Terminating Therapy

The first book of its kind to provide an in-depth approach to termination of therapy, Terminating Therapy guides you through the practical, ethical, legal, and emotional challenges of how and when to end therapy. Written for a wide range of practitioners at every level of experience, this book provides straightforward advice on ending therapy on a positive note.

Foreword by Arthur Freeman, Ed.D., ABPP vii

Preface xi

Acknowledgments xiii

1 Termination Strategy: A Pragmatic Approach in Contemporary Practice 1

The Importance of Termination 1

Pragmatic Strategy for Termination 18

Summary Points for Applied Practice 23

2 Professional Skills and Termination 25

Building A Base of Collaboration 25

Applying Reasonable Professional Standards 36

Summary Points for Applied Practice 46

3 Positive Closure from the Start: Groundwork for Termination 47

Optimize the Match 47

Set Policy and Shape Expectations for Termination 52

Formulate a Termination Plan 60

Summary Points for Applied Practice 76

4 Talking about Termination: A Closer Look at Communications 77

Orientation to the Topic of Termination 77

Making the Decision to Terminate 86

Creating a Record 104

Summary Points for Applied Practice 106

5 Achieving Closure: Assuring Professional Action 109

Directing the Termination Process 109

Managing Risks 123

Summary Points for Applied Practice 133

6 Adapting Termination to Client Needs: A Consumer-Oriented Perspective 135

Sociocultural Context 135

Clinical Needs 138

Developmental and Health-Related Needs 163

Practical Concerns 168

Summary Points for Applied Practice 171

7 Provider Challenges 173

Termination Dissonance 173

Sudden or Crisis Terminations 180

Self-Management Challenges 189

Summary Points for Applied Practice 198

8 Termination with Couples, Families, and Groups 201

Attending to Multiple Interests 201

Termination and Group Therapy 212

Summary Points for Applied Practice 216

9 Supervisory Termination 219

The Supervisory Relationship 219

Problems in Supervisory Termination 233

Summary Points for Applied Practice 244

10 A Consumer’s Guide to Ending Psychotherapy 247

Understanding How to End on a Positive Note 248

References 265

Subject Index 275

Author Index 287

Denise D. Davis is Assistant Director of Clinical Training for the doctoral pro-gram in Clinical Psychology at Vanderbilt University. She has nearly twenty-five years of experience as a private practitioner, clinical educator, and consultant. "Terminating Therapy provides a thoughtful and comprehensive discussion of the many issues involved in termination. It addresses underlying principles and concrete actions in a way that will be consistently helpful to practicing clinicians. This is the single best source I have seen on the subject of termination."
—Steven D. Hollon, PhD, Professor of Psychology, Vanderbilt University

"The simplicity and clarity of her style belie the subtle clinical wisdom that anyone—seasoned therapist/provider or client new to the process—might profitably access. This text, heavily punctuated with 'how to?' and 'what should?' queries throughout, provides guidance and raises issues garnered only from broad clinical experience from which anyone in the practice of psychotherapy might benefit. This work is a must-read clinical treasure that offers gems in sample vignettes and pragmatic applications throughout."
—James L. Rebeta, PhD, President, Manhattan Psychological Association, and Assistant Professor of Psychology, Weill Medical College of Cornell University

The first book of its kind to provide an in-depth and practical approach to termination in the current era of time-limited therapy

A successful termination is a vital phase of any kind of psychotherapy, yet often taken for granted or not considered when therapy is initiated. This text presents a much-needed guide to wrapping up treatment with your clients, covering:

• The practical challenges faced by practitioners and possible solutions

• How to conceptualize termination as a task of the therapeutic alliance

• Setting termination goals and linking them to the treatment plan

• Communicating effectively about termination

• Recognizing appropriate reasons for termination

• The six essential steps to ensure that the practitioner is doing "enough" to achieve a clinically and ethically appropriate process

Written for a wide range of practitioners at all levels of experience, this unique book includes numerous case studies illustrating both typical and difficult situations and provides practical and straightforward advice on ending therapy on a positive note.

"Denise Davis is right on point in her book Terminating Therapy: A Professional Guide for Ending on a Positive Note. In this book she addresses the confusion that exists in this area of professional practice in a very productive way, clarifying it in fashion that offers guidance that is ethical, legal and in the best interests of both the patient and the therapist. Her common sense approach to termination issues is refreshing and makes this book a must read for all mental health professionals regardless of their specialty."
—Jeffrey N. Younggren, Ph.D., Risk Management Consultant, American Psychological Association Insurance Trust

Denise Davis' review of the process of termination grounds the reader in practical fundamentals of initiating, framing and maintaining treatment as she consistently focuses on the needs, goals and progress of clients, yet never overlooks the at times knotty concerns of clinicians striving to deliver safe and ethical service that reflects best practices and evidence-based accountability. With sensitivity, Denise Davis provides a helpful compilation of practical pitfalls that might befall any therapeutic alliance. This work is a "must-read" clinical treasure… Davis’ work clearly fills a gap in the literature to enrich client and clinician alike.
—James L. Rebeta, Ph.D., President, Manhattan Psychological Association, Assistant Professor of Psychology in Clinical Psychiatry, Weill Medical College of Cornell University

"Terminating Therapy provides a thoughtful and comprehensive discussion of the many issues involved in termination. It addresses underlying principles and concrete actions in a way that will be consistently helpful to practicing clinicians. This is the single best source I have seen on the subject of termination."
—Steven D. Hollon, Ph.D., Professor of Psychology, Vanderbilt University