Ending Therapy

Ending Therapy

Curt and Katie talk about termination of treatment, both when it is planned and when it is unplanned. We look at best practices, challenges, and how to handle it the best way you can.

It’s time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age.

In this episode we talk about:

  • When to start talking about termination during treatment
  • Setting expectations for the end of treatment
  • How to address client’s instinct to “ghost” from treatment
  • Normalizing the different paths to ending treatment
  • Different reasons that you may not be able to complete treatment
  • Planning ahead to diminish negative impacts of abrupt terminations that are out of your control
  • Providing referrals, closure, and understanding that even that doesn’t always create positive outcomes
  • The elements of a positive termination
  • Managing expectations of what health and healing are and what would qualify someone to finish treatment
  • Highlighting strengths and progress as well as on-going goals and challenges
  • Acknowledging the relationship you’ve had with the client
  • Processing your own response to the termination
  • What to look at and learn when your client abruptly terminates
  • Requesting termination sessions when someone decides to end suddenly – things to consider
  • What to do when your client ghosts you
  • Closing the client’s chart

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Resources mentioned:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links.

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Who we are:

Curt Widhalm is a Licensed Marriage & Family Therapist in private practice in the Los Angeles area. He is a Board Member at Large for the California Association of Marriage and Family Therapists, a Subject Matter Expert for the California Board of Behavioral Sciences, Adjunct Faculty at Pepperdine University, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant. As a helping professional for two decades, she’s navigated the ups and downs of our unique line of work. She’s run her own solo therapy practice, designed innovative clinical programs, built and managed large, thriving teams of service providers, and consulted hundreds of helping professionals on how to build meaningful AND sustainable practices. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

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Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano http://www.crystalmangano.com/


Transcript (Autogenerated)

Curt Widhalm  00:00

This episode of Modern Therapist’s Survival Guide is sponsored by SimplePractice

Katie Vernoy  00:03

SimplePractice is an all in one platform where you can schedule appointments and paperless intakes, file insurance claims and more. Our integrated telehealth feature allows you to meet with clients remotely. While our billing system allows you to track and accept payments at the press of a button.

Curt Widhalm  00:17

Stay tuned at the end of the episode for a link for a free 30 day trial to SimplePractice.

Announcer  00:22

You’re listening to the Modern Therapist Survival Guide where therapists live, breathe and practice as human beings to support you as a whole person and a therapist. Here are your hosts, Curt Widhalm and Katie Vernoy.

Curt Widhalm  00:37

Welcome back to the Modern Therapist Survival Guide. I’m Curt Widhalm with Katie Vernoy. And we spend a lot of time talking about building relationships with clients, building relationships with referral sources, and really talking about a lot of things at the beginning of therapy. But we’ve had one of our listeners request for us to talk about the end of therapy and about termination. And if you’re expecting a dad joke to fall in line with some sort of Arnold Schwarzenegger, I’ll be back sort of thing. I’m actually not going to do it because this is actually about not coming back.

Katie Vernoy  01:10

I was having the Doors “This Is The End” playing in my head. But I won’t sing it because we’re not doing jokes today. Apparently,

Curt Widhalm  01:17

it’s not that we’re not doing jokes. We’re just not doing that joke.

Katie Vernoy  01:20

Okay. All right. So termination. That’s something that I felt like I got a lot of experience with when I was in public mental health because I was moved from program to program. There was clients who were coming in and out of the system. And so I feel like I’ve had a lot of experience with termination, and not all of them good. And so I think this was actually a really nice request, because too often, termination is an afterthought, how do we close out treatment? How do we make sure that we’re taking care of our clients all the way through, and so I’m ready to jump in, are you ready to jump in Curt?

Curt Widhalm  01:55

So for me termination starts in the first session. And I think that this is really good clinical planning, and it sets the tone for what you’re actually doing in therapy. And I go over termination in my informed consent with clients and do it from the beginning. And mostly in my practice, since I’m usually working with teenagers, I kind of phrase it in the terms of, I don’t want you to feel like you’re having to come back forever. Like this isn’t to rush you out the door from the very beginning. But I want to give you kind of a hope that I’m not just here to keep making you come back. And here’s how we’re going to get there. So I think setting an expectation that termination can and will happen at some point is really paramount to then when you get to those later stages where you are talking about termination in a more like time sensitive matter that that is set up from the very beginning.

