Terminating/discharging and transferring clients

Terminating/discharge & transferring clients

Dear Supervisees,

Many of you wonder what's the proper way to terminate/discharge clients or even transfer them. First thing I recommend is for interns to consult with their onsite supervisors on what's their policy and procedures (expectations and requirements) for terminating/discharging or transferring. There are, of course, some appropriate typical procedures depending on the reason for terminating/discharging or transferring. For instance, it can be due to the clinician's limited scope of expertise on a particular presenting problem, or that clients potentially need a different type of service, or that the clinician is planning on leaving the site which is typically due to finishing their clinical training. In most cases, including either of these fore-mentioned reasons for discharge or transferring, clinicians would have some time to prepare their clients for a new clinician or even finishing with their service. Though the particulars may look different across these scenarios, I will share some essential tips that should be appropriate considering any reason for discharge or transferring. So first, giving your clients typically four sessions notice should be ample time to wrap up some of the work you are doing with them, and also help them with addressing any of their current concerns or questions that they may have with being transferred or discharged. Note, discharge is typically based on either the client's wishes or an agreement (between the clinician and the client) that the client has made significant progress to terminate accordingly. If you are wondering why not just give clients two weeks/sessions notice; for some clients, two sessions may seem sudden. They may feel abandoned and not considered being left with short notice, especially if you have been working with them for a while. As for transfer cases, I have found to be helpful for those of you that happen to know who the new clinician will be to recommend co-therapy so the clients can become familiar with the new clinician and vice a versa. For terminating/discharge, again this should be because the client is indeed "ready" and not simply because you are leaving, you would review the progress made based on the identified goals, highlight strengths and resources, review perhaps any tools/skills/strategies they have gained, and identify their plan moving forward without therapy, and so for forth.

Now, what about for those of you on the other end; that is, you are the one receiving the transferred client/s. Well, first of all, in either of these scenarios, clinicians should always demonstrate professionalism and be responsible for assuring that clients feel safe and respected. So, typical questions supervisees have wondered about receiving transferred cases, have been, "Do I review the previous therapist's notes?" "Do I take a blank slate approach?" Well regardless, becoming familiar with the case whether through the notes or speaking to the previous clinician, that in itself should not be considered an absolute truth; the best source of information is the client himself. The challenge at times clinicians, such as yourself may face, is clients "resistance," as may they think they have to start all over again (i.e., re-tell their story). Reframing the circumstances as an opportunity to re-assess where the clients are with regards to reaching their goals and determining where they hope to be, can help open a dialogue to what's been helpful or hasn't, to make some adjustments accordingly, as you develop a therapeutic alliance in building trust.

So, in summary,

• Check with your internship site what's their policy and procedures
• Make sure you give clients ample time to adjust to the idea of transferring or discharging
• Make sure you are adhering to the code of ethics
• Provide clients with the necessary insights to help put them at ease with the upcoming changes to their services
• Consider your clients level of vulnerability
• Consider your client's culture and diversity implications
• Consider strengths, resources, and safety

https://www.apa.org/monitor/2009/09/ethics

https://www.psychologytoday.com/us/blog/in-therapy/200809/terminating-therapy-part-i-what-why-how

https://www.psychologytoday.com/us/blog/in-therapy/200810/terminating-therapy-part-ii-the-ideal-termination

https://www.psychologytoday.com/us/blog/in-therapy/200810/terminating-therapy-part-3-the-not-quite-ideal-termination