Ending therapy with a client can come about because of a whole host of reasons. Right?
The way I was taught therapy ends
I’m not sure if things have changed much since I was in graduate school. But at least, back in my day, when we talked about clients ending therapy it typically was taught to us as happening in one of two ways.
Of course there is the ideal, gold standard where your client accomplishes all of their therapeutic goals. You then have a sort of graduation process and send them off on their merry little way.
The other reason we were taught that therapy might end with a client is because the client wasn’t ready, and they were ditching what was in their best interest.
Those were the only two ways that were discussed.
Feeling shame
So, naturally, I was quite surprised as I launched into my therapy career to discover that there are a wide range of reasons why therapy ends with a client.
Personally, I started to carry shame when therapy ended for reasons other than the client naturally arrived at a graduation moment. I thought that wasn’t how it was supposed to go.
But, as it turns out, I’m not the only one. And, it’s not because I’m providing bad therapy. (At least I hope!)
But, at the very least this is an experience that I hear about from so many other therapists. So I thought this article would be helpful to those of you who are carrying shame around reasons why therapy is ending with your clients.
Prefer to watch instead? Check out the video version of this article below:
The ‘idyllic’ ending to therapy
The proper term for the ending of therapy with a client is termination. Personally, I have a deep beef with the use of the word termination to describe the ending of any kind of relationship. Even in the most intimate relationships, it sounds aggressive. (Think: Arnold Schwarzenegger)
Now, it’s very possible for therapy to end in the idyllic way that I was taught that it was supposed to end.
You have a check-in moment with your client where you both agree that they have met their goals and are ready to graduate. Then you have a couple of last sessions where you reflect back on their growth and discuss how they are going to carry on without you.
You say your goodbyes and send them off into the world. Maybe even some tears are shed.
This does happen! But…the number of times this has happened in my career is minimal. Like, I could count them on two hands? Maybe one hand?
That doesn’t necessarily mean that all the other reasons for ending therapy are bad ones. It just doesn’t typically look like that idyllic textbook example in my practice.
Ending with anger
It is worth mentioning that the category of therapy ending that gets a lot of airtime, but at least in my experience, is really rare, is the angry client storming off from terrible therapy.
There are certainly clients who get angry and clients who end therapy because they’re angry. But, having a client storm out in the middle of a session because you said something upsetting is extremely rare. I’ve never had that happen to me.
As I said, these more commonly taught reasons therapy comes to an end seem to be the least common reasons why therapy ends. At least in my experience.
8 reasons why therapy ends
1) moving
Oftentimes the reason why therapy ends is very logistical and practical.
First, clients may be ending therapy because they are moving away. This is an obvious reason when you’re meeting with clients in person. This one would happen to me all the time, especially when I was working in San Francisco which is such a transient city.
Moving was one of my most common reasons why therapy ended in my earlier years. Now this was back in 2012, so obviously since then virtual therapy has become much more commonplace. But, the reality is, depending on where you’re licensed there are specific rules about who you can see and where your clients can live.
2) different modality needed
The ending to therapy may come when you need to refer your client to another therapist.
When you begin working with a client you may start working with them on something that’s in your therapeutic skills wheelhouse.
Then, either you come to realize that the client has something going on that is outside of your wheelhouse or they have something new pop up that’s not within your area of specialty or qualifications.
Referring your client to a different therapeutic modality is pretty common. For example, if I’m working with someone in individual therapy I may see that maybe they’d benefit from couple’s therapy. In that situation I might refer that person and their partner to a couple’s therapist.
(Now, I’m fully aware of the different schools of thought about whether it’s more ethical to have co-occurring individual and couple’s therapy vs. choosing to do one modality. We’re not going to get into that ethical dilemma today. 🙂)
3) stalled client
Another reason for ending therapy is when the client just isn’t making progress. This is so sad when it happens. Or sometimes their symptoms might be getting worse even though you’re doing the best job you know how to do.
If someone isn’t improving after seeing you after some amount of time, especially if you have already attempted to change your approach, then it is ethically so important to explore if working with someone else might be a better fit for your client.
4) not a good fit
Another reason why we might end therapy is because someone might not be a good fit for us. Depending on what context we’re working in, this might happen more often.
Especially if you’re working in a setting where your clients are assigned to you and you don’t get to do your own screening process.
There’s no need to force it with a client if you’re not a good fit. You can always refer to a different therapist.
5) financial constraints
Another very common reason for the therapy relationship ending is finances. Obviously if somebody loses their job and they can no longer pay for therapy then your client will need to stop meeting with you.
But your client may get a new job, or get promoted and switch insurance carriers. And if you’re not paneled with that insurance carrier then your client will get referred to someone who takes their insurance.
Sometimes it happens where your client has changing financial priorities. For example, maybe they’ve been investing in therapy financially for a season but they also have another financial goal that they are planning on pivoting into. Maybe they’re going to start school, or want to buy a new house.
6) ghosting
Therapy can end because of…ghosting? Yep.
Basically this is when someone never schedules a follow-up session, or they cancel a session and never follow-up to book again. I see this happen in my practice all the time. Clients will just drop out of the picture.
It might be something legitimate. For example, they may not have had the time in their schedule to sign up for a follow-up session Other things in life became a priority. Then a few months go by and they realize that they are doing okay.
Most people won’t circle back to their therapist to communicate that they aren’t in need of therapy anymore. And that is okay!
I think it’s really common in our profession to shame clients for doing this. But, honestly, this is quite socially acceptable behavior across the board. So I don’t think there is any need to shame our clients in the way we speak in consult groups and among colleagues.
7) flaky attendance
Ending therapy may happen because a client is very inconsistent in their attendance. Or they have a lot of cancellations/no-shows.
Maybe they have totally legitimate reasons for cancelling so much. But, whatever the reason, they aren’t able to access prioritizing showing up to therapy appointments.
This may cause you to have a conversation with a client and bring your relationship to a close or refer out as needed.
8) time constraints
Another reason why therapy ends is because, depending on the context, there could be a time constraint. Some third party payers like insurance, or coverage through an employer, will only pay for a specific number of sessions.
Regardless of how the client is doing at the end of the sessions, they aren’t going to pay for anymore. So the therapy naturally ends because you ran out of sessions.
Responding with curiosity vs. shame
Now this is certainly not an exhaustive list of every single reason why the therapeutic relationship can end but I hope it colors in more of an accurate picture of what it tends to look like when ending therapy with a client.
I used to carry so much shame when therapy ended for these many other reasons other than the client being magically ready to graduate in the time frame we had planned.
If it ended differently, I used to think that I had done something wrong. I would frequently consult, with a heavy heart, on these endings. (I do think it’s a good idea to consult in all of these situations.) But I would be consulting wondering: “What the heck did I do wrong?!”
I think it makes way more sense to have a sense of curiosity and an open-mind about what might have happened. Bring it up in consult group, explore together, but no need to take it personally or judge anybody else.
Clients who are stuck or quit
As mentioned above, sometimes clients decide to end therapy because they are stalled. It may ultimately be a good idea for you to end your therapeutic relationship with your client, but before you do, there are some things you can try to help your client who is stuck.
Of course, we all have clients who just up and quit. Check out my article on how to cope when clients quit therapy.
Until next time, from one therapist to another: I wish you well!
-Marie
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