Chapter 8- Termination of the Counselling Relationship – Flashcards

- Termination= the decision to end a counselling relationship - May be made unilaterally or mutually- one sided or mutually agreed upon - Closing may produce mixed feelings on the part of both the counselor and the client, and unless handled properly, closing has power to harm as well as heal- we need to terminate properly in order to make sure client is in best place possible

Understanding the process of closing a counseling relationship has been avoided for many reasons, including: - Ending is associated with loss, which seems incompatible to the growth-focused process of counselling - Closing is not directly related to micro-skills that facilitate counselling relationships. (small skills by counsellors such as attentive listening, body language) - Loss, however, may be also associated with post traumatic growth- positive life changes that come as a result of suffering or struggling with natural or human made traumatic events - Post traumatic growth= out of traumatic situation, a person has had tremendous growth and human development of themselves. - "Termination is the opportunity to end a learning experience properly"

In counseling, closing signifies the end of therapy, and can also be a motivator in the following ways: - The knowledge that the counseling experience is limited in time can spur a client to work hard while there is still time. (Client being strategic in what is important to share as you have limited sessions) - Closing is a means of maintaining changes already achieved and generalizing problem-solving skills acquired in counseling to the real world. (Toolbox- give client tools/strategies to deal with problems. Ex: giving a client with anxiety coping methods such as CBT to help them calm down and get over it). - Closing serves as a reminder that the client has matured- Viewed as an accomplishment.

Several pragmatic considerations in the timing of closing: - Has the clients achieved behavioural, cognitive, or affective contract goals? - Value of contracts! - Can client concretely show where they have made progress in what they wanted to accomplish? - Is the counseling relationship helpful? (If either client or counsellor feels that it is no longer helpful, closing is appropriate)- unethical to continue counseling if it's not helpful and no progression has being seen. - Immediacy, which is checking up on the progress and helpfulness can be a way to terminate it's shown to not be helpful. Looking at how many anxiety attacks they currently received vs. how many they had when first coming to see counselor, if amount has changed then counseling is clearly unhelpful. - Should be planned vs. abrupt - Has the context of the initial counseling relationship changed? (Ex: a move, prolonged illness, etc.)- if counselor or client moves away to another city or are transferred then it is hard to continue counseling, which usually leads to termination.

A counselor can close a session effectively in several ways: - Make a brief statement indicating that time is up - Use nonverbal gestures to indicate the end of the session - It can be helpful to summarize what happened in the session - An important part to terminating each session is to set up the next appointment - Important not to raise any important topics near the end of a session

Behaviours That Signal the End of Counselling include: - decreases in the intensity of work; more humour, consistent reports of improved ability to cope, verbal commitments to future, less denial/anger/withdrawal that one came in with

- Reduce/elimination of initial issue - Reduction/elimination of stress-producing feelings - Clients coping ability and understanding of self and others - Clients ability to relate, love and be loved - Clients ability to plan and work productively - Clients ability for enjoyment - Financial issues- client cannot continue to pay for counselling

- Fading - a gradual decrease in the structures developed to create desired changes (shortened sessions, longer time in between appointments...)-suggest maybe seeing client once a month instead of weekly as they don't need sessions as much. - Help clients develop successful problem-solving- emphasis on education & prevention as well as decision-making skills. (Toolbox skills, talk about how they would deal with problems in the future using the new toolbox skills). - Foster generalization- translating what is learned from the counseling experience to life. (Use skills taught in counseling in real life)

- Can come from a client or counsellor - Resistance is especially likely if the counselling relationship has lasted a long time or has involved high levels of intimacy, and the two have built a dependency upon each other Other factors that promote resistance includes: - Pain of earlier losses - Loneliness - Unresolved grief - Need gratification- need someone to tell them they are headed in the right direction - Fear of rejection* - Fear of having to be self-reliant

1. Asking for more time at the end of a session 2. Asking for more appointments once the goal has been reached 3. The development of new problems - very common

1. Determine ways to make transition a gradual process- ex: so we have 2 sessions left, 1 session left, gradual ending... 2. Discover significance different activities have had in life 3. Describe this significance to others 4. Delight in what was gained and in what lies ahead 5. Define areas of continuity in your life- exercises to do to help client with termination

1. Closing signals the end of a significant relationship 2. Closing arouses the counsellor's anxieties about client's ability to function independently- omg are they going to come back to me because they can't function on their own?? 3. Closing arouses guilt in the counsellor about not having been more effective 4. Counsellors professional self-concept is threatened by a client leaving abruptly or angrily 5. Closing signals the end of a learning experience for the counsellor 6. Closing ends an exciting experience of living vicariously through the client's adventures 7. Closing becomes symbolic of other farewells in the counsellors life 8. Closing arouses in the counsellor conflicts about his/her own individuation- we all at some point become separated from the group we are from... so in this case we all at some point have to be separated from the counsellor Supervision!!!!- this is a place counsellors go to process what's happening in counseling and therapeutic relationship.

Has to do with how well clients believe they have achieved personal goals. -If the counselor finds that the client wishes to quit, an may be set up.

Counsellors must find out why a client terminated early. Reasons may include: - To see if the counselor really cares - To try to elicit positive feelings from the counsellor - To punish or try to hurt the counsellor - To eliminate anxiety - To show the counselor that the client found a cure elsewhere - To show the counselor that the client does not feel understood

- Appointments- regularly scheduled with brief amounts of time between appointments - Orientation to counselling- the more clients know about the process of counselling, the more likely they are to stay with it - Consistency of a counsellor- counsellor who does initial intake should continue counselling the client - Reminders to motivate client attendance- Cards, phone calls, texts, or emails (with client's permission to send reminders) can be effective.

"Good" Reasons for Termination Include: - Illness - Working through countertransference - Relocation to another area - The end of internship or practicum - Extended trip - Referring the client to someone else

Poor Reasons for Termination Include: - Counsellor's feelings of anger, boredom or anxiety - Permanent counsellor-initiated closing is more painful for clients and challenging for counsellors - In this case, it is still vital that counsellors monitor the client's progress, end relationship at a specific time, and make post-counselling plans

Welfel and Patterson (2005) present 4 Guidelines a Counsellor Can Use to End a Counselling Relationship in a Positive Way: 1. Be aware of the clients needs and desires and allow the client time to express themselves 2. Review major events of the counselling experience and bring review to the present 3. Supportively acknowledge changes the client has made as well as follow-up issues 4. Request follow-up contact

- Follow up= checking to see how the client is doing after closing has occurred - Short-term follow-up= 3-6 months after closing - Long-term follow-up= at least 6 months after closing 4 Main ways follow up is conducted: 1. Invite the client in for a session 2. Phone call 3. Sending a letter 4 mailing or emailing a questionnaire

- Referral= arranging other assistance for a client when the initial arrangement is not or cannot be helpful - Referrals involve how (calling on a helping resource), when (timing), and who (to whom you are sending the client)