Client termination

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Looking for feedback regarding patient termination. If you have a patient who wants to terminate, how do you handle it? If the client sends an email indicating they want to stop, do you ask for one more session? Do you prefer speaking with them in person? Assuming this is a longtime client of over a year? Not just someone you had a few sessions with. Interested in how you handle this and if varies by client. Thanks for any replies!

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Really depends a lot on context. In my current role, we place a lot of emphasis on getting people through so it is quite rare I am still seeing someone after a year (though many return for boosters or another course later). Some exceptions obviously. DBT team keeps folks longer. Sleep team is usually < 8 sessions. From the get go, I encourage folks to talk to me about the process and be open about it.

In general, I will say that planning around the termination process was definitely something I found hugely overemphasized in graduate school and completely different from how it works elsewhere. Chances are, no conversation will happen and they will just ghost you one day. In hindsight, I think a lot of the grad school training was about managing the emotions of the trainees by fostering a sense of control than anything else. Your time for tracking them down will be limited. You may or may not even be doing your own scheduling. Many will be terminating for financial reasons. If someone's insurance drops, they are already hard up, and they need to pay $200 out of pocket to see you...are you really going to try and talk them into "just one more." I sure wouldn't.
 
At my training site we're expected to have termination sessions in person whenever possible. I don't plan for this at the start of therapy, but instead just wait for it to come up naturally. When the client expresses an interest in terminating I hear their perspectives on how they're currently doing and their thoughts on how future challenges will be addressed. If everything sounds good then I let them know they're welcome to return if they need support in the future, but otherwise wish them well and close their file. For a client who just can't make it in for whatever reason then a phone session will have to do. For clients who ghost without a formal termination session I call and send a letter stating their file will be closed, but they are welcome to seek services in the future.
 
Thanks for your perspectives. It sounds like you’re sensitive to individual client’s needs.
 
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