clients/Patients
Psychologists do not engage in sexual intimacies with individuals they know to be close relatives, guardians, or significant others of current clients/patients. Psychologists do not terminate therapy to circumvent this standard.
10.08 Sexual Intimacies With Former Therapy Clients/Patients
(a) Psychologists do not engage in sexual intimacies with former clients/patients for at least two years after cessation or termination of therapy. (b) Psychologists do not engage in sexual intimacies with former clients/patients even after a two-year interval except in the most unusual circumstances. Psychologists who engage in such activity after the two years following cessation or termination of therapy and of having no sexual contact with the former client/patient bear the burden of demonstrating that there has been no exploitation, in light of all relevant factors, including (1) the amount of time that has passed since therapy terminated; (2) the nature, duration, and intensity of the therapy; (3) the circumstances of termination; (4) the client's/patient's personal history; (5) the client's/patient's current mental status; (6) the likelihood of adverse impact on the client/patient; and (7) any statements or actions made by the therapist during the course of therapy suggesting or inviting the possibility of a posttermination sexual or romantic relationship with the client/patient.
2.06 Personal Problems and Conflicts
(a) Psychologists refrain from initiating an activity when they know or should know that there is a substantial likelihood that their personal problems will prevent them from performing their work-related activities in a competent manner. (b) When psychologists become aware of personal problems that may interfere with their performing work-related duties adequately, they take appropriate measures, such as obtaining professional consultation or assistance, and determine whether they should limit, suspend, or terminate their work-related duties.
CALIFORNIA ASSOCIATION OF MARRIAGE AND FAMILY THERAPITS (CAMFT), ETHICAL STANDARDS 2008:
http://www.camft.org/scriptcontent/index.cfm?displaypage=../CamftBenefits/EthicalStandards1.html
1.3 TREATMENT DISRUPTION:
Marriage and family therapists are aware of their
professional and clinical responsibilities to provide consistent care to patients and maintain practices and procedures that assure undisrupted care. Such practices and procedures may include, but are not limited to, providing contact information and specified procedures in case of emergency or therapist absence, conducting appropriate terminations, and providing for a professional will.
1.3.1 TERMINATION:
Marriage and family therapists use sound clinical judgment when terminating therapeutic relationships and do so in an appropriate manner. Reasons for termination may include, but are not limited to, the patient is not benefiting from treatment; continuing treatment is not clinically appropriate; the therapist is unable to provide treatment due to the therapist’s incapacity or extended absence, or in order to avoid an ethical conflict or problem.
3.2 ABANDONMENT:
Marriage and family therapists do not abandon or neglect patients in treatment. If a therapist is unable or unwilling to continue to provide professional services, the therapist will assist the patient in making clinically appropriate arrangements for continuation of treatment.
1.3.4 NON-PAYMENT OF FEES:
Marriage and family therapists do not terminate patient relationships for non-payment of fees except when the termination is handled in a clinically appropriate manner.
1.2 DUAL RELATIONSHIPS-DEFINITION:
Marriage and family therapists are aware of their influential position with respect to patients, and they avoid exploiting the trust and dependency of such persons. Marriage and family therapists therefore avoid dual relationships with patients that are reasonably likely to impair professional judgment or lead to exploitation. A dual relationship occurs when a therapist and his/her patient engage in a separate and distinct relationship either simultaneously with the therapeutic relationship, or during a reasonable period of time following the termination of the therapeutic relationship. Not all dual relationships are unethical, and some dual relationships cannot be avoided. When a concurrent or subsequent dual relationship occurs, marriage and family therapists take appropriate professional precautions to ensure that judgment is not impaired and that no exploitation occurs.
1.2.2 SEXUAL CONTACT:
Sexual intercourse, sexual contact or sexual intimacy with a patient, or a patient's spouse or partner, or a patient’s immediate family member, during the therapeutic relationship, or during the two years following the termination of the therapeutic relationship, is unethical.
Should a marriage and family therapist engage in sexual intimacy with a former patient or a patient’s spouse or partner, or a patient’s immediate family member, following the two years after termination or last professional contact, the therapist shall consider the potential harm to or exploitation of the former patient or to the patient’s family.
1.8 EMPLOYMENT AND CONTRACTUAL TERMINATIONS:
When terminating employment or contractual relationships, marriage and family therapists primarily consider the best interests of the patient when resolving issues of continued responsibility for patient care.
