Client termination, whether it is planned or unplanned, is difficult.
It can lead the clinician to having a multitude of emotions. After all, it is the ending of a relationship, which can be a challenging thing for any of us to go through.
To make it harder, most individuals are not taught appropriate techniques to end a relationship. How many of us plan on how we are going to conclude a relationship? We are social beings at heart and are not often focused on planning for the conclusion of a connection nor are we trained in healthy ways to process the ending of a relationship.
Despite these challenges, it is important for clinicians to always be focused on the possibility of termination in order to gain comfort and understanding of how it impacts both the client and clinician.
In an earlier article, I offered some tips on how to deal with planned client termination. In this article, I'll be focusing on unplanned client termination.
The Challenges of Unplanned Termination
Unplanned termination often leaves the clinician wondering what happened and can lead us to ask ourselves the following questions:
- Was it something I said?
- Did my interventions not work?
- Am I even an effective therapist?
For new clinicians, it can shake their confidence in their abilities and leave them thinking, “what’s wrong with me?” It can cause additional anxiety in regards to their interventions and clinical knowledge. Even for experienced clinicians, unplanned termination can lead them to question their own abilities and clinical effectiveness.
As a result of various reasons – such as therapist burnout or the desire to protect the ego – experienced clinicians may be more prone to try to disconnect their abilities from the unplanned termination and attempt to place the blame of an early or unplanned termination on the client instead of honing in on their own behaviors.
A clinician may see early termination as being caused by:
- The client not being ready for change
- The client not wanting to participate in therapy
- A poor match between client and therapist
- A poor match between client and practice
The problem arises when the termination is blamed on these reasons and not thoroughly explored as to how we, as clinicians, can work to reduce some of these influences.
Unplanned Termination is an Opportunity
Whether you are new or experienced, unplanned termination is a fact of life as a clinician and a great opportunity for the clinician to take a step back for some self-reflection. This occasion can serve as an important reminder for clinicians to evaluate their own practice techniques and how these techniques may either help or impede the therapeutic relationship with those we serve.
Reflect on Your Techniques, Styles, & Interventions
During an unplanned termination, it is important for clinicians to reflect on and assess things such as current outreach techniques, clinician and staff interactions with clients, and session styles or current interventions.
By completing this exploration, clinicians can identify and modify these areas after learning how these aspects of the therapy process impact the client/therapist relationship and client’s experience with therapy as a whole. After all, it is the client’s experience that often affects the possibility of an early or unplanned termination.
For example, if clients feel they are getting something out of therapy, they are more likely to commit and stay the therapeutic course. By facilitating techniques to increase commitment to the therapeutic process, therapists can reduce the chances of early/unplanned termination.
Reflect on the Office Environment
Another area to reflect on is the environment of the office. Here are some questions you could ask yourself:
- Are other staff members warm and friendly?
- Does the building and office space appear as inviting?
- How does the area or office setting assist the client in coping with the current stigma of mental health?
These are all important factors for the clinician to think of as they can often impact the client and their potential to return to the therapy office.
It may be helpful for the clinician to try to approach this aspect from the client’s point of view. Think about other offices or places you have visited. What was appealing or welcoming about these areas? Are there ways to replicate these characteristics into your own office space?
By creating a warm and friendly environment, we are helping to put our clients at ease in seeking services, which in turn can reduce unplanned and early termination.
Reflect on Setting Expectations
Addressing expectations of the therapy process is an additional key aspect to explore. Discussing these expectations with new clients at the beginning of therapy can further reduce early termination.
Therapists can also help take the guesswork out of upcoming sessions by orienting new clients as to what to expect regarding style and theoretical orientation and how they can impact the process. The client will have a clearer picture of what will occur in upcoming sessions which will help to alleviate some of the client’s fear of the unknown.
Setting expectations up front also allows for the therapist and client to develop a realistic view of the upcoming therapeutic process and outcomes. Additionally, this can be a great way to begin building a strong and healthy therapeutic rapport without getting too personal too fast or pushing the client before they feel they are ready. This is a great opportunity to ensure that everyone within the therapy room is on the same page. It can also reduce some of the client’s ambivalence towards the therapy process and increase commitment to the process and the clinician as a professional.
It is imperative that clinicians continue to take stock of and fine-tune these areas of the process in order to lower early unplanned termination rates of our clients. If we pay attention and adjust these aspects of therapy, we can create a better experience for those we serve – which will ultimately help reduce the chances of early termination.
Unplanned termination is a necessary and difficult part of our jobs as therapists; however, by taking some of the steps described above, you can make the best of unplanned client termination – and even grow from it.