Katie Vernoy   02:52

I think it’s important that it’s not a surprise, I think, especially for kids, it’s a really important but in a slightly different perspective on that. I have clients who I think will get to a tough situation, or aren’t quite sure if therapy is working for them. And in the past, I’ve had clients who will kind of ghost on me, and being able to talk about – normalize that experience and talk about how to address it and giving them permission to say, Hey, I’m done. Or hey, I don’t think this is working for me. Or this is something where I’m not feeling like I’m getting what I came in for, whatever it is and and I think this happens periodically. It’s not something where it’s like a whole bunch of people are saying like Katie, you suck. So I want to clarify for my own vulnerability, but but I think it’s this piece of being able to talk from the beginning and saying, even after this session, you’ll have some vulnerability about what we discussed, there’ll be some difficulty in thinking about where we’re moving forward, there may also be hope and wanting to stay with me forever. But I think there’s this piece of making sure that if you have feelings of I feel like I’ve done or I want to decrease treatment, that we discuss it because it’s so important that in this relationship, we have a healthy goodbye. And I think really talking about that possibility from the beginning, makes it I think, especially for the women that I see who have had a lot of trauma or complexity in their life, being able to say this is a container where we’re going to be in this together, you can tell me if you want to change it and you have control in the collaborative relationship of when we finish. And I want to make sure that we, we have a goodbye together that we talk to each other because – and I normalize the instinct of saying like, you know, it can be really easy to just kind of cancel appointments and then not reschedule and have that finish. And I think that’s, that’s okay if that happens, but my preference is that we actually consciously finish out treatment together so that you have that goodbye that we have the closure because so much in our life, we don’t have the opportunity to be able to really have closure and do this together. So I definitely do that. At the beginning, too, and it’s not like with the kids like you’re not here forever, it’s, it’s with my clients, we’re going to talk about when the appropriate time is together so that you don’t feel shocked. And you don’t feel like you have to stay in here forever.

Curt Widhalm  05:12

One of the things that I’m thinking of as you’re talking is that this is also probably going to vary pretty wildly depending on your work atmosphere that Katie brought up, working in community mental health, that some of these decisions might not be necessarily a you reached your treatment goals sort of thing, and some of this might be shifting around work departments, or if you’re, you’re changing jobs. Some of this might be in the private practice world, I don’t run into this because my business is all private pay, but if you’re working with clients through insurance panels, then they might run out of sessions. So not all of this is going to happen in the most positive sort of ways are necessarily at the completion of treatment either. And we’re going to try and explore some of those throughout today’s episode. But your miles may vary depending on what your particular work situation is, and we’ll try and hit that based on what our experiences are, and what are stories from colleagues are throughout this, but take this all with kind of a how this applies to your practice as it is today.

Katie Vernoy  06:22

I think it’s important to really look at the ones that we don’t have control of first to make sure we have time for them, because those are the most difficult. And I think the financially based ones are really important, somebody loses their insurance coverage, they run out of sessions, they can no longer afford a fee that you can take in your private practice, you have to move divisions or departments in your work, you leave your job, there are times when I guess you have control over if you leave your job sometimes. But in the situations where it’s just kind of an abrupt termination, because of outside more financial forces, the logistics of it, there’s no insurance, they can’t pay your moving departments, and they can’t follow you or your moving areas and they can’t follow you. I think it’s really important to acknowledge the difficulty of that and to with as much notice as possible, really start talking about that transition. Because I know for myself when I was moving from department-to-department and then moving to different agencies and that kind of stuff, I found that the conversation, the conversations on my end got easier, but it was really important for me to understand in this particular relationship, how is it going to impact this client? And I misread it sometimes, there was some clients were like, oh, they’re not gonna care, and I didn’t provide enough support and space to process the loss of the relationship and some of those situations. And I think it took.. it didn’t damage the whole, you know, treatment effect. But it definitely was something where I hope that there were kind of repairs that they made afterwards, because it was so sudden and abrupt oftentimes, you know, I sorry, guys, I got a move, you just, you know, you’re off probation. And now you get to go home and I can’t follow you, you know, it’s, it’s this stuff where being able to really look inside the relationship, what do they need? How do they need to process this goodbye? That you feel comfortable, and that they have the resources they need.

