What to Know About Therapy Termination

What Does 'Termination' Mean in Therapy?

Termination can occur quickly if a client’s needs change or the therapist is suddenly unable to practice, or it can include discussion for several sessions.

In some cases, the client comes specifically for short-term therapy (for example, if they are using an Employee Assistance Program that only allows a set number of sessions), and the client and therapist discuss termination from the first session.

All therapy relationships come to an end at some point, so it can be helpful to understand how this process can look and what it means to terminate therapy.

Different Reasons to Terminate Therapy

Two main ways that therapy termination occurs are when the client is going to stop receiving therapy or when the client will continue to receive services through a different provider. There are many reasons why both types of termination occur.

If a client is terminating with one therapist and will continue to see a different provider, the reasons for this include:

• The client or therapist feels that there is not a good fit between them, and this will impede treatment progress. This often occurs early in treatment.
• The therapist or the client is moving away, and the therapist is not permitted to continue offering services to the client due to jurisdictional issues.
• New symptoms arise for the client that are outside of the therapist’s expertise, and they recommend another provider to ensure that the client gets the best possible care.
• The client has seen their current therapist for a long time and feels that a new therapist might help them address things or make progress in a different way than the current therapist can.

Reasons why a client might terminate therapy completely include:

• The client chooses to stop coming regardless of whether they feel they have made progress. Dropping out of treatment prematurely can prevent them from getting appropriate support, and giving clients a voice in their treatment is an important factor in ensuring that clients get appropriate care for as long as they need it.
• The client wants to take a break from treatment for any reason and plans to return in the future.
• The client loses insurance coverage and can no longer afford services. (Often when this occurs the therapist can work out a sliding scale fee, but some organizations will not allow therapists to do this.)
• The client has achieved their treatment goals and no longer needs continuing services.

Common Concerns About Terminating Therapy

Change is often anxiety-provoking, and the end of a relationship can bring up many different feelings. Termination in therapy is no exception to this rule.

You Feel Anxious About Starting Over

If a client is transitioning to a new therapist, they might be worried that they will not connect with the new therapist. They might have anxiety about “starting over” with the therapy relationship. It takes time to build trust with a new therapist, just like it probably took time to build trust with the previous therapist.

In many cases, the terminating therapist can provide a referral to someone that they trust and know will be able to help.

You're Worried About the Efficacy of a Different Treatment

If a client is transitioning to a different type of care, they might be worried that the unfamiliar treatment will not be effective. No intervention or method of treatment is right for everyone, and it is possible that even a treatment that has helped others with similar symptoms will not help someone else.

Talk with your therapist about what your options are if you feel that the new therapy is not the right fit. They can give you information about what to expect and how to know if it is not a good fit.

You Fear a Symptom Relapse

Clients who have achieved their treatment goals might have anxiety about termination because they worry symptoms could re-emerge in the future.

You May Feel Sad

Finally, clients might feel sad or grieve that the relationship with their therapist is ending. Especially if therapy lasted a long time, they feel a connection to their therapist and will miss the relationship. This grief is something that you and your therapist can work through as you prepare for your final session.

How to Know It's Time to Terminate Therapy

Often, the therapist reviews the client’s treatment plan on a regular basis and notes the client’s progress. If the client seems to be achieving these goals, the therapist might suggest talking about termination. However, the client can also bring up termination at any time.

If either the client or the therapist notices that progress has stalled, they might bring up the possibility of making an appropriate referral. Again, this is to ensure that the client continues to get the best possible care.

When Termination Is Not The Right Option

If the therapist brings up the topic of termination and the client is not ready, it is OK to share this. You and your therapist can work together to decide what the best course is going forward.

Some clients reduce their sessions to once every few months or keep the option to call and have sessions on an occasional, as-needed basis when significant stressors arise.

What Does a Final Session Look Like?

It can be difficult to say goodbye to your therapist, and some clients might choose to end therapy abruptly by not coming back. While this is their right, and they can choose not to work through termination with the therapist, it can be beneficial to process the termination together before ending therapy.

A final therapy session can look many different ways depending on the therapist’s style and the type of treatment offered. Termination sessions often include reviewing the client’s treatment and the progress they have made over time, as well as how they will use the skills and insight they learned going forward. It may also include safety planning for future triggers or stressful situations.

Some clients might want to give their therapist a termination gift to mark the transition and express their gratitude. Check with your therapist first, as ethics codes have different guidelines around accepting gifts, and some employers have rules about whether the therapist is permitted to accept a gift from a client.