What Does A Psychotherapist’s Termination Letter Include?
Some may be associated with a group of professionals, including other therapists. In all cases, record-keeping is an important component of good client care.
The clinical record serves as an important reference document and should be complete and accurate. Clinical records Clinical records encompass a client profile personal information provided by the client at the outset of the therapeutic relationship and corresponding treatment records. They are kept on a client-by-client basis. When more than one person e. However, when the couple or family attend in different combinations, the member should generally keep separate files or sub-files for each individual.
For example, if one member of a couple attends for an individual session, a file for the individual session should be maintained separately from the file for the couple. Similarly, in a group therapy setting, records for the group may be maintained in one file. A unique identifier is a code e. If using unique identifiers, members must securely maintain a key linking each client to their unique identifier.
The clinical record should also include where relevant: the date of every consultation the member receives from another healthcare provider, or the member provides to another healthcare provider, regarding service provided to the client; specific information related to any referral made by the member regarding the client; notes, forms and other material, regardless of the medium or format i.
Maintaining separate records RPs may maintain additional notes and documentation, e. It is important to note that the entire record must be managed in accordance with legal and College requirements. The record, including any separately maintained notes and documentation, must be made available to the client upon request in accordance with PHIPA. In addition, disclosure of the entire record to a third party may be legally compelled, and members should exercise caution when considering what information to include in the record.
If the client was self-referred, this should be noted as well. Plan for therapy The plan for therapy will depend on particular circumstances including the therapeutic approach or model used. It will also include any reports on tests administered to the client. As the therapeutic relationship continues, changes in the therapy plan will also form part of the record.
The initial plan establishes the direction of therapy and helps guide future sessions and evaluate change. The therapy plan may be updated, and will include both subjective and objective information. Subjective information is relevant information provided by the client. Objective information is relevant information observed by the member. Client contact The record includes a notation of all in-session and out-of-session contacts with a client, including any advice or directives given.
Examples of out-of-session contacts with clients include letters, emails, texts, telephone calls and videoconferencing. The documentation should provide a clear record of the incident, which can be used to explain the event and relevant details surrounding it.
Mandatory reports There are certain circumstances where federal or provincial laws require the member to advise a person or organization of a serious concern e.
Members keep a record of all such mandatory reports they make. If the report was not made in writing, members maintain details of the report in their records. Amending records Every entry into the clinical record indicates who made the entry and when. If an amendment to a record is needed, the amendment should indicate what change was made, when, by whom, and why, making sure that the original entry is still legible.
Accessibility of records Records are prepared and maintained in a timely and systematic manner. Regardless of how the information is structured or stored, it is important that client records are easily accessible.
The Standard: Record-keeping — Clinical Records Members keep an accurate and complete clinical record for each client. Members provide access to legible client records, when requested to do so by a client, authorized representative or another legal authorization.
College publications are developed in consultation with the profession and describe current professional expectations. It is important to note that these College publications may be used by the College or other bodies in determining whether appropriate standards of practice and professional responsibilities have been maintained.
6 Strategies for Ethical Termination of Psychotherapy
It may occur as an anticipated and well-articulated treatment plan that indicates the next phase of the psychotherapy process or it may occur precipitously or by surprise.
How termination should be seen is both a clinical and ethics issue. These two issues are intertwined and each should be seen as essential for meeting our obligations to our clients. While there is much more to the topic and psychotherapists will hopefully immerse themselves on the literature on termination, this brief article suggests six essential strategies that lay a solid foundation for meeting these obligations to our clients. Address Termination Issues from the Outset. Include in the Informed Consent Discussions and Agreement The process of informed consent is intended to share all relevant information with clients so that they can make decisions about participation in the treatment services being offered Barnett, When psychotherapy is being provided by a trainee this is a crucial issue as trainees typically have an end date to their time at each setting.
Clients have the right to know from the outset if their psychotherapist will be there for them for the next five months or for the next five weeks.
This enables them to make informed decisions about participation and helps to prepare them for what is to come, helping them to participate more fully in the process, and thus, hopefully to benefit more fully from the experience. But, in order to know when treatment should end, there must first be an agreement on the goals of treatment.