Curt Widhalm  08:24

And that’s a really huge key. And especially if you’re working in agencies, or work environments, where there’s a really high staff turnover, or, and I see this a lot with associates and interns who are maybe committed to a place for a year or, you know, varying times where the clients are used to a very high turnover of staff. And there’s definitely issues at the very beginning of, oh, you’re just another therapist sitting in a chair, and you have to reestablish kind of that working relationship from the beginning. But it brings up its own special issues as far as the termination goes as well, because they’re somebody who’s maybe gone past that jaded therapist relationship sort of aspects from the clients end, and now are losing it again and needing to be able to provide an appropriate amount of space for emotional reactions to that, that it might be a really good connection that all of a sudden now they’re writing you off because they’re protecting themselves for another therapist relationship ending. I’ve also seen this happen in my practice, were one of my associate’s clients when my associates got licensed and moved out of the area, appropriately terminated with her caseload and provided referrals. And unsurprisingly, several of her clients didn’t want to go and have an emotional investment into another therapist right away. And one of the clients came back and I saw her for a couple of sessions while we were trying to manage a crisis for her, but she came back with kind of this idea that her experiences, the client was, “oh, my therapist is moving, I must be done with therapy”. Oh, there, there really is kind of a whole layer of this, that we really need to prepare for it and really make sure that our clients understand because even with, you know, several sessions that this particular client took it as “well, I guess I don’t need help anymore, because the the therapy world is moving away from me”.

Katie Vernoy  10:32

I think that actually is something that maybe we should circle back to what’s ideal in a, in a termination, if especially a planned one, but even an unplanned one, I think we can get some of the elements, and I think one of the pieces is really being able to talk about progress, and what has been accomplished, what they feel they’ve accomplished, especially really getting a lot of that from the client perspective, what that how they felt they’ve grown, you know, what objectives or goals or however, you know, you’re assessing it within your treatment planning have been met, what’s still to be worked on, and getting a really clear sense and a normalization of where they are in their process. Because I think, clients, if this is their first time in treatment, or if this is their first time with a proper termination, they may have not really a good sense of what it means because even in developing the relationship, the clients really are not aware of the role that they’re playing. And so in termination, I think being able to bring them into the conscious assessment, if they’re not all the way through depending on your orientation of how’d we do? What was your experience? What’s changed? How have you grown? What are the things you’re struggling with? What are the new things that have come up in your in your life that you’ve had to kind of grapple with? And where were their areas still to grow? Because I think so often and I find myself clarifying this throughout treatment is people have this, you know, a lot of clients anyway, have this idea that they will be healed. And they will be well, when they’re happy all the time. And when everything’s easy for them. And when everything’s like the curated Facebook posts from everyone else, and I think it’s something we’re just really getting to a place of, here’s where you are, here’s your growth. But here’s the places where you’re still struggling, and that’s okay, you’re a normal human being. And this is a, this is either an opportune time to kind of go out and do it on your own or this is an inopportune time. And we have to shore up the the resources that you still need, whether it’s another therapist, whether it’s some support groups, if it’s, you know, medical treatment, if there’s anything that that kind of is needed, being able to do that assessment, and help them to really identify what’s next for them, because they may not be consciously having that assessment.

Curt Widhalm  12:48

And that’s really what are the ethics codes and I’ll try not to jump too much into all of the different ethics that talk about termination. But what’s really consistent across the ethics codes is that having a pre termination plan is paramount to a complete therapeutic relationship that that is referring them out to other services or to really highlighting the skills that they’ve learned so that way, they can continue to apply it without necessarily having their weekly session with you or whatever your relationship might be. But that just because they’re finishing therapeutic treatment with you doesn’t mean that their work stops. And I think that that’s a really important piece to have as part of your termination plan is it’s not just, um, goodbye, and here’s where you’ve been. But it’s, here’s how you continue to work on these issues. And it’s not the daisies and rainbows that Katie’s talking about, of what some clients might have in mind as far as how they’re going to feel, but it’s that they now have the skills to be able to handle things that they might not have handled before.

