Endings are a significant part of the therapeutic process and are often deeply meaningful or symbolic for clients. A good ending can be a life-changing experience for some, enabling healing of past hurts and affirming the client in their ability to manage on their own without their therapist. On the other hand, a bad ending can trigger painful memories and have the effect of re-traumatising a client.
Complaints about endings
Clients have complained about their therapists for:
- ending their therapy abruptly, without notice or preparation
- ending by text or email, without offering a final attended session
- making the decision to end therapy on their own rather than by mutual agreement with the client
- not accepting a client’s wish to end
- blurring the boundaries, and not being clear about a change in relationship from professional to personal
Key considerations for practice
Endings are an inevitable part of therapy and should be kept in mind from the beginning. While they may seem commonplace to therapists, a feature of their everyday practice, endings may be hugely significant to clients and we should not underestimate their impact.
Endings are sometimes unplanned or forced by a change in the therapist's or the client's circumstances. Ideally you would both sense when the client is ready to end and work towards it by mutual agreement.
Have the ending in sight
You should be thinking about the ending from the outset, and where necessary bring it into the client’s awareness too. Be alert to clients’ over-dependence and don't encourage them to see the therapy as a permanent arrangement. For some the work might be about internalising the therapist – helping to prepare them for the time when they will manage without your direct support. Periodic reviews can help to keep the work on track.
Be clear about the ending
Make it clear whether the therapy is open-ended or time-limited, and ensure that this is explicit in your initial contracting with clients. Clearly this will depend on the setting in which you operate, whether you're bound by the terms and conditions of an employer, counselling service or Employee Assistance Programme (EAP), for example, or whether you're in private practice and have the freedom to offer long-term therapy.
Understand what ending means to the client
Be aware of the possible meaning of endings to clients. Some may have previously experienced bad endings, triggering memories and feelings such as abandonment and rejection, and they will require sensitive handling. If poorly managed, therapeutic endings can be re-traumatising. However, a good therapeutic ending can provide a reparative experience for clients.
Readiness to end
Ideally you and your client should work towards the ending together, so that it does not come as a surprise to either of you. A mutually agreed ending is better than one which is forced, premature or unilateral. You might want to challenge a client’s wish to end, or conversely, their reluctance to end, but ultimately it is the client’s decision which you must respect (principle of Autonomy).
Leaving the door open
Ensure clients understand whether they can return at a later date and resume the therapy, and whether this is an interim or a final ending. Be clear if you're offering a follow-up or review session, or whether you're inviting them to contact you at any time for a top-up or refresher session.
Change of relationship
If the relationship is changing from a therapeutic one to, say, a personal one, it's important to observe the boundaries and mark the ending of one relationship before making the transition. Complaints have arisen because boundaries have been blurred, resulting in clients not knowing what type of relationship they are in and feeling confused, misled or misunderstood.
Endings initiated by the therapist
Sometimes therapists need to stop work with a client due to retirement, illness or reasons beyond their control. Where possible:
- give the client plenty of notice
- consider giving notice in proportion to the length of the therapy, so longer term clients have more time to prepare for the ending
- for fixed duration contracts, consider reminding the client at every session how many sessions they have left
- avoid ending therapy abruptly by text or email
- offer a final session to review the work undertaken
- ensure the client is aware of alternative sources of support, referring them on where appropriate
- be careful not to make your client feel that they have done something wrong
- consult with your supervisor
It's good practice to have a clinical will in place, so that someone is appointed to contact your client and help them find support if you're suddenly incapacitated.