1.15 DOCUMENTING TREATMENT DECISIONS:
Marriage and family therapists are encouraged to carefully document in their records when significant decisions are made, e.g., determining reasonable suspicion of child, elder or dependent adult abuse, determining when a patient is a danger to self or others, when making major changes to a treatment plan, or when changing the unit being treated.
CANADIAN PSYCHOLOGICAL ASSOCIATION (CPA) CODE OF ETHICS AND CONDUCT, 2000:
http://www.cpa.ca/cpasite/userfiles/Documents/ Canadian%20Code%20of%20Ethics%20for%20Psycho.pdf
II.37 Terminate an activity when it is clear that the activity carries more than minimal risk of harm and is found to be more harmful than beneficial, or when the activity is no longer needed.
I.41 Collect, store, handle, and transfer all private information, whether written or unwritten (e.g., communication during service provision, written records, e-mail or fax communication, computer files, video-tapes), in a way that attends to the needs for privacy and security. This would include having adequate plans for records in circumstances of one's own serious illness, termination of employment, or death.
II.42 Be open to the concerns of others about perceptions of harm that they as a psychologist might be causing, stop activities that are causing harm, and not punish or seek punishment for those who raise such concerns in good faith.
FEMINIST THERAPY INSTIUTE (FTI) CODE OF ETHICS, 1999:
http://www.feministtherapyinstitute.org/ethics.htm
While termination is not specifically mentioned in the Feminist Therapy Institute Code of Ethics it has a number of standards that are relevant:
The ethical guidelines that follow are additive to, rather than a replacement for, the ethical principles of the profession in which a feminist therapist practices.
A feminist therapist will contract to work with clients and issues within the realm of her competencies. If problems beyond her competencies surface, the feminist therapist utilizes consultation and available resources.
A feminist therapist negotiates and renegotiates formal and/or informal contacts with clients in an ongoing mutual process. As part of the decision-making process, she makes explicit the therapeutic issues involved.
This code is a series of positive statements that provide guidelines for feminist therapy practice, training, and research. Feminist therapists who are members of other professional organizations adhere to the ethical codes of those organizations. Feminist therapists who are not members of such organizations are guided by the ethical standards of the organization closest to their mode of practice.
NATIONAL ASSOCIATION OF ALCOHOLISM AND DRUG ABUSE COUNSELORS (NAADAC) ETHICAL STANDARDS, 2004:
http://naadac.org/documents/index.php?CategoryID=23
Principle 8: Preventing Harm
I shall terminate a counseling or consulting relationship when it is reasonably clear that the client is not benefiting from the relationship.
NATIONAL BOARD FOR CERTIFIED COUNSELORS (NBCC) CODE OF ETHICS, 2005:
http://www.nbcc.org/extras/pdfs/ethics/nbcc-codeofethics.pdf
Section A: General
10. Sexual intimacy with clients is unethical. Certified counselors will not be sexually, physically, or romantically intimate with clients, and they will not engage in sexual, physical, or romantic intimacy with clients within a minimum of two years after terminating the counseling relationship.
Section B: Counseling Relationship
9. Certified counselors who have an administrative, supervisory and/or evaluative relationship with individuals seeking counseling services must not serve as the counselor and should refer the individuals to other professionals.
Exceptions are made only in instances where an individual's situation warrants counseling intervention and another
alternative is unavailable. Dual relationships that might impair the certified counselor's objectivity and professional
judgment must be avoided and/or the counseling relationship terminated through referral to a competent professional.
10. When certified counselors determine an inability to be of professional assistance to a potential or existing client, they must, respectively, not initiate the counseling relationship or immediately terminate the relationship. In either event, the certified counselor must suggest appropriate alternatives. Certified counselors must be knowledgeable about referral resources so that a satisfactory referral can be initiated. In the event that the client declines a suggested referral, the
certified counselor is not obligated to continue the relationship.
CODE OF ETHICS OF THE NATIONAL ASSOCIATION OF SOCIAL WORKERS (NASW), 1999:
http://www.socialworkers.org/pubs/code/code.asp
1.16 Termination of Services
(a) Social workers should terminate services to clients and professional relationships with them when such services and relationships are no longer required or no longer serve the clients' needs or interests.
(b) Social workers should take reasonable steps to avoid abandoning clients who are still in need of services. Social workers should withdraw services precipitously only under unusual circumstances, giving careful consideration to all factors in the situation and taking care to minimize possible adverse effects. Social workers should assist in making appropriate arrangements for continuation of services when necessary.