Katie Vernoy  13:56

And I think a lot of times, folks don’t acknowledge that because they’re just living in their own skin the whole time. And so, throughout treatment, I think it’s really important to assess progress and strength and all of that. But I think especially at the at the end, being able to acknowledge that and really having I like to put a hopeful spin on it, even if they’re really struggling and it’s not an ideal time is, is helping to instill hope and empowerment and, and the possibility for them to continue to grow. I think for that piece moving on from that piece, I think it’s really being candid, but also really having a positive reframe for it because I think digging into like ‘you really need to work on this’ is not  – you don’t want to open that up in a termination session or even in the pre termination planning. I think there’s times when there’s safety issues that you have to address, but I think in general being able to, to kind of close it up and close up the piece of work that you’ve done and be able to transition them to the next stage is important. And then I think it’s also important to kind of create in that moment, the relationship into more of a superficial place so that the depth is closed up that there’s a there’s a closure to that. And that was advice I got. And I’m curious kind of what you think of that, because that’s something where I move into a place where it becomes a little bit more chatty, it’s a little bit more person to person, it’s a little more, how’s the weather, if you will? And I think for me, I find that very comforting, because it helps to, to put a different feel to it. But I don’t know, I don’t know if that’s universal a piece of advice that that people do

Curt Widhalm  15:33

I think that this is one of those times where the therapy answer, “it depends”, really, I think that part of this is really around kind of how you work, what your theories suggest that you do. I think that part of this really depends on the populations that you work with, that sometimes working with immature teenagers, some of the therapy that we’re doing just looks like chatting anyway, because that’s the way of getting them involved in therapy in the first place. So there might not be as marked as of a, of a shift that is what you’re talking about. But I think that there definitely is kind of the, we’re really shying away from either the clinical stuff that you’ve accomplished, it’s also really important in those situations to look at is the client avoiding talking about things and because I have several clients who will chat up a storm about absolutely nothing at all, so that we don’t have to acknowledge what they’re emotionally going through at that time.

Katie Vernoy  16:37

I think that is important, I think, recognizing that we have held an important place in this person’s life. And it’s not just closing their treatment, but it’s also really honoring the relationship and helping them to express their feelings about the closing of the relationship, because it’s not like, it’s not a death, although it can feel that way if we never see them again, there is not – we’re not friends that we were like, oh, we’re moving away, and you can keep in touch necessarily, I definitely say to my clients, if they want to reach out, I’m going to be available to you know, kind of in that same capacity of if they want to re-engage or if they want to give me an update. But it’s really a different type of termination than any other and so being able to honor “Hey, you might be having some emotions over there about” You’re gonna miss me, You’re gonna miss me so much, it’s gonna be awful. No, I think it’s something where being able to acknowledge that this is a different type of relationship. And, and I mean, there’s the practical stuff of I tell them that, you know, they can always come up to me, and I may not acknowledge them in public, if they see me because of confidentiality. But if they do come up to see me and acknowledge me, I will respond to them. But I think it’s being able to talk about “this is weird”.

