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Terminating Therapy: A Professional Guide to Ending on a Positive Note

ISBN: 978-0-470-10556-6
290 pages
March 2008
Terminating Therapy: A Professional Guide to Ending on a Positive Note (0470105569) cover image


The first book of its kind to provide an in-depth approach to termination of therapy, Terminating Therapy guides you through the practical, ethical, legal, and emotional challenges of how and when to end therapy. Written for a wide range of practitioners at every level of experience, this book provides straightforward advice on ending therapy on a positive note.
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Table of Contents

Chapter One. Termination Strategy: A Pragmatic Approach In Contemporary Practice.

A. The Importance Of Termination.

1. How Does Theoretical Orientation Impact Termination?

2. How Is Termination Managed In Today's Practice Environment?

3. What Makes Termination Difficult To Plan Even In Brief Therapy?

4. What Circumstances Elevate The Risks Of Adverse Events At Termination?

B. Strategies For Effective Termination.

1. What Are The Main Objectives Of A Pragmatic Termination Strategy?

2. How Can I Distinguish Good Termination From Bad Termination?

C. Summary Points For Applied Practice

Chapter Two. Professional Skills And Termination.

A. Building A Base Of Collaboration.

1. What Is A Collaborative Stance Toward Termination?

2. Is It Useful To Distinguish Types Of Termination?

B. Applying Reasonable Professional Standards.

1. What Are The Standards For Ethically Responsible Termination?

2. What Is Client Abandonment And How Can It Be Avoided?

3. Can Termination Be Broken Down Into Specific Applied Skills?

C. Summary Points For Applied Practice.

Chapter Three. Positive Closure From The Start: Groundwork For Termination.

A. Optimize The Match.

1. How Does A Practice Profile Help To Manage Terminations?

2. Can A Provider Ethically Screen Referrals?

B. Set Policy And Shape Expectations.

1. Should Termination Be Included In Informed Consent?

2. How Can I Estimate The Length Of Therapy At The Outset?

C. Formulate A Termination Plan And Discharge Criteria.

1. What Is A Termination Plan And How Is It Linked To The Treatment Goals?

2. How Can I Assess Client Motivation And Use It In The Termination Plan?

3. How Do I Know If The Client Is Benefiting Or Likely To Benefit From Therapy?

D. Summary points for applied practice

Chapter Four. Talking About Termination: A Closer Look At Communications.

A. Orientation To The Topic Of Termination.

1. What Makes Termination Difficult To Discuss?

2. What Is The “Culture Of Expectations” And How Does It Impact Termination Discussions?

3. Are there beliefs that affect the provider’s approach to termination?

B. Making The Decision To Terminate.

1. What Are Clinical, Practical And Ethical Reasons For Termination?

2. Are There Any Conversational Targets To Help Structure Termination?

C. Creating A Record.

1. What Documentation Is Necessary?

D. Summary Points For Applied Practice.

Chapter Five. Achieving Closure: Assuring Professional Action.

A. Directing The Termination Process.

1. Are We Ending Sessions Or Ending The Relationship?

2. How Do I Know That I've Done Enough For An Appropriate Termination Process?

B. Managing Risks.

1. When Should I Insist On Termination?

2. What If The Client Refuses Termination Or Becomes Hostile?

3. What Should I Do About My Personal Needs And Limits?

C. Summary Points For Applied Practice.

Chapter Six. Adapting Termination To Client Needs – A Consumer Oriented Perspective.

A. Sociocultural Context.

1. Does The Client's Cultural Background Or Social Environment Impact Termination?

B. Clinical Needs.

1. How Do Axis II Personality Disorders Affect Termination Strategy?

2. What About Termination When The Client Has A Chronic Or Recurrent Axis I Disorder?

B. Developmental And Health Related Needs.

1. Does life stage or health status affect termination needs?

C. Practical Concerns.

1. How Can I Handle Practical Concerns About Time, Convenience And Money?

D. Summary Points For Applied Practice.

Chapter Seven. Provider Challenges.

A. Termination Dissonance.

1. I Am Not Sure That We Are Talking Enough About Termination.

2. I Am Worried That This Client Will Never Be Able Terminate Therapy.

3. I Can't Seem To Satisfy This Client.

B. Sudden Or Crisis Terminations.

1. My Client Has Disappeared And Does Not Return My Call.

2. I've Just Been Fired.

3. My Client Has Suddenly Died.

C. Self-Management Challenges.

1. I Can Not Seem To Let Go.

2. I Think I Mishandled Termination.

3. I Have Lost Control Of The Therapy Relationship And Don't Know How To Terminate.

4. I'm Feeling Burned Out. How Can I Get My Enthusiasm Back?

D. Summary Points For Applied Practice.

Chapter Eight. Termination With Couples, Families And Groups.

