A structured approach to processing clients' unilateral termination decisions

Abstract

Research over several decades reveals that close to half of clients in the United States terminate psychotherapy before finishing their work, sometimes without discussing the matter with their therapist. As a result, therapists may experience significant distress, both because they had no input into the termination decision, and because they wonder if they were unhelpful, unskillful or even harmful to their clients. This article proposes a structured approach to enable therapists to process unilateral termination experiences. Its six steps are designed to help therapists honor their initial reaction response to the termination; appraise possible causes of the termination; determine most probable causes of the termination, and take commensurate responsibility; mourn; perform reparative tasks for the benefit of current and future clients; evaluate their subsequent well-being and sense of self-efficacy; and take a broader perspective. Designed as pantheoretical, the proposed structured approach is based on empirical data as well as commonly held theory.