Curt Widhalm  17:51

And I run into this, oftentimes with kind of structural changes in clients lives, that a number of my clients, I probably go through about four or five long term relationships that end because my client is moving out of state for college. And these are really weird situations for me sometimes, because these are people that I’ve seen grow from, you know, middle schoolers and high schoolers. And, you know, there’s, there’s definitely pride that I have for them to be able to move on in their lives. But it’s also, knowing that they haven’t quite reached what they’re looking at life is or that they’re still developing a way of relating and knowing that I’m holding an important place in their life for them to have consistently come to me for that kind of a timeframe. And usually around winter break, I expect some of them to contact me back, “hey, I’m back in town, I’d love to see you for a couple of sessions just to kind of have a booster”, but there’s also kind of this termination relationship that’s like, well, who’s not calling me back what’s going on with them. And read into that what you want. There’s all sorts of countertransference that’s, that’s there. And most of the time, it’s positive, but I think that it’s a structural thing that happens sometimes in clients lives where you, you plan for it, you can have these great plans that I love hearing when my clients come back to me and they’re like I, you know, have really continued to grow in this way because of our work. It’s different from that very scary, like, I went to college, and I did that thing that you said, and you’re trying to go through your memory of like, ‘What did I say? Hopefully it was good’. But in some of these situations that even though there’s a plan termination doesn’t necessarily mean that the work is complete. And I think that that’s something that if you have a really good relationship, it’s a lot easier to have those conversations of like, here’s what you need to continue to grow on. As opposed to maybe some other situations where it’s a little bit more abrupt.

Katie Vernoy  20:07

Yeah. Before we move into abrupt things, I wanted to comment on your like, who isn’t reaching out and that kind of stuff. Because I think that’s something that’s somewhat unacknowledged. I think it’s something that I’ve always kind of acknowledged to myself, but I realized that, you know, there’s kind of those posts in the Facebook groups about, does anyone else feel sad with their clients terminate or, or their clients ghost on them or whatever. And I know for myself, both having terminated with one therapist, and I still kind of wonder where she is, and what’s going on, and, you know, have wanted to reach out but never have really done it. And then also being the therapist where the clients have finished up, whether it was moving away to school or a planned termination or, or whatever, where I really a think about them, I missed them. I I wish I knew what was going on. You know, it’s kind of there’s there’s the part that’s more the, the not the voyeur, I guess, but the person that’s like, I wonder what you know, the story didn’t finish, I want to know what’s going on still. And then there’s the part of this was somebody who I’ve felt connected to, and I missed them because of the relationship that was developed. And I think it can be some grief and loss for us too. And I think it’s important for us to acknowledge that whether it’s a plan termination or not, we can be really sad that we’re not going to this person is not going to be in our lives anymore. And so I just wanted to acknowledge that because I don’t know that I’m like checking off who’s like reaching back out and who’s not. But I certainly have missed a lot of my clients. And there’s people I still think about, and it’s not appropriate for me to reach out to them necessarily. But I definitely, I definitely want to just acknowledge that piece of it, because I think it’s self care that we need to do.

Curt Widhalm  21:55

And I think acknowledging it is awesome, just in that it is a it is a experience that we have and to pretend that it’s not there does nobody any good. Have your limitations. Don’t Google stock your former clients but you can have your feels.

Katie Vernoy  22:14

Thank you. Thanks for your permission.

Curt Widhalm  22:20

Abrupt terminations.

Katie Vernoy  22:21

I think oftentimes, for me, abrupt terminations have been typically ones that weren’t driven by somebody moving or somebody losing insurance or that kind of stuff, ones that were more clinically related. were times when there was a challenging situation that happened in session. I’ve had people do abrupt terminations when I’ve been required to do some reporting. You know, child abuse, dependent adult abuse, elder abuse reporting. Times when this is what I’ve talked about before, where I commented on the torturous nature of it and said, this is how it’s going to be that was very early in my career. But I think, in truth, oftentimes, those abrupt terminations aren’t necessarily predictable, but they are things where I have been a little bit surprised that I go back and look at the notes and say, “oh, okay”, and sometimes it’s a learning lesson. It’s like, “Oh, I missed this thing”. And sometimes it’s like, “oh, okay, that was where the client had finished”, and they were done and they didn’t have the resources to let me know, in a different way. But it’s always hard. I feel like there’s always a self assessment, did I do something that hindered the work or hurt the relationship or hurt the client? And do I need to work on that? And is it just something that can happen with clients, and I think there’s, there’s a combination, and it’s not necessarily one or the other. But it’s, it’s important in abrupt terminations, to be able to have that assessment, so that you approach it. And you can also learn from it.

