Oh, goodbyes...most of us aren't very good at them in our personal lives, but it's important that we become good at the process around saying goodbye in our professional lives. Termination is a vital part of treatment and deserves our attention and respect. We may not always get to control how and when we say goodbye to clients, but we can provide a model for our clients of how to say goodbye in a healthy way that honors whatever relationship we've had. So, how does termination show up on the exam? Let's look at an example.
Sample:
A 27 year-old male client has been working with a therapist for 4 months around interpersonal difficulties. During a session, the therapist confronts the client regarding a pattern of behavior that appears to be contributing to the presenting problem. At the next session, the client arrives and reports that his relationship problems are resolved and he no longer needs treatment. What should the therapist do FIRST?
A. Proceed with termination and help the client process his feelings
B. Offer the client referrals for community resources and proceed with termination
C. Explore the client's readiness for termination and support his self-determination
D. Reflect on the previous confrontation and explore the client's feelings after the last session
So, how do you know when a client is ready to terminate? Sometimes it's dependent on a specific number of sessions, sometimes it's dependent on achievement of particular treatment goals, and sometimes people just need a break, even if they're not done with the work yet. Ideally, termination is an entire phase of treatment that helps the client consolidate the gains they've made and anticipate future problems. Sometimes, though, clients may use the idea of termination to avoid a conflict in treatment, or to deal with uncomfortable feelings that have come up. So what do you do then? The social workers in the crowd may all be thinking about that "self-determination" piece -- and it's true, we're ethically bound to respect the client's self-determination, but this doesn't mean that we just go along with everything the client says, right? Again, one of the ways we can intervene with clients is to model ways of dealing with conflict and uncomfortable feelings.
Answer:
Well, in this case, D is the best answer. While you might end up doing A, B, or C eventually, the FIRST step would be to bring up the previous confrontation and encourage the client to explore the feelings he had in response to the therapist's intervention. If you skipped D and went to one of the other interventions first, you run the risk of reinforcing a pattern of interaction that may be contributing to the client's problems, and you miss the opportunity to help the client create a new way of being in relationship with another person. If you attempted to execute D and the client still maintained his stance, then you might have to move on to one of the others, but don't skip over the opportunity to repair a therapeutic rupture like this!
Coming up next week: Medication Management
Think our straightforward, sensible approach could help you PASS your social work or MFT exam? If you're preparing for a social work exam, check out our Social Work Study Materials. If you're preparing for an MFT exam, check out our MFT Study Materials. Learn more about our offerings at The Therapist Development Center.
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