Chapter 12

Termination

Final Phase

  • During the final phase of counseling, the treatment plan is revisited to compare client progress with the treatment plan, known as client outcome.


  • Outcome research is used to determine whether what we do actually benefits clients. Interest in outcome research is growing due to managed care and awareness of unsound treatments


  • There are both external and internal reasons for monitoring client outcome.

Evaluation

Basic outcome evaluation methods include:
  • progress notes

  • global measures of change

  • measure specific changes (example using the Beck Depression Inventory II)

  • subjective scaling

  • client self report

  • reports by others to monitor change

  • client satisfaction scales

  • goal attainment scaling

  • program evaluation


The process of termination includes looking back at the original goals and celebrating client success. Termination should occur not only when clients accomplish their goals, but also when they fail to make progress or when there is evidence that they can manage their issues independently.

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  • A general way of helping clients deal with feelings of loss at termination is to take time to prepare them and to:


  • identify both positive and negative feelings

  • Highlight the clients’ actions success

  • Encourage independence


  • Techniques

  • Therapeutic gains can be maintained following termination through the use of several techniques, including fading, observation, the use of paraprofessionals, self-help groups, self-management skills, and letter writing.



  • Be knowledgeable of the self-help groups in your community for referral.

  • Activity


    Helper’s Reaction to Termination. Counselors often have their own thoughts and feelings regarding termination and may postpone termination because of their own attachments and feelings of sadness and loss (pg. 272). Further, their own history with loss may also play a role in this countertransference issue. Counselors may be unprepared for their own reactions and feelings at termination or the loss experienced by the client, regardless of how they are intellectually informed of the last meetings. How would you know if this was happening to you as a counselor? How could you recognize it, if at all? What would things could you do to help or manage the issue?


    Attachment to a Client. Students can become very attached to a particular client, making termination difficult. Is it appropriate to stay in touch with a client? To see them outside of a counseling setting? What problems might arise if you do this? Ethically? For the client? For you? How would you handle a client’s request to call you once in a while? What if the client said that he or she will not continue counseling because he or she could not bear to start all over again?