Curt Widhalm  23:49

In my practice, I see this a lot with kids coming from divorced families, where something shifts in clinical work that one of the parents all of a sudden pulls consent for treatment. And, and it might not have anything to do with what I’m working with kid, right, might have encouraged a kid to actually express their genuine feelings towards a non-preferred parent, and then the parent doesn’t have the ability to reflect or take on that kind of response from the kid. That’s where the therapy gets blamed, instead. And so there ends up being kind of this disruption or this abrupt termination that you might not even get to say goodbye, you might not be able to reflect back on the progress that has been made or provided an encouraging session of here’s how you can continue to stick through things. And it really is hard and it comes with some of the territory of being a therapist is that you, you can still, you know, try to have a termination session. And I think that in some agencies, maybe we’re clients aren’t paying for sessions, that it’s easier to convince him to come back in to wrap things up nicely. Its not so easy when you’re in a private practice type model of like, “Hey, I think that you should come in while you hate me for a termination session that you don’t want to pay for, because you hate me”, that really becomes kind of something that in order to terminate properly, you should see that termination session through or to be able to provide resources of here’s where you might get some of these other things that you’re working on and get those needs met in order to have proper termination.

Katie Vernoy  25:39

So that’s a question I have is with calling someone back in for a termination session. And so I’ve had people text and say, I’m done, or I’ve had people leave a message or that kind of stuff. And oftentimes, what I’ve done is depending on the relationship, I’ll reach out to them and say, I want a termination session. And I’m kind of willing to do it pro bono if needed in order to have that closure. But I think the difficulty is not everyone has the financial flexibility to be able to do that. Can we require someone to pay for a termination session when we think it’s in the best clinical interest? And they’re ambivalent, at best and coming? Like, what are the laws and ethics there around that because I think there’s the ethical responsibility to have a proper close out of treatment and make sure that they’re taken care of as they move forward, if we can, but if we’re forcing them to come in, quote, unquote, and then we’re forcing them to pay, it feels pretty bad. So what are your thoughts on that? Because I guess I’m willing to do it pro-bono So I don’t like run into that. But I think there’s that piece of this is kind of weird, you know, it’s kind of an awkward situation to be in.

Curt Widhalm  26:52

It does not, as far as I’m aware of, have any guidance in, in our ethics codes. And I’m trying to go through my memory on this and not just kind of be like, Aaright, everybody, you need to wait 15 minutes and listen to silence and whatever we ramble about. But in providing proper termination, I think the way that I like to conceptualize it is that proper termination is about how we wrap things up for the client. It’s about things that we do. I am not on board with kind of exerting my powers of the therapists over a client and forcing them to do things that they don’t want to do. If they’re really like, “Hey, I’m, I’m good. I don’t want to come back in and I definitely don’t want to pay for this”. You can have maybe a brief termination on the phone. I mean, if you’re already having that phone call, finish up the phone call doing the termination work. I don’t think that if I’m forcing somebody to come in that I’m going to force them to pay for me, especially when it’s my idea. But more often than not, if you are doing good therapy, and you’re doing some of the other things that we recommend of really having a strong working alliance, having good client feedback, then you shouldn’t run into this particular situation a whole lot. Because when you get to the end of therapy, you’re probably in what Katie was describing earlier of like, so we’ve had a couple of sessions where we’re not doing a lot like, are we are we done? What does this look like?

