When clients decide to stop
clinical work, the termination session or process is often the final
chance to make useful interventions. Some clients terminate passively by not keeping an appointment
and not calling for another. Others ask the clinician's opinion about
stopping, and still others decide on their own and seek closure. The last
possibility is that the clinician terminates
the work for various reasons.
This article offers perspective and suggestions on the last three
situations with two groups of clients: (a) those who are
not recovering from psychological wounds, and (b)
those who are.
Premises:
-
some
ways of terminating are more effective than others, and...
-
an
effective termination
leaves all people concerned
feeling...
-
satisfied that the work and investment were worthwhile,
-
heard and mutually respected; and if appropriate...
-
feeling
open to possibly continuing the work in the future.
For
perspective, compare this to how you felt terminating with any professional
consultants you've used along the way...
Common Options
This model proposes that in any solitary or social situation, each
person has current surface and underlying primary
This suggests identifying "What do typical clients and clinicians need at
termination? Consider these options...
-
The client and clinician probably need to
review why they did this work together - i.e. what clinical goals were
agreed on, and what resulted? One way of doing this is for the clinician
to ask an open-ended question like "Recall your life when you initiated
this work. What, if anything, would you say is different about your life
and situation now?"
-
A mutual need is to affirm that the
client's growth and healing are ongoing, not an event, and that this work
was an important phase of this long-range process.
-
The clinician may need honest (vs. polite)
feedback on what interventions and traits were useful to the client, and
any that weren't.
-
The client may need to hear the clinician's
(a) opinion on the odds of and any limits to - further improvements for them and their family,
and (b) suggestions for further work.
-
Each needs to feel clear on responsibilities
related to any financial issues related to the work - e.g. insurance
paperwork, treatment summaries, bills, etc.
-
The clinician may need to refer the client
to another
human-service program or provider for further or different work.
-
The clinician may need to summarize key
suggestions made during the work, and encourage the client to remember
and implement them. This summary can include specific comments on
beneficial changes in the client's...
-
basic
attitudes and
- specially improved self-respect,
and confidence;
-
and faith;
-
clarifying and acting on their life purpose;
-
communication and problem-solving knowledge,
and
-
freeing any
blocked grief, and/or promoting a
-
managing any toxic
-
resolving one or more stressful
-
negotiating a difficult life-transition,
like adapting to a new occupation, child birth or death, retirement,
divorce, disability, financial condition, or similar;
-
reducing the effects of the [wounds +
unawareness]
on their descendents;
-
successfully resolving one or more primary
relationship and/or family
and...
-
any other key situational topics.
Option - provide the client with a
written summary of any of these, and include it in case documentation.
-
The client may need to thank the clinician
for his or her skill, efforts, and encouragements; and/or the
clinician may need to appreciate things about the client - e.g.
consistently being on time, remembering appointments and/or giving
appropriate notice of cancellations, openness to trying new things, and risking
honest disclosures during the process.
-
Both need some sense of temporary or
permanent closure to their relationship and common effort. If
significant bonding occurred, each person may need to
-
either may need to "check in" periodically
with the other by phone or email for various reasons;
-
The clinician may need to review the case
progress and process with a supervisor, consultant, co-worker, or
peer-review group, and identify key learnings;
and...
-
Any other situational needs unique to this
client and situation.
Can
you think of other things a typical clinician and any clients need when
they terminate?
Clients not in Wound-recovery
My
clinical experience since 1981 with over 1,000 typical Midwestern Anglo individuals, couples,
and families is that a high percentage of typical divorcing-family
and stepfamily clients are managed by one or more
(GWCs)
in
of their (a) childhood
and
and (b) their personality subselves and false-self dominance, and (c) how
these relate to their presenting (surface) problems.
Whether the clinician has
explicitly described these during the work or not,
most client adults are not ready to commit to wound
recovery during the work unless they have hit
With
GWC clients in denial, I
propose that clinicians are ethically responsible to emphasize the value of
eventual recovery from
psychological wounds as part of any termination process - specially if living
and/or unborn kids are involved. An ecological way of doing this is to give
the client one or more handouts describing
subselves, wounds, and personal
recovery. You're welcome to copy and
pass on any of the materials in this non-profit site, with this
If
you've been working with several family members - including kids - it's
helpful to have everyone who participated in the work (and perhaps family
members who haven't) attend a termination session. Ideally, this will
include both divorcing parents and any new partners of theirs. This
gives each person a chance to express their feelings about the work and
any effects, hear and react to others' comments, and affirm themselves and
each other for any progress. In typical low-nurturance families a focused,
well-moderated family meeting like this is
rare.
If the client is a divorcing
family, this is the clinician's final chance to fill the needs
above and...
-
frame
as a family learning opportunity vs. a "failure,"
-
define a successful
divorce, and encourage parents to
strive for that together in the coming years; years;
-
summarize key divorce-recovery
needs for adults and kids (option - provide a written
checklist or summary like this).
-
recap the concept and value of a healthy
family
and...
-
recommend any appropriate
support resources.
If the client is a courting
couple with one or more prior kids - in addition to filling the
needs above, use termination to recap and emphasize...