A. Attending To Multiple Interests.

1. How Does Termination Differ When Therapy Involves More Than One Person?

2. When Should I Recommend Termination With Couples?

3. If One Member Of A Couple Or Family Terminates Therapy, Does That Mean The Other Participants Must Terminate As Well?

4. Are There Risks Of Abandonment In Couples Or Family Therapy?

5. What Should I Do If I Think Couples Therapy Should Be Terminated In Favor Pursuing Individual Therapy?

5. How Can I Respond When A Parent Abruptly Terminates The Therapy Of A Child Or Teen?

6. What About Handling The Opposite Situation, When A Parent Essentially Remands The Child Or Teen To Treatment?

B. Termination And Group Therapy.

1. How Can I Minimize The Disruption Of Early Termination From A Group?

2. Is There A Best Way To End A Group?

C. Summary Points For Applied Practice.

Chapter Nine. Supervisory Termination.

A. The Supervisory Relationship.

1. Should Termination Be Included In The Supervisory Contract?

2. Is There A Clinically And Ethically Appropriate Process Of Supervision Termination?

3. When Is Supervisory Termination Complete?

4. Should Required Ongoing Supervision Ever Be Formally Concluded?

B. Problems In Supervisory Termination.

1. When Should Multiple Roles Precipitate Supervisory Termination?

2. What Circumstances Should Precipitate A Supervisee's Termination?

3. Are There Situations That Should Prompt A Supervisor's Termination?

4. Are There Any Particular Challenges To Expect In Terminating Supervision?

C. Summary Points For Applied Practice.

Chapter Ten. A Consumer's Guide To Ending Psychotherapy.

A. Understanding How To End On A Positive Note – Frequently Asked Questions.

1. What Is Psychotherapy Termination And When Does It Happen?

2. How Do I Know If I've Had Enough Therapy?

3. Are There Any Other Reasons To Stop Therapy?

4. What Does It Mean To “End On A Positive Note?”

5. Shouldn't I Stay In Therapy Until I Feel Totally Together?

6. I Really Depend On Therapy. Do I Have To Let It Go?

7. Should I Quit Therapy If I Feel Lost Or Stuck?

8. I Can Not Seem To Talk About Ending Therapy. What Should I Do?

9. Doesn't My Therapist Have To Continue Therapy Until I Feel Ready To Stop?

10. Will My Therapist Stop Working With Me If My Problems Are Too Difficult?

11. I Am Angry And Disappointed In Therapy. What Are My Options?

12. Will I Be Able To Return To Therapy If I Need To?

13. What Happens To My Records After I Stop Therapy?

14. Can My Therapist Talk About Me Once Therapy Ends?

15. Can My Therapist And I Be Friends After Therapy?

16. I Think My Therapist And I Have A Mutual Attraction. Can We Get Together After Therapy?

17. Should I Let My Therapist Know How I'm Doing After We Stop Therapy?

18. Will We Have Some Sort Of Graduation At My Last Session?

19. Should I Bring A Gift To Mark The Ending?

20. Can I Refer My Friends Or Other Family Members To My Therapist?

B. Helping Kids And Teens End Therapy On A Positive Note.

1. How Long Do I Have To Be In Therapy?

2. Once I Stop, Can I Ever Go Back To My Therapist?

3. Will The Therapist Report My Problems To My School Or College?

4. Does Ending Therapy Mean That I Am Normal?

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Author Information

Denise D. Davis is Assistant Director of Clinical Training for the doctoral pro-gram in Clinical Psychology at Vanderbilt University. She has nearly twenty-five years of experience as a private practitioner, clinical educator, and consultant.
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"Denise Davis is right on point in her book Terminating Therapy: A Professional Guide for Ending on a Positive Note. In this book she addresses the confusion that exists in this area of professional practice in a very productive way, clarifying it in fashion that offers guidance that is ethical, legal and in the best interests of both the patient and the therapist. Her common sense approach to termination issues is refreshing and makes this book a must read for all mental health professionals regardless of their specialty."
Jeffrey N. Younggren, Ph.D., Risk Management Consultant, American Psychological Association Insurance Trust

Denise Davis' review of the process of termination grounds the reader in practical fundamentals of initiating, framing and maintaining treatment as she consistently focuses on the needs, goals and progress of clients, yet never overlooks the at times knotty concerns of clinicians striving to deliver safe and ethical service that reflects best practices and evidence-based accountability. With sensitivity, Denise Davis provides a helpful compilation of practical pitfalls that might befall any therapeutic alliance. This work is a "must-read" clinical treasure… Davis’ work clearly fills a gap in the literature to enrich client and clinician alike.
—James L. Rebeta, Ph.D., President, Manhattan Psychological Association, Assistant Professor of Psychology in Clinical Psychiatry, Weill Medical College of Cornell University

"Terminating Therapy provides a thoughtful and comprehensive discussion of the many issues involved in termination. It addresses underlying principles and concrete actions in a way that will be consistently helpful to practicing clinicians. This is the single best source I have seen on the subject of termination."
Steven D. Hollon, Ph.D., Professor of Psychology, Vanderbilt University

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