Katie Vernoy  28:29

Yeah, yeah, I agree. But I think it really depends on the clientele. And I think that there are definitely times when there’s been a lot of conversation, there’s been a lot of discussion on how we’re doing, is this working, where are we going from here? And there can be missteps, or there can be challenges that clients have really hard times dealing with where they can, they can pop out a treatment, and they may pop back in, but they can pop out a treatment because of their level of, of distress, and their, their level of frustration with you, and I think even the best laid plans can sometimes go awry, and I think in some of those experiences with clients who’ve had a lot of trauma, or who have a lot of emotional dysregulation, or that kind of stuff, my attempt has always been to at least get somebody on the phone. But with the advent of text and email, that can be difficult because people can keep getting back to you or ignoring you. And so I think it’s, it’s something where, even with the best practices, you can still end up in a situation where you have a client who is so dysregulated and so triggered by what’s happened, you know, in a session, whether it was a misstep of yours or just, you know, some, you know, therapeutic progress that was, you know, a little bit quicker than they were expecting. I think in those situations, I’ve I’ve tried to get them on the phone, but I think there’s a challenge there. So I guess I’m kind of rambling at this point, but I just I want to acknowledge that there’s going to be hard terminations even if people are doing really good work, because I do think that there going to be times when people just exit. And sometimes you won’t know why sometimes it’s personal stuff. And sometimes it’s because of a challenging conversation in the room. And I think the best we can do is reach out, appreciate what they’ve had to say and see if we can get them at least on the phone. But it sounds like what, to summarize, it sounds like forcing them to come in and pay for a session just doesn’t feel good. And neither of us do it. And I think it’s, it’s, we can recommend, we can talk about why but I think if it starts feel to feel pressure, and I think that becomes potentially an abuse of the power differential.

Curt Widhalm  30:38

Definitely. One thing that Katie has brought up a couple of times and want to touch on a little bit is this aspect of clients goes to ghosting us, when they just stopped contacting us whatsoever. And, in general, when I respond to these kinds of clients, I tend to give usually about two to three phone calls, emails, whatever trying to reach out to them before I close out their, their books. And I do this because I want to show that they are important that this is important work, give them an opportunity to respond back. But some clients because of whatever just stopped responding. And I think that that’s becoming maybe more and more prevalent for a lot of clinicians that I’m hearing is that just the advent of where we’re at in society, and technology allows for us to kind of just float away a little bit easier and block phone numbers than it is to really have to go in and meet things out. But in general, I get about three attempts at contacts in order to try and get somebody back in.

Katie Vernoy  31:46

I think that’s about right. I think there’s It’s different with different clients. For me, I think typically it’s probably about that I try to make sure if the ghosting starts with a no show for a plan session that obviously has a different connotation and is more in depth that we want to talk about it here, but I think oftentimes I’ll follow up with phone calls after that, if someone’s kind of said, “Hey, I need to take a break for a little bit”, depending on and this is more a therapist, that, uh, that a thoughtful practice, but depending on the availability I have, if someone says, “Hey, I need to take a break for a month, I’ll be back”, sometimes I’ll check in and see if they want to schedule and sometimes all kind of allow that to kind of to fade out. And so I think, you know, in those situations, depending on the client, I can make sure that I close that stuff out. So I think it I think again, it goes to It depends, but I think probably three attempts is a good is a good rule of thumb. I don’t know.

Curt Widhalm  32:44

So as we come to the termination of this episode, what we would like you to do is that there’s obviously theory based things that go into termination, have a plan for it, make sure that you’re talking about it with your clients ahead of time, the appropriate through the termination process, and the shownotes you can find those on our website, MTSGpodcast.com, and you can find all of our old episodes there. Please join us in our Facebook group, the Modern Therapist Group and share your ideas around termination. And join us in Los Angeles for the Therapy Reimagined 2019 Conference. We’re still working out some details on that. But we’re still buzzing high off of our conference this year. So stay tuned for more information on that. And until next time, I’m Curt Widhalm with Katie Vernoy

Katie Vernoy  33:35

Thanks again to our sponsor SimplePractice. They are inspired by the work health and wellness professionals do and work to help them start run and grow their businesses.

Curt Widhalm  33:44

So practices co-founder Howard Spector was trained as a therapist and struggled to find a software that was both flexible for his needs while keeping him in control of important tasks like client communication, scheduling and billing. So he made SimplePractice to make it easier for all of us

Katie Vernoy  33:59

Go to ter.li/simple18 to sign up for a free 30 day trial,

Curt Widhalm  34:05

Or click on the link in the show notes.

Katie Vernoy  34:07

Because running your practice should be simple so you can do the work that really matters.

Announcer  34:11

Thank you for listening to the Modern Therapist Survival Guide. Learn more about who we are and what we do at mtsgpodcast.com. You can also join us on Facebook and Twitter. And please don’t forget to subscribe so you don’t miss any of our episodes.

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