The recent Risk Management in Psychological Practice conference at John Jay this past Sunday covered a section entitled: We Are Not Getting Along.
- Therapist duty v. patient responsibility
- Informed consent and deviations
- Termination policy
- Resistance to termination
- Treatment compliance
- Setting and enforcing limits
- Patient threats
- Boundary issues
- Ethical issues
1. At intake, do I discuss patient duties such as responsibility for participating in mutual goal-setting, monitoring progress, or planning for termination? If not, why not?
2. Do my written informed consent documents and patient contracts mention patient responsibilities, including those related to termination? If not, why not?
3. Do I re-open the conversation about termination if the contract needs to change (e.g., patient is making no progress; third party reimbursement is ending)? If not, why not?
4. Do I raise issues of nonpayment or noncompliance when they first arise, and consider the possible need for termination? If not, why not?
5. Do I dread ending particular therapy relationships? If so, which ones, and why?
6. As therapy relationships end, do I spend sufficient time exploring patients’ issues related to the ending, including negative as well as positive feelings about the therapy? If not, why not?
7. Do I remain aware of my possible role in complicating a termination, instead of just blaming the problems on patient variables? If not, why not?
8. Do I obtain consultation in cases involving difficult terminations? If not, why not?
II. Codes of Ethics (several organizations):
III. An excellent resource:
Difficult Therapy Termination Issues
- Reimbursement issues
- Lck of progress
- Therapist-patient mismatch
- Boundary violations
- High risk patients
I think it behooves us to revisit risk assessment and risk management concepts in several contexts regularly.