This article explores common reasons for ending therapeutic relationships and how therapists can navigate termination ethically, compassionately, and professionally.
Related articles: Assessing Therapist-Client Fit, Essential Qualities in the Therapeutic Alliance, Transference, Projection and the Therapeutic Alliance.
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Introduction
Ending a therapeutic relationship is an inevitable and significant part of mental health practice. Whether therapy ends due to achieving treatment goals, lack of progress, logistical changes, or other reasons, the termination process must be handled with care. For clients, ending therapy can evoke a wide range of emotions, from feelings of accomplishment and closure to grief, abandonment, or uncertainty. For therapists, navigating the process ethically and compassionately is essential to ensure the client’s well-being, honour professional responsibilities, and protect the integrity of the therapeutic work.
Understanding when and how to end therapy is a nuanced process that requires a combination of clinical judgment, ethical considerations, and self-awareness. This article provides an in-depth examination of reasons for ending therapy, how therapists can assess and navigate these situations, and key considerations for ensuring a compassionate and ethical conclusion to the therapeutic relationship.
Therapeutic relationship rupture vs. termination
Research has shown that ruptures in the therapeutic relationship are common, with estimates ranging from 40% to 55% of clients experiencing some form of rupture during therapy. However, ruptures do not always signify the end of therapy; many can be repaired through open communication and intervention. That said, irreparable ruptures may lead to premature termination, highlighting the importance of regularly assessing the health of the therapeutic relationship.
In a study by Safran and Muran (2000), it was found that approximately 28% of premature terminations in therapy were linked to unresolved ruptures in the therapeutic relationship. The repair of these ruptures is key to improving therapy outcomes and preventing premature termination.
Reasons for ending a therapeutic relationship
There are many reasons why a therapeutic relationship between therapist and client may end. Some are related to therapeutic process (e.g. achieving goals or not progressing), while others can be due to factors outside of the therapy room (e.g. a client relocating). In this section we’ll explore some of the most common reasons for ending a therapeutic relationship and provide you (the therapist) with best practices and recommendations to respond to each situation.
Achieving treatment goals
One of the most common reasons for ending therapy is the successful achievement of the client’s treatment goals. When therapy is goal-oriented, there comes a natural endpoint when the client reaches a level of functioning that allows them to manage independently. Therapists can assess this through regular progress evaluations (e.g. through psychological assessments and outcome measures), ongoing dialogue with the client, and mutual reflection on progress.
Recommendations for clinicians: Therapists should celebrate the client’s progress and ensure a gradual winding down of therapy. Discussing potential challenges and setting up future “booster” or check-in sessions if needed can help clients feel supported as they transition out of therapy.
Lack of progress
In some cases, therapy may not yield the desired results despite the best efforts of both therapist and client. A lack of progress may indicate a need to end the current therapeutic approach and consider alternative interventions, whether that means a referral to another therapist or a change in treatment modality.
Recommendations for clinicians: Open, honest communication about lack of progress is essential. It’s important to explore the reasons for the stagnation, which may include mismatched therapy goals, incompatible therapy styles, or external factors affecting the client’s ability to engage in treatment. When appropriate, refer the client to another professional or recommend alternative treatment options.
Therapist-client mismatch
A mismatch between therapist and client can arise when there is a lack of rapport or when the therapeutic style does not align with the client’s needs. Research shows that the quality of the therapeutic relationship is one of the most significant predictors of therapy outcomes. A rupture in the relationship, such as when the client feels misunderstood or disrespected, can signal a need to end the therapeutic relationship. For more on how to know if your client is a good fit for you, read Assessing Therapist-Client Fit.
Recommendations for clinicians: Therapists should remain attuned to relationship dynamics and be open to exploring concerns with clients. If a mismatch becomes apparent, addressing the issue directly and offering referrals to a more suitable therapist can ensure the client receives appropriate care.
Client no longer requires therapy
Sometimes, the client may feel they no longer need therapy or wish to end the relationship due to personal reasons. This can happen when clients perceive themselves to be sufficiently equipped with coping skills or simply wish to take a break from treatment.
Recommendations for clinicians: Therapists should respect the client’s autonomy but also engage in an honest discussion about their readiness to end therapy. It’s essential to explore whether the decision is coming from a place of empowerment or avoidance. Preparing the client for potential challenges post-therapy is an important part of ending treatment on stable ground.
Logistical issues
Therapy may end due to external factors, such as the client moving away, changes in insurance coverage or financial circumstances, or changes in the therapist’s practice, such as retirement or moving to a different clinic. These logistical issues can sometimes force an otherwise productive therapeutic relationship to end prematurely.
Recommendations for clinicians: In these cases, it’s crucial to provide ample notice and assist the client with finding another therapist if desired. Transitioning clients smoothly to new care options, whether through warm handoffs or detailed referrals, is key to ensuring continuity of care.
Therapist’s ethical duty to end therapy
Therapists may need to end the therapeutic relationship if continuing therapy would violate ethical guidelines. This can occur if the client becomes dependent on therapy, if boundary issues arise (for example, the client has exhibited aggressive behaviour), or if the therapist determines that they are unable to provide the necessary level of care.
Recommendations for clinicians: It’s important to consult with a supervisor or colleague when facing complex ethical issues. Addressing these concerns transparently with the client, while providing referrals and support, helps protect both the client’s welfare and the therapist’s ethical integrity. Understanding concepts such as transference, projection, projective identification and countertransference can also help therapists become more attuned to boundary issues.
