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Termination Guidelines

By Jeffrey Barnett, Ph.D., and Ofer Zur, Ph.D.
2008

For an online course on Termination Issues for Mental Health Professionals
for CE Credit, which is based partly on this web page, Click Here.

  • Clarify expectations and obligations from the outset. The Office Policies are the best way to articulate and discuss such expectations and obligations. (For Zur Institute's Clinical Forms, click here.)
  • Be familiar with the relevant guidelines and standards in your professions' Codes of Ethics with regards to termination and abandonment issues. Summary of the different Codes of Ethics on Termination Psychotherapy and Counseling, available at www.zurinstitute.com/ethicsoftermination.html.
  • Some terminations are short and swift, while others may be long and protracted.  Then termination can have different meanings and be just an end of a phase in intermittent-long-term therapy.  The form and type of termination depends on the client, setting of therapy, therapeutic orientation, quality and type of therapist-client relationship and the therapist.

  • If necessary, review with patients their insurance coverage, limits to managed care contracts, and how utilization review may impact on termination. Set up arrangements for addressing patient treatment needs if continued authorization is denied.
  • Make adequate arrangements for coverage during any periods of planned or unplanned absences.
  • Provide patients with referrals to other treatment sources, if needed, and work to assist them in their transition to other health care providers.
  • Do not terminate patients who are in crisis, regardless of payment issues. Provide needed treatment or help them find it elsewhere.
  • Many clients unilaterally decide to drop out of therapy.  They may do that with a phone message or by simply not showing up to their next scheduled appointment.  You must remember that it is the client's prerogative and choice whether to continue in therapy or not.  Except in extreme situations, such as when the client poses a danger to self or others, you need to respect their choice. Do not tacitly condone patients dropping out of treatment when your clinical judgment indicates continued care is needed. When clinically and otherwise appropriate, notify the patient of your assessment and recommendations.  There is no ethical, clinical or legal mandate to send a registered letter to client.  Different clients and situations may require different actions and, at times, lack of action.
  • It is not unusual for therapy to break down rather than go through a smooth, clear or distinct termination process with patients with personality disorders (i.e., BPD) or those who were diagnosed with severe mental illness, such as schizophrenia or Bi-Polar disorders. Termination with these clients can be very abrupt or very long, painful, confusing and tumultuous.  Obviously, each case should be handled according to the specific context of therapy. The context of therapy includes client, setting, therapy and therapist factors.
  • When appropriate, offer referrals and other recommendations and, when relevant, offer to help with the transition to other professionals.  If clients give you written authorizations to disclose information, you can help with the transition to other care givers by providing written or verbal summaries and recommendations.
  • Document discussions of termination issues, agreements reached, decisions made and their rationale, and, when relevant, document the recommendations and follow-ups.  To purchase a Termination Summary form, click here.
  • Termination of treatment is not always a permanent ending of the professional relationship.  Termination is often not relevant during, or an end of phase in, intermittent-long-term psychotherapy.  These forms of therapy may continue throughout the life span of individuals and families.
  • Termination is a phase of each patient's treatment. If possible and appropriate, plan for it, prepare for it, process it. Additionally, each clinician should consider termination in light of their theoretical orientation and treatment approach, each patient's/client's diagnosis and treatment needs, and any relevant diversity factors that might impact the process.


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Ofer Zur, Ph.D., Director 		Sonoma Medical Plaza, 181 Andrieux Street, Suite 212, Sonoma, CA 95476
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