(c) Social workers in fee-for-service settings may terminate services to clients who are not paying an overdue balance if the financial contractual arrangements have been made clear to the client, if the client does not pose an imminent danger to self or others, and if the clinical and other consequences of the current nonpayment have been addressed and discussed with the client.
(d) Social workers should not terminate services to pursue a social, financial, or sexual relationship with a client.
(e) Social workers who anticipate the termination or interruption of services to clients should notify clients promptly and seek the transfer, referral, or continuation of services in relation to the clients' needs and preferences.
(f) Social workers who are leaving an employment setting should inform clients of appropriate options for the continuation of services and of the benefits and risks of the options.
ETHICS GUIDELINES OF UNITED STATES ASSOCIATION FOR BODY PSYCHOTHERY (USABP), 1999:
http://www.usabp.org/associations/1808/files/USABPethics.pdf
IV. AVOIDING HARM
3. Body psychotherapists do not engage in sexual intimacies with individuals they know to be the parents, guardians, spouses, partners, offspring, or siblings of current clients. Body psychotherapists do not terminate therapy to circumvent this rule.
6. Body psychotherapists make reasonable efforts to ensure continuity of treatment. When services must be terminated for a legitimate reason, the therapist makes every reasonable effort to insure that appropriate referrals are made for the ongoing needs of the client prior to termination and makes reasonable efforts to terminate the relationship satisfactorily.
7. Should a client desire to terminate the therapeutic relationship, body psychotherapists provide professional insights into the benefits and consequences of this course of action without explicit or implicit coercion to maintain the relationship against the client's wishes. At all times they make clear the client's right to terminate when he/she chooses.
SUMMARY OF CODES OF ETHICS ON TERMINATION:
These Codes of Ethics provide a detailed review of the principles and standards to be followed my mental health professionals in each of the professions indicated. Despite there being a broad range of professions (Counselors, Marriage and Family Therapists, Psychiatrists, Psychologists, Feminist Therapists, Social Workers, and Body Psychotherapists) a great deal of agreement is seen in how each mental health profession view the clinician's responsibilities regarding termination. It is clear that each profession regards the informed consent process as essential for addressing termination and abandonment issues from the outset. Each mental health clinician must inform clients/patients how to contact him or her in between sessions should an emergency or crisis arise, each must make appropriate arrangements for coverage by a competent professional during periods of absence, and each must address the termination process as an essential phase of treatment.
For termination to be handled in a clinically effective and ethical manner discussions between clinician and client/patient should occur, when possible, in advance and be addressed in a thoughtful and sensitive manner in anticipation of it occurring. Clients/patients should not be abandoned and should treatment need to end and ongoing treatment needs remain, efforts must be made to assist clients/patients to obtain needed services through help with the referral process prior to ending the present therapeutic relationship. In fact, the Codes of Ethics of the mental health professions are consistent in requiring that clinicians assess each client's/patient's ongoing treatment needs prior to initiating termination. This is essential so that the clinician may ensure that any ongoing treatment needs are adequately addressed through the referral process.
Several Codes of Ethics make it very clear that mental health professionals do not terminate professional relationships for the purpose of pursuing a personal, social, business or sexual one. It is clear throughout the mental health professions that the focus is on the client's/patient's needs and not on the clinician's. Around the issues of termination, like with any other clinical concern, mental health professionals do not engage in exploitation or abuse of the power inherent in their role in the professional relationship. The Codes of Ethics make it clear that treatment termination motivated by gratification of the clinician's needs is a form of exploitation. Terminations of treatment should be determined by each patient's/client's clinical needs.
It is also acknowledged in several of these Codes of Ethics that at times mental health professionals may need to terminate the professional relationship without the opportunity for advanced notice. It is stated that this is done only in the most unusual circumstances such as "when threatened or otherwise endangered by the client/patient or another person with whom the client/patient has a relationship" as stated in Psychologists' Ethics Code (see above). It is also made clear that mental health professionals terminate treatment services at times to promote the best interests of their clients/patients. Examples include when providing further treatment likely would prove harmful, when the client/patient is not benefiting from treatment, when the client's/patient's treatment needs no longer remain within the mental health professional's areas of professional competence, and when a multiple relationship that is either inappropriate or incompatible with on going treatment is discovered or initiated.