-
the
[wounds + unawareness]
that may threaten the clients and their descendents,
-
five related
that stress most stepfamily re/marriages, and...
-
the long-term benefits of each partner
making three informed
commitment
by patiently working together on
over many months. Option - show the couple a copy of the related
guidebook
Stepfamily Courtship (Xlibris.com, 2002)
Option - document these suggestions and resources in a handout.
Clients in Wound-recovery
You may have been working with (a) a divorcing-family or stepfamily in which one
or more adults are committed to personal wound-recovery, or (b) with a
recovering individual. Effective termination with each of these client-types differs in
several respects from ending with non-recovering wounded clients.
Terminating with
Recovering Families
The key difference about these clients is that one or more of the family
members has committed to reduce their
psychological wounds and harmonize their personality subselves under the expert
of their resident
Other family members may be indifferent,
skeptical, curious, anxious, or
supportive.
In addition to appropriate topics above, a termination session may be
the last time the client family members will hear...
-
a
summary of the [wounds + unawareness]
and its
and...
-
an informed, professional opinion on...
-
if and
how the cycle is stressing their family via psychological wounds, and
threatening their descendents; and...
-
the client-family's
and what that means for
marriages,
kids, and future generations; and...
-
the concrete personal and family
benefits,
over time, of true (vs. pseudo) wound-recovery; and...
-
an invitation to help other people learn of
these vital concepts and help to break
the cycle in local or larger society.
Options - (a) document these suggestions
and resources in one or more handouts, if you haven't done so before, and/or
(b) invite the person/s in recovery to continue individually with you or
another qualified clinician.
Terminating with Recovering
Persons
Many variables determine how long a recovering adult works with a clinician
and when and why the client chooses to end. Some clients will be in pseudo
(trial) recovery where some subselves seek healing, and others oppose it. Some will be in preliminary
(addiction)
recovery, and others in full (wound) recovery. Though each case is
unique, some general
termination suggestions apply:
-
Summarize
subselves are created and cause
psychological wounds, and what that usually
-
Summarize the key steps in,
requisites for, and
life-long
benefits of true personal wound recovery;
-
Hilight specific inner-family changes the
client has made so far, and affirm any related benefits s/he has
reported;
-
If appropriate, (a) frame
pseudo recovery as
valuable learning experiences, not "failures;" and (b) note the value of
including
exploration and growth as an essential aspect of effective wound
recovery and
-
Summarize useful recovery steps and
techniques the client can
adopt or continue (e.g. inner-family dialogs, council meetings, and
-
Recap the types of recovery
support that are available locally and on the Web, and the value of
experiencing a range of them, over time;
-
Encourage the client to keep building the
reflexes of (a) sensing who is leading their subselves in any situation
- their true Self (capital "S") or other reactive, well-meaning,
distrustful subselves, and (b) brainstorming effective options when a false
self disables
with) the Self;
-
Emphasize the long-term recovery and social benefits of practicing
effective communication
and include...
-
Any other termination options relevant to the
particular client and work.
Option - document these suggestions
and resources in one or more handouts, if you haven't done so before,
When the Clinician Needs to Terminate...
Circumstances causing a clinician to end work with a client can include:
-
personal reasons, like illness or
disability, retirement, moving away, new family responsibilities,
clinical overload, or taking a new job; or...
-
the clinician feels s/he has nothing further
to offer the client; or...
-
the clinician feels disrespected or ignored by the
client too often; or...
-
the client often comes to sessions in an
altered state from drugs, despite requests not to; or...
-
the clinician doesn't like or respect
the client, and/or can't condone and enable the client's
unethical or illegal behaviors.
In all cases, the clinician needs to
(a) have her or his Self make the decision, and to (b) honor her or his own
integrity and ethical responsibility by being clear and honest with the
client about
the reason/s for termination. The clinician can choose whether or not to
define conditions for resuming the work in the future - e.g. "If you choose
to attend 12-step meetings for six months and are drug free for that time,
call me." The client probably needs to own and express feeling abandoned, frustrated, disappointed, and perhaps
resentful. If wounded clients repress, intellectualize, or minimize
these reactions, the clinician can facilitate their feeling and
expressing these appropriately.
In some cases, this is a final chance to respectfully propose that any
traits or behaviors of the client contributing to the termination (e.g.
chronic interruptions, lateness, drug usage, defocusing, over-explaining,
arguing, etc.) are evidence of probable false-self dominance. It may or may
not be appropriate to make a referral to another clinician or program.
If the clinician is ambivalent about terminating, consulting with a
supervisor, case manager, or colleague can provide useful perspective.
Recap
This article offers perspective and
options for effective termination of clinical service to
divorcing-family and stepfamily clients, and persons committed to false-self
wound-recovery. Basic premises: (a) a termination session offers the last
chance for useful interventions, and (b) the clinician and each
participating client has specific needs to fill for termination to be
mutually effective. The article proposes a set of common clinician and
client termination-needs, and suggests special needs for (a) clients who deny psychological wounds and their effects, and (b) those who admit them and are committed to
some form of personal healing.
Pause and reflect - why did you read this article? If you got what you
needed, what do you need to do next? If not, what
you need?
The Web address of this article is
https://sfhelp.org/pro/rx/terminate.htm