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Unit 18 Termination Phase: End Processes

1. What are steps of termination process?

Following are the steps of termination process: 

i) Inform regarding planning of termination 

ii) Summarise hypothesis, goals and what happened in therapy, 

iii) Examine changes, 

iv) Identify issues left out, 

v) Anticipate problems, 

vi) Reinforcement and hope building, and 

vii) Plans for follow-up. 

2. What are the types of terminations?

There are two main types of terminations in family therapy:

• Planned Termination: This type of termination is designed, considered, and usually initiated by the family therapist. It occurs when the goals of therapy have been largely met, and the family is ready to manage on their own. Planned termination is a process, not an event, and involves gradual tapering of sessions.
• Unplanned Termination: This is a sudden termination where the tasks and goals of family therapy are left unfinished. Unplanned termination can occur due to client-related factors (e.g., lack of motivation, feeling not ready), or therapist-related factors (e.g., failure to establish rapport, setting unrealistic goals).

3. What are the therapist related factors in unplanned terminations?

Several therapist-related factors can contribute to unplanned terminations:

• Failure to Establish Rapport: A therapist who is unable to create a trusting and comfortable therapeutic relationship with the family can cause the family to discontinue therapy.
• Setting Unrealistic Goals: Setting therapy goals that are too difficult or not aligned with the family's needs and expectations can lead to frustration and early termination.
• Poor Communication Skills: The therapist's failure to communicate effectively with the family, especially in areas such as providing clear direction, can result in the family feeling unheard and misunderstood, leading to unplanned termination.
• Lack of Cultural Sensitivity: If the therapist fails to understand and respect the family's cultural background, it may cause a rupture in the therapeutic alliance.
• Lack of therapist self-awareness: Therapists who are not aware of their own feelings or biases may make a mistake or cause unintentional harm to the therapeutic relationship.
• Poor handling of termination anxiety: If the therapist does not address the family's anxiety or fear of ending the therapy, or the family's feelings of unfinished business this may lead to premature termination.

4. What are the indicators of a planned termination? 

Indicators of Planned Termination

A family therapist may consider planning for termination when:

• The objectives of treatment are met. This is determined through a review by both the therapist and the family to assess whether desired changes have taken place and if the family is ready for termination. It is helpful to ask the family to examine what has changed and if they realize their problem-solving skills have improved.
• The family's functioning has changed positively, such that they now possess the resources needed to deal with any remaining problems. Even if all initial goals have not been met, termination can be considered if the family has the capacity to address them independently. This may involve structural and functional changes that allow family members to cope with issues they could not manage before.
• The family demonstrates confidence in the changes they have made and can maintain these changes achieved in therapy. This confidence indicates to the therapist that termination is appropriate. Techniques may be used during termination to help the family further develop this confidence for the future.
• Therapy has been ineffective despite a good trial. In such cases, the therapist may decide to terminate therapy, and arrange a referral to another professional so that the therapy process can continue while ensuring that the family maintains hope for change.
• Individual therapy may be more indicated than family therapy. For example, in cases of domestic violence, where a family member is not willing to take responsibility or participate in therapy for fear of becoming more aggressive.
• There is evidence of generalisation of skills learned in therapy to many similar family problems.

5. What are the steps of termination? 

Steps of Termination

The termination phase of therapy includes the following steps:

1. Inform regarding planning of termination: The therapist explains to the family that termination is being considered. The reasons for this decision, whether the goals are largely complete or there has been little to no progress, are shared with the family.
2. Summarise hypothesis, goals and what happened in therapy: The therapist works with the family to review what was achieved during the therapy sessions, summarising the initial hypothesis, the therapy goals, and the events that occurred.
3. Examine changes: The therapist guides family members to reflect on the changes they have made during therapy, ensuring they acknowledge how these changes have positively affected their lives.
4. Identify issues left out: Family members are given an opportunity to reflect on any issues they feel have not been adequately addressed, allowing them to identify areas they would like to work on independently. This may include goals that were set but not fully achieved, or new concerns that have emerged.
5. Anticipate problems: The therapist helps the family identify potential challenges they may face in the future and supports them to consider how they can utilise their resources and strengths to meet these challenges. This helps to prepare the family and build confidence in their ability to manage problems independently.
6. Reinforcement and hope building: The therapist acknowledges the efforts made by family members and positively reinforces the changes achieved. This may include a recap of the changes that have been made. Positive reinforcement is used to build hope and belief in the family's ability to solve problems, and motivates them to continue their efforts to improve.
7. Plans for follow-up: The therapist makes plans for follow-up sessions, explaining when these sessions will be scheduled and their purpose. The family is assured of the therapist's continued availability should they need further support, and are informed about the possibility of "booster" sessions should new issues emerge.

These steps aim to provide a structured and supportive approach to ending therapy, ensuring the family feels prepared and confident in their ability to manage on their own.

Important Points

• Planned terminations are designed, considered and usually initiated by the family therapist.
• Termination can be planned when the goals of the therapy has been met.
• Confidence of family regarding handling the problems can be one of the indicators of termination.
• Some families may decide to terminate if they are not interested in improving their family functioning.
• Lack of motivation to change may lead to unplanned termination.
• Family therapist's failure to establish rapport with family can become the cause of unplanned termination.
• Setting unrealistic goals is one of the therapist related factors for unplanned termination.