While treatment goals may be modified over the course of treatment as clients make progress and life circumstances change, failure to have an open discussion of goals from the outset and failure to reach agreement on what these goals are impacts the nature, focus, and scope of the treatment offered as well as when and how this treatment will end Davis, Have a Professional Will Psychotherapy can end for a variety of reasons.
As is highlighted above, the most desired reason for ending treatment is that the client has achieved the agreed upon goals of treatment. But, psychotherapy may end for a variety of reasons, both client and psychotherapist initiated.
While some possible interruptions to treatment may be anticipated and planned for e. It is recommended that each psychotherapist make advance arrangements with one or more colleagues to step in and offer assistance to clients when any of these events occur. While each of these cannot be anticipated from the outset of treatment, open discussions with clients about their progress in treatment and any issues that may impact their ability to continue should be explored at least periodically.
To fulfill our obligations to clients, even when they initiate termination, we should ensure a reasonable good faith effort to help address any ongoing treatment needs. While we are not required to meet client treatment needs indefinitely, and doing so in some of these situations is not practical, offering assistance in connecting with alternative treatment resources is important to do whenever possible.
When clients discontinue treatment, for any reason, before the agreed upon goals of treatment have been achieved, it is recommended that the client be contacted either verbally or in writing to make recommendations for addressing any ongoing treatment needs, offering options and alternatives, and offering assistance in procuring them.
Sample letters that may be sent to clients to address these issues may be found in Barnett, MacGlashan, and Clarke and in Vasquez, Bingham, and Barnett The latter may include failure to make needed coverage arrangements during periods of anticipated absence such as vacations, attending a conference, or other times when client access to the psychotherapist may be limited.
Charges of abandonment may even arise from not being sufficiently accessible between regularly scheduled treatment sessions. It is vital that reasonable expectations be established from the outset, with clients being provided with information on how to access the psychotherapist between sessions, when it is or is not appropriate to contact the psychotherapist, and the preferred means of contact.
It is not abandonment when a client drops out of treatment precipitously or when the client does not fulfill treatment obligations. Nor is it abandonment if the client cooperates with treatment recommendations and the treatment is ended appropriately, after discussion, with notice, and with referrals being made; and in fact, these actions may not be necessary in situations where the psychotherapist is threatened or assaulted.
When continued treatment is not possible or not indicated based on client actions and responses, ending the treatment is not seen as abandonment. Of course, documenting all such situations, discussions, consultations with colleagues, actions taken, and efforts to contact clients, should occur on an ongoing basis. If possible, treatment endings should not come as a surprise. Work collaboratively with clients toward successful treatment endings.
Termination should be considered a process and not an event. Concluding Thoughts How the psychotherapy relationship and process end has important implications for our clients. It is hoped psychotherapists will consider the guidance provided in this brief article when considering your approach to this essential aspect of psychotherapy. Addressing endings from the beginning, and on an ongoing basis throughout treatment, can help ensure that treatment is provided and ended in an ethical and clinically competent manner.
Efforts to reduce misunderstandings and to be responsive to client needs can help prevent claims of abandonment.
We can each institute practices that will help us to fulfill our obligations to clients. Further, keeping up with the literature on termination practices is recommended as part of our ongoing professional development and lifelong learning as psychotherapists. Ethical Principles of Psychologists and Code of Conduct. Informed consent in clinical practice: The basics and beyond. Termination and abandonment: A proactive approach to ethical practice.
Retrieved from www. Risk management and ethical issues regarding termination and abandonment. Jackson Eds. Davis, D. Terminating therapy: A professional guide to ending on a positive note. Ethical competence in psychotherapy termination.
Professional Psychology: Research and Practice, 40 6 , Hardy, J. How to survive and thrive as a therapist: Information, ideas, and resources for psychologists in practice. Vasquez, M.
