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order to appreciate—and
understand—life fully, you must come to terms with death.
And, just as beginnings and endings are integral to life, they are also central
to human psychology. Consequently, once psychotherapy
begins, its ending—its termination—becomes a vital presence
in the psychotherapy.
In regard to
the termination of psychotherapy, you might be surprised to discover that
the critical issue in most cases is not the reason for termination but
the manner in which the termination occurs.
But first, before
considering the issues related to termination, let’s consider the matter
of how long treatment might take.
How Long Should
Treatment Take?
The length of treatment
depends on the nature, the severity, and the extent of the emotional wounds that have
afflicted you—and those criteria in turn affect the strength of your resistance
to change, which in turn affects the length of the treatment. For example,
someone who experienced a lack of parental involvement
and guidance in childhood, but who had supportive friends and teachers throughout
childhood would likely be receptive to changing old patterns of thinking and behavior
and so might need anywhere from a few weeks to a few months of weekly sessions of
treatment. In contrast, someone who experienced repeated parental
abuse throughout childhood, who lacked a supportive
social network throughout childhood, and who experienced continued emotional
trauma as an adult would likely develop strong
defenses resistant to facing the pain of the abuse, resistant
to changing behavioral patterns, and resistant to relinquishing the desire for revenge
on the abusers. Overcoming those resistances could take several years of weekly
treatment.
Therefore, considering
that the length of psychotherapy is not a fixed length, we can start to consider when
and how to terminate the treatment.
Reasons for
a Client to Terminate Treatment
Unless psychotherapy
begins under a specific legal contract, such as the purchase of a complete
treatment program, we can state one general principle about the course of
treatment: If you begin treatment voluntarily, you
may terminate treatment at any time, for any
reason.
• |
The
best reason to terminate psychotherapy
would be that you have come to understand your life and its
unconscious motivations to such an extent that you no longer need a
psychotherapist to guide you. If you began psychotherapy feeling as if your
psychotherapist were almost a god, you end psychotherapy realizing—as
the psychoanalyst Jacques Lacan taught—that
your psychotherapist is no more necessary to you than any other person.
This isn’t an insult; it just means that you have more
or less “dissolved” all your illusions about finding your
identity
in other persons. |
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• |
There can also
be less admirable reasons for terminating
psychotherapy. For example, some people might start psychotherapy because
they are unemployed and feel depressed. After a few sessions they might find
a job, start feeling better, and decide to quit psychotherapy. Maybe they
didn’t really come to terms with the unconscious
basis of their depression, but if they want to stop psychotherapy, they have
the right to do so.
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The psychotherapist
might not think it’s a good idea for someone to leave psychotherapy and
might even note in the client’s chart
that the client terminated psychotherapy Against Medical Advice (AMA).
But AMA is just a legal device to protect the psychotherapist in case of
a future lawsuit, so that the psychotherapist can say to the court, “But
I warned the client!”
Nevertheless,
regardless of what your psychotherapist thinks, you can do whatever you want.
It’s your life.
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• |
Then there are
pragmatic reasons for terminating
psychotherapy, exemplified by those cases when a client, having been in
psychotherapy for a while and having done good hard work, receives a job
offer in another city or state and decides to move. Or maybe the client has
made good progress in psychotherapy, feels more confidence, and decides to
go back to school—but no longer has the time for psychotherapy. Or maybe
financial issues prevent the treatment from continuing. These are not necessarily
“foolish” decisions, even though the client might still have unresolved
psychological conflicts. The point here is that not everyone wants to, or can afford
to, pursue psychotherapy to the point of deep
unconscious healing. For some persons, “good
enough” may be good enough. |
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• |
There are also
unfortunate reasons for terminating
psychotherapy. Through good work clients can find relief from their initial
symptoms, but then they might also start to
encounter some deeper unconscious
issues that frighten them. So they find reasons to leave
the treatment. The reasons may seem pragmatic, but they really are excuses for
the clients to run and hide from their own unconscious. |
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• |
There can also
be safety reasons for terminating
psychotherapy. For example, a psychotherapist might make a serious clinical
mistake (not just an unpleasant interpretation), and a client might believe
that trust has been broken. If the client makes an effort to speak about the
problem within the treatment but isn’t given a competent explanation,
there may be no other option than for the client to terminate treatment for his
or her own psychological safety.
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Note that if your
psychotherapist does something illegal or unethical—such as try to have
sex with you—then you would be well advised to terminate psychotherapy
and make a consumer
complaint to the psychotherapist’s licensing board. |
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The Manner of
the Termination
The only way
to terminate psychotherapy honestly is to talk about it. So take at least one or
two sessions to review your treatment before leaving. Remember how your life
once was. Recognize what you’ve learned and how you’ve grown because
of the psychotherapy. Recognize also what still needs to be done. Assess your
weaknesses. And then look ahead to anticipate future problems and plan strategies
to cope with them.
