No matter what setting we are in, termination is a part of our work with clients. Whether we see a client for 1 session or for several years, the ultimate goal should be getting a client to a place where they meet their identified goals and termination occurs. Your ASWB licensure exams (whether LMSW or LCSW) are likely to have at least a couple questions surrounding termination issues. Today we’ll discuss some key points on termination, how this could show up on your social work exams, and will wrap things up with a practice question.
When is a client ready to terminate?
How do you know if a client is ready to terminate? While every client is a unique individual and we want to honor their self-determination, here are some indicators of readiness for termination:
- All goals and objectives have been met
- The client has returned to a state of homeostasis after a crisis
- Presenting issues have been resolved, discussions in therapy become less focused.
Equally important for testing is knowing things that are NOT indicators of readiness for termination. It is important to understand the difference between the above indicators of readiness and those listed below. The behaviors listed below indicate a continued need for therapy rather than a readiness for termination.
- Avoidance of emotional topics
- Changing the subject when discussing presenting issues or working on goals
- The client skipping sessions or canceling a session after a particularly difficult therapy session
Common termination issues
Once a social worker identifies a client may be ready for termination, several issues can arise. Oftentimes clients are hesitant to terminate, fearing that if they stop coming to therapy, they will regress in the progress that they have made. This is NOT a reason not to pursue termination. Rather, we want to normalize this concern and build the client’s sense of confidence and competence in their ability to maintain progress.
How do we do this?
The most commonly utilized strategy for this is gradually decreasing the frequency of contact between the social worker and client. For example, if a social worker and client were meeting weekly, they could move down to meeting every other week for a period of time. Once the client sees that they are successfully able to manage for that period of time, the frequency of meeting can decrease further until the client feels ready to terminate. And one of the great things about the social work profession is that we can always leave the door open! If down the road the client’s life presents with additional issues, there is the opportunity to resume the therapeutic relationship. This is part of the reason it is important not to engage in dual relationships with clients even after therapy ends. Once a client, always a client.
ASWB practice question
A client has been meeting with a social worker for 6 months around issues of anxiety and depression. The client has met all of the agreed-upon treatment goals and the social worker brings up the topic of termination. The client becomes tearful and states that she doesn’t want to end therapy as she is sure her life will go back to how it used to be. What is the BEST course of action for the social worker to take?
A. Validate the client’s concerns and continue therapy until the client is ready to terminate
B. Honor the client’s self-determination and create new treatment goals
C. Normalize the client’s concerns and discuss gradually decreasing the frequency of therapy
D. Normalize the client’s concerns and schedule a final termination session
(scroll for answer)
The correct answer is C: to normalize the client’s concerns and gradually decrease the frequency of therapy. A and B are incorrect because they do not acknowledge that this is a normal reaction to therapy, nor do they work to move the client towards termination in a clinically appropriate way. D is incorrect because best practice would be to gradually decrease the frequency of therapy to build the client’s sense of competence, not just to have one final session.
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