Psychotherapy termination: Clinical and ethical responsibilities. Journal of Clinical Psychology: In Session, 64, — Younggren, J. An ethical and legal review of patient responsibilities and psychotherapist duties. Professional Psychology: Research and Practice, 42 2 , Termination and abandonment: History, risk, and risk management. Professional Psychology Research and Practice, 39 5 , You Might Also Like:.
Termination, Therapists’ Retirement and Professional Will
Beginnings and endings: time and termination in psychoanalysis. Contemporary Psychoanalysis, Mendenhall, Susan Termination guidelines. The Central Valley Therapist, Alliance and termination status in couple therapy: A comparison of methods for assessing discrepancies, Psychotherapy Research, Apr 5,Bhatia, A.
Psychotherapy, 54 1 Counselling and Psychotherapy Research, 15 1 American Journal of Psychotherapy, 70 4 Gil, E. Termination challenges in child psychotherapy.
Breaking Up Is Hard to Do: Terminating Therapy Before Things Get Out of Hand
Goode, J. A collaborative approach to psychotherapy termination. Parting ways; Anticipating and avoiding problems which commonly occur during termination. Hyman, M. Lane, R. Psychology Press. Jordan, J. Clinical characteristics associated with premature termination from outpatient psychotherapy for anorexia nervosa. European Eating Disorders Review, 22 4 Premature termination in couple therapy as a part of therapeutic process.
Cross case analysis. Archives of Psychiatry and Psychotherapy, 2, Type of counseling termination and trainee therapist-client agreement about change, Counselling Psychology Quarterly, 23 1Leslie, Richard, R. Lutz, W. Additionally, as is highlighted in Standard The client may move from the area such as due to a job transfer, retirement, or seeking employment opportunities elsewhere.
Termination: Ending the Therapeutic Relationship-Avoiding Abandonment
Landmark legal rulings such as Capps v. Valk and Collins v. Meekerand reaffirmed in Sparks v. Hicksset a legal precedent on termination and abandonment. What the clinician must do, however, is to take necessary actions to help ensure that any ongoing treatment needs the client has are adequately met.
Thus, this standard of care requires that clients not be abandoned but that any ongoing treatment needs be openly discussed as a part of the treatment process and that relevant referrals are made and adequate time is given so that the client may obtain needed treatment. As is stated in the ruling of Capps v. Recommendations for Ethical Practice Include discussions of treatment termination and possible interruptions of treatment, to include emergency contact procedures and treatment coverage arrangements in ongoing informed consent discussions.
FREE 9+ Letter of Termination Samples in MS Word | PDF
Be sure that ongoing treatment needs can appropriately be met either personally or by those to whom you delegate this responsibility and inform clients of these arrangements in advance. Include processes and procedures in employment and practice contracts that ensure that client treatment needs will be met should you leave the practice setting or be otherwise unable to provide needed treatment.
This will help both psychotherapist and client determine if goals were successfully met. Consult with colleagues to obtain a second or third! If treatment needs to be ended when ongoing client needs exist, discuss this openly with the client, offer referral recommendations, and provide some reasonable period of time for the client to make contact with and arrange for treatment with another psychotherapist.
Document all these discussions and actions. Make a reasonable good faith effort to contact the client and go on record with your recommendations for any ongoing needed treatment and the reasons why. Sample letters that may be modified by psychotherapists to fit individual situations and then be sent to clients to fulfill this obligation may be found in Barnett, MacGlashan, and Clarke and in Barnett, Zimmerman, and Walfish Remember that ideally, termination should be planned for, discussed openly in treatment, and be an essential aspect of the treatment process that assists the client toward effective independent functioning.
It is also important to emphasize that termination is not absolute; it should be made clear that clients may contact you if difficulties are experienced in the future and they would like assistance in addressing them at that time. Termination and abandonment: A proactive approach to ethical practice. Retrieved from: www. Ethical principles of psychologists and code of conduct. Risk management and ethical issues regarding termination and abandonment.
Jackson Eds. Barnett, J. The ethics of private practice: A practical guide for mental health clinicians. New York: Oxford University Press. Capps v. Valk, Kan. Collins v. Meeker, Kan. Davis, D. Ethical competence in psychotherapy termination.