Ways to avoid
a proper termination:
• |
If you simply
stop coming to sessions and don’t return your psychotherapist’s
messages, for example, that’s hiding,
not terminating. |
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• |
If you get involved
with a new “lover,” for example, and find psychotherapy to be
inconvenient for your dating schedule, that’s running,
not terminating. |
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• |
If you get angry
at your psychotherapist because of transference and
quit psychotherapy rather than deal with your feelings within the psychotherapy,
that’s bolting, not terminating. |
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But if you have
terminated the treatment honestly and politely, you also have the option
to return to treatment again in the future—either for a one- or two-session
“tune up” or to work on deep issues still unresolved.
Termination by
the Psychotherapist
There can also
be times when psychotherapists must terminate treatment.
• |
Psychotherapists
in training who work in an agency may leave the agency at the end of an
internship, and treatment with all of their clients will have to be
terminated, sometimes prematurely. |
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• |
Sometimes
psychotherapists who work for an agency will decide to leave the agency to
go into private practice. Things can get sticky here because if a
psychotherapist tries to take any clients from the agency into the private
practice, the agency might claim that the psychotherapist is
“stealing” its clients. So the psychotherapist has to be very careful
about how everything is presented to clients. Nevertheless, clients are free
to do what they want. |
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• |
Sometimes
psychotherapists will have countertransference issues
that can interfere with the treatment. Psychotherapists may have to consult
with peer professionals to discuss their cases, and it may be decided that
circumstances ethically require the termination of treatment to protect a
client’s best interests.
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Countertransference
problems will be minimized if psychotherapists have had intense training
in psychodynamic psychotherapy or
psychoanalysis. For example, a client and
psychotherapist may have opposing political views, and the client may have
a tendency to argue politics; but if the psychotherapist has the expertise
to keep the treatment focused on the underlying
emotional issues—rather than get caught up
in surface arguments—then the psychotherapist’s personal feelings
need not become a problem.
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• |
Sometimes
psychotherapists will realize that the psychotherapy has moved into an area
that requires expertise they do not have, and trying to continue
psychotherapy without proper training or supervision would be an ethical
violation. |
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• |
Sometimes a
managed-care company will decide that treatment
must be terminated. This is usually done for practical business reasons that
have nothing to do with the client’s welfare, but psychotherapists
on the case can lose their jobs for not following orders, even if it is
not in the client’s interest to terminate the treatment. Psychotherapists
in such a position should seek legal advice immediately, lest their
licensing boards take action if their clients file complaints. |
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Regardless of
the reasons for a psychotherapist needing to terminate the treatment,
psychotherapists are bound by ethics to treat their clients with due respect and
consideration in all things, including termination. The reasons for termination
should be discussed fully and honestly. Clients should be given enough advance
notice so that their emotional reactions can be carefully processed.
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If the
client-psychotherapist relationship is an issue contributing to the need
for termination, then any block to the client and psychotherapist working
together effectively may prohibit a full processing of the termination
itself. |
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Finally, a suitable
referral to another psychotherapist should be made, if necessary.
Legal Aspects
of Termination
If your psychotherapy
was not entirely voluntary—that is, if it were court-ordered, for
example—then premature termination will be a violation that will cost
you dearly. But in any other case there shouldn’t be any legal problems.
Just remember these points:
• |
Even
after psychotherapy has terminated, you still hold the
privilege
of confidentiality. Your psychotherapist
cannot reveal anything about your treatment without your permission. Your
psychotherapist will also have the legal obligation to retain your treatment
records (or “chart”) for quite a while, according to state law.
For example, California law (Health and Safety Code section 123145) requires
that records be kept for a minimum of seven years, but this law does NOT
APPLY to private practice settings. Hence psychologists in CA are referred
to the Specialty Guidelines for the Delivery of Services by the American
Psychological Association which recommends that full records be maintained
for three years after termination and that summary records be maintained
for an additional 12 years. |
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• |
You
may request that your treatment records be sent to another qualified
professional. Note that your original
psychotherapist has a legal right to the chart itself, so only copies of
the information in your chart will be sent. |
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If a
person dies while in psychotherapy, or after psychotherapy,
privilege—including
the right to see the psychotherapy records—usually passes to that
person’s estate. In such a case,
professional legal advice may be needed. |
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Clinical questions
about the termination of psychotherapy can be found
on the Questions and Answers About Psychotherapy
page.
No
advertising—no sponsor—just the simple truth . . .
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Additional
Resources
CA Law:
Legislative Council
Website —the official site for California legislative information.
Search their database for any law you can think of.
CALIFORNIA CIVIL CODE —Table of Contents
CALIFORNIA HEALTH AND SAFETY CODE —Table of
Contents
CALIFORNIA EVIDENCE CODE —Table of Contents
CALIFORNIA PENAL CODE —Table of Contents
CALIFORNIA WELFARE AND INSTITUTIONS CODE —Table
of Contents
Related pages within A Guide to Psychology
and its Practice:
Choosing a
Psychologist
Confidentiality
Consumer Rights and
Office Policies
Fear of
Psychotherapy
Legal Issues
Psychology: Clinical
or Counseling or ...?
Psychology and
Psychiatry
Questions and Answers
about Psychotherapy
Reasons to Consult
a Psychologist
Types of Psychological
Treatment
CONTACT ME
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