Ethical+Therapy+Termination

Therapy Termination Literature Review  “Termination constitutes the final phase of psychotherapy and, as such, an important ethical and clinical responsibility. Regardless of theoretical orientation, all psychotherapists attend to the steps involved in ending treatment, usually referred to as termination” (Vasquez, Bingham and Barnett 2008) Vasquez et.al continue in their article, “Psychotherapy Termination: Clinical and Ethical Responsibilities,” that termination is a conceptualized process that serves as the culmination of a client achieving therapy’s goals or treatment ending for other reasons (2008). Other researchers have determined that “premature or early termination of psychotherapy and counseling is a common and significant problem in clinical practice” (Lampropoulos, Schneider, & Spengler 2009).

Whether the client or the counselor terminates therapy, there are ethical deliberations the professional counselor must consider. While counselor termination presents serious ethical problems, early client termination has been identified as a substantial problem in clinical practice with dropout rates ranging from 30% to 60%. Studies have reported that up to 80% of clients will terminate treatment prior to the tenth session. Lack of substantiated research has hindered efforts to identify early predictors but factors such as counselor age vs. client’s age, counselor multi-cultural awareness, and failure of counselor training to tailor treatment to specific lower SES groups have affected the dropout rates (Lampropoulos, et al. 2009).

The construct of the United States healthcare industry mandates limits on the number of visits a client is authorized. These limits as imposed by a managed care organization should be addressed at the outset with clients (Daniels 2001). Paula Danzinger and Elizabeth Welfel’s research paper, “The Impact of Managed Care on Mental Health Counselors : A Survey of Perceptions, Practices, and Compliance with Ethical Standards” surveys 108 mental health practitioners in four states and found that the majority of participants reported that managed healthcare negatively affects their work and presents ethical challenges (2001). Among a number of ethical issues identified, of primary concern to the respondents of the survey was the allocation of services (Danzinger and Welfel 2001). Danzinger and Welfel continue, “Research suggests that quality mental health care is difficult to realize under managed care due to monetary incentives to limit services that are available to clients” (2001).

The America Counseling Association’s (ACA) Code of Ethics addresses specific issues related to  counselor termination in section A.11 further defining that client abandonment is prohibited, inability to assist, when appropriate to terminate a counseling relationship, and when appropriate transfer of services is warranted. ( [] ). Mary Herman and Barbara Herlihy illustrate some of the ethical dilemmas facing counselors in the article “Legal and Ethical Implications of Refusing to Counsel Homosexual Clients” published in the Journal of Counseling and Development, 2006. The constructs as outlined in the ACA Code of Ethics have been challenged on several fronts as counselors have placed their moral convictions or religious beliefs before their professional propriety by refusing to see clients whose lifestyle choices violated the counselor’s beliefs or value systems. Courts have upheld the client’s rights and counselors are advised to “avoid entering or immediately terminate a counseling relationship when they determine that they are unable to be of professional assistance to a client and to refer that client” (Herman & Herlihy 2006).

The pathway for counselors is not always clear. Each and every client a counselor encounters is unique as is the situations the client’s present. To act in an ethical manner in termination of counseling “counselors need to remain cognizant that they are…obligated to seek the knowledge, skills, and sensitivity required to effectively counsel a diverse client population” (Herman & Herlihy 2006). Thus for the ethically successful counselor the goal of termination is “to enhance each client’s ability to carry on his or her psychological work out side of the treatment room” (Vasquez et.al 2008).

References
Daniels, J. A. (2001). Managed care, ethics, and counseling. Journal of Counseling and Development : JCD, 79(1), 119-122. Retrieved from http://search.proquest.com/docview/219025309?accountid=12774

Danzinger, P. R., & Welfel, E. R. (2001). The impact of managed care on mental health counselors: A survey of perceptions, practices, and compliance with ethical standards. Journal of Mental Health Counseling, 23(2), 137-150. Retrieved from http://search.proquest.com/docview/198709406?accountid=12774

Hermann, M. A., & Herlihy, B. R. (2006). Legal and ethical implications of refusing to counsel homosexual clients. Journal of Counseling and Development : JCD, 84(4), 414-418. Retrieved from http://search.proquest.com/docview/219047401?accountid=12774

Lampropoulos, G. K., Schneider, M. K., & Spengler, P. M. (2009). Predictors of early termination in a university counseling training clinic. Journal of Counseling and Development : JCD, 87(1), 36-46. Retrieved from []

Vasquez, M. T., Bingham, R. P., & Barnett, J. E. (2008). Psychotherapy termination: clinical and ethical responsibilities. Journal Of Clinical Psychology, 64(5), 653-665. doi:10.1002/jclp.20478

include component="backlinks" page="page:Ethical Therapy Termination" limit="10" media type="youtube" key="rIHbU5bCA9w" width="560" height="315" align="center"