Novice therapists: Addressing the challenge of self-doubt
For novice therapists, feelings of self-doubt and imposter syndrome are common, even after earning the necessary qualifications to practice. Many newly trained therapists may question their competence or worry that they are not fully equipped to handle the complexities of certain clients, leading to hesitancy when engaging in or continuing therapeutic relationships. While it is important for novice therapists to trust in their training and abilities, there is also a fine balance to be maintained between challenging these self-doubts and knowing professional limits.
Recommendations for clinicians: New therapists should seek regular supervision and consultation with more experienced colleagues, which can help clarify whether their doubts are based on a genuine lack of expertise or simply the natural uncertainty that accompanies any new professional endeavour. Supervision helps therapists to reflect on their practice, gain feedback, and ensure they are working within their competencies. Continuing professional development (CPD) also helps therapists stay abreast of latest developments and effective interventions for different client populations. Ultimately, therapists should strive to build self-assurance while adhering to ethical practices, ensuring that they prioritise the best interests of their clients at all times.
Tips for navigating the termination process
Managing the conclusion of a therapeutic relationship can be difficult for both therapists and clients. In this section, we examine key factors that can help therapists ease the process of termination.
Open communication
Successful termination relies on open, honest communication. Clients should be aware of the possibility of termination from the outset of therapy, with ongoing discussions about progress and the potential end of the relationship. These conversations prevent the client from feeling blindsided by the termination and allow them to process the end of therapy in a healthy manner.
Recommendations for clinicians: Maintaining open communication also benefits the therapist, reducing feelings of guilt, anxiety, or discomfort that may arise when ending therapy. Self-care strategies, such as supervision or peer consultation, can support therapists in managing these emotions.
Gradual transition
In most cases, therapy should not end abruptly. A gradual transition, such as tapering the frequency of sessions, gives clients time to adjust to the end of therapy. This period can also serve as a time for reviewing therapeutic gains, practicing new skills, and planning for future challenges.
Recommendations for clinicians: Setting clear timelines and using the final sessions to empower the client with tools for continued growth ensures a smoother transition.
Handling Client Resistance
Clients may resist the end of therapy due to attachment to the therapist, fear of facing future challenges alone, or unresolved issues. In these cases, it’s essential to address the resistance directly and explore its roots. Therapeutic techniques, such as cognitive restructuring or role-playing, can help clients process their fears and prepare for the end of therapy.
Recommendations for clinicians: Compassionate listening and acknowledging the client’s emotions are essential. Therapists can normalise the client’s feelings while reinforcing the progress made and emphasising the client’s ability to thrive independently.
Integrating therapist self-care
Ending therapy can be emotionally draining for therapists, particularly in cases where the therapeutic relationship was long-term and/or complex. Therapists may experience feelings of loss, guilt, or uncertainty. Regular supervision, peer support, and personal self-care practices (e.g. mindfulness, therapy for the therapist) can mitigate these emotional burdens.
Recommendations for clinicians: Therapists should make time for reflective practices, such as journalling or mindfulness, to process their feelings and ensure they can approach the termination process with clarity and compassion. For a deep-dive on self-care strategies and interventions for therapists, download our e-book, Fit Your Own Mask First: Professional Self-care for Helpers.
Administrative and ethical considerations
Properly documenting the reasons for ending therapy and the steps taken to ensure continuity of care is crucial. This protects both the client and the therapist, ensuring transparency and accountability. Therapists must also follow their profession’s ethical guidelines regarding termination, including providing adequate notice, referrals, and post-therapy support when necessary.
Recommendations for clinicians: Therapists should check their professional association and/or credentialing body’s Code of Ethics to ensure they are following appropriate guidelines. For those working within organisations, consult with relevant stakeholders (this may be a supervisor or the HR department, for example), to obtain relevant documentation and guidelines regarding this.
Conclusion
Ending a therapeutic relationship is a critical phase in the therapeutic process that requires careful attention, empathy, and professionalism. Whether the termination stems from achieving treatment goals, lack of progress, or external circumstances, the process must be handled with thoughtful consideration to ensure that the client’s emotional well-being is prioritised. Open communication, a gradual transition, and addressing any resistance to termination can all help ease this journey for both clients and therapists. By approaching termination with care, therapists can ensure it serves as a valuable, positive conclusion to the therapeutic journey.
Key takeaways
- Ending therapy should be a carefully planned, gradual process to help clients transition smoothly.
- Honest, ongoing dialogue about progress, goals, and termination helps both clients and therapists prepare for the end of therapy.
- Whether ending due to goal completion, mismatch, or logistical issues, it’s important to tailor the process to the client’s needs and readiness.
- When clients resist termination, explore the roots of their resistance with empathy and offer support for the transition.
- Ending therapy can evoke emotional responses in therapists, so supervision and self-care practices are essential to manage these emotions.
- Properly documenting the reasons for ending therapy and the steps taken to ensure continuity of care – while following relevant ethical guidelines regarding termination – protects both the client and the therapist.
References
- Safran, J. D., & Muran, J. C. (2000). Negotiating the Therapeutic Alliance: A Relational Treatment Guide. Guilford Press.
- Norcross, J. C. (2002). Psychotherapy Relationships that Work: Therapist Contributions and Responsiveness to Patients. Oxford University Press.
- Gelso, C. J., & Hayes, J. A. (2007). Countertransference and the Therapist’s Inner Experience: Perils and Possibilities. Lawrence Erlbaum Associates.