Terminating in Social Work: 2 Pathways for Ending Therapy

Terminating in social work happens for many reasons, including the client not engaging in services, being referred out to another agency, or the client reaching all treatment goals and no longer requiring services. Ideally, termination is a gradual process, but in the field of social work, ideals may not always occur.

Before we discuss the different pathways for termination, a good rule of thumb is to discuss termination with clients during the intake session. This includes reviewing the agency or practice’s policy on missed appointments, and the overall expectations for treatment moving forward. This is part of the client giving informed consent, but also ensures the client is aware of what treatment entails.

If the Client Has Successfully Completed Treatment

  1. Congratulate yourself & your client on this milestone! Ending therapy because your client has reached their goals and has shown growth & healing is a TREMENDOUS success! Remember to acknowledge this and reinforce the progress along the way.
  2. Have a conversation with your client about their progress and accomplishments. Discuss the impact of their treatment and how you feel they no longer require therapy as frequently due to their success. Explore your clients thoughts about this, and any emotions that come up. If they feel rejected, remind them that their growth is a success and is reflective of their hard work and healing.
  3. Discuss how to move forward. Depending on the client and their needs, termination may vary in gradual change. If you’re meeting weekly with a client, perhaps this change now means meeting biweekly. After a period of time meeting biweekly, you meet monthly. And from there, the client is discharged from treatment.
  4. Reflect on treatment. Termination can be very difficult, especially when there is a strong therapeutic relationship. Show empathy and pride in your clients progress. Explore what worked well, what they would have changed, and get feedback from your client on your own practice.
  5. Create an after-treatment plan. Make sure you highlight your clients supports, learned skills and behaviors, and methods to continue their journey after treatment. Offer them further resources, including other programs, support groups, or information on returning to services if necessary.
  6. Say your goodbyes. Leaving is the hard part, even for therapists. But it’s important that you show confidence in your client’s abilities and share words of compassion and encouragement.
  7. Finish the paperwork. Of course with all things social work, remember to complete the paperwork & the discharge summary. Send your client an official letter indicating their discharge from treatment for their records. This can also include the after-treatment plan.

If the Client is Not Engaging with Treatment

  1. Remember that clients don’t engage in services for a variety of reasons. Continue to reach out to your client, and if you’re able to speak with them, discuss their thoughts on treatment, assess motivation, and barriers & strengths to continuing therapy.
  2. Continue outreach. At my workplace, we send a missed appointment letter after every missed appointment. We also try to call, text, or email clients with appointment reminders. If we send 3 missed appointment letters in a row, then we send a warning notice. This details the dates of the missed appointment and provides the date and time for the next scheduled appointment. It is noted that if they missed this session or do not reschedule, they will be discharged.
  3. If you are able to get in touch with the client, try creating a therapist-client contract. This is a signed contract between the therapist and the client, and shows that both parties agree to x number of sessions in 1 month. This also states the consequences if the client misses a certain number of sessions, including possible discharge.
  4. If the client has not been in touch with you, they received the warning notice, and they did not show to their appointment or call to reschedule, it is time to discharge them. Write a letter indicating their case has been closed for not engaging in services, and detail the dates of the missed appointments, the letters, and the times of attempting to contact them. In the discharge letter, also include at least 3 other agencies they can seek mental health treatment at if desired, and let them know that their mental wellbeing is important.
  5. Make sure you have documented all of these communication and outreach attempts, and complete the discharge report to finalize treatment termination.

Termination in social work and mental health services can be bittersweet. But no matter how it feels, it’s important that it’s done well! To listen to my experience when termination went wrong, check out the Social Work Bubble Podcast Episode 13!

From your own experiences & knowledge, share your tips for termination in the comments, so we can all continue to grow together in this wonderful field!

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