Termination Guidelines, by Jeffrey Barnett, Psy #termination, #psychotherapy, #counseling, #abrupt, #treatment #plan, #follow #up, #referrals, #codes #of #ethics, #psychologist, #mft, #social #worker, #counselor, #marriage #and #family #therapist, #social #work, #online #courses, #ce, #continuing #education, #apa, #nbcc, #apa, #nsw, #camft


Termination Guidelines

  • Clarify expectations and obligations from the outset. The Office Policies are the best way to articulate and discuss such expectations and obligations. (Zur Institute’s Clinical Forms .)
  • Be familiar with the relevant guidelines and standards in your professions’ Codes of Ethics with regards to termination and abandonment issues. Summary of the different Codes of Ethics on Termination Psychotherapy and Counseling
  • Some terminations are short and swift, while others may be long and protracted. Then termination can have different meanings and be just an end of a phase in intermittent-long-term therapy. The form and type of termination depends on the client, setting of therapy, therapeutic orientation, quality and type of therapist-client relationship and the therapist.
  • If necessary, review with patients their insurance coverage, limits to managed care contracts, and how utilization review may impact on termination. Set up arrangements for addressing patient treatment needs if continued authorization is denied.
  • Make adequate arrangements for coverage during any periods of planned or unplanned absences.
  • Provide patients with referrals to other treatment sources, if needed, and work to assist them in their transition to other health care providers.
  • Be cautious in regard to termination of patients who are in crisis. Try to avoid terminating clients who are in acute or temporary crisis due to payment issues.
  • The average number of visits among U.S. patients receiving psychotherapy in 2007 was 8 sessions, according to a study published in the American Journal of Psychiatry.
  • 41 percent of patients in the U.S. quit psychotherapy “prematurely,” according to a 2010 study in the journal Psychotherapy Theory, Research, Practice, Training.
  • Many clients unilaterally decide to drop out of therapy. They may do that with a phone message or by simply not showing up to their next scheduled appointment. You must remember that it is the client’s prerogative and choice whether to continue in therapy or not. Except in extreme situations, such as when the client poses a danger to self or others, you need to respect their choice. Do not tacitly condone patients dropping out of treatment when your clinical judgment indicates continued care is needed. When clinically and otherwise appropriate, notify the patient of your assessment and recommendations. There is no ethical, clinical or legal mandate to send a registered letter to client. Different clients and situations may require different actions and, at times, lack of action.
  • The question of whether therapists need to send a letter to clients who unilaterally dropped out (i.e. pre-mature termination) was recently addressed by Davis & Younggren in a 2009 PPRP article, where they clearly stated “In ordinary circumstances, however, letters are typically unnecessary and potentially counterproductive to the natural dissolution of the relationship (Davis, 2008). For instance, the client might feel embarrassed or scolded for his or her oblique termination and be less inclined to return. The client might perceive the psychotherapist’s actions as controlling and unnecessarily intrusive. It might seem that the psychotherapist is trying to break up with the client or get rid of him or her with such a formal action. Routine letters of closure not only present an unrealistic administrative burden on the provider, they add to the risk of negative client reactions.” (p. 575)
  • It is not unusual for therapy to break down rather than go through a smooth, clear or distinct termination process with patients with personality disorders (i.e. BPD) or those who were diagnosed with severe mental illness, such as schizophrenia or Bi-Polar disorders. Termination with these clients can be very abrupt or very long, painful, confusing and tumultuous. Obviously, each case should be handled according to the specific context of therapy. The context of therapy includes client, setting, therapy and therapist factors.
  • You can terminate treatment with clients (or another person with whom the client has a relationship) who threaten or stalk you, your family member or your employees via phone, email, online, in-person or other means. You can also terminate treatment with clients who intrude into your private life via the Internet or in “real” life. You are allowed to protect your privacy and secure your own, your family members’ and employee’s sense of privacy and safety. (Document, document and document.)
  • You must terminate therapy when it becomes reasonably clear that the patient no longer needs the service, is not likely to benefit, or is being harmed by continued service. For those patients who have ongoing treatment needs, when appropriate, one should offer to provide them with assistance with referrals to other appropriately trained and accessible professionals (except when we are being threatened, assaulted, stalked, or other relevant situations).
  • Document discussions of termination issues, agreements reached, decisions made and their rationale, and, when relevant, document the recommendations and follow-ups. Purchase a Termination Summary form
  • Termination of treatment is not always a permanent ending of the professional relationship. Termination is often not relevant during, or an end of phase in, intermittent-long-term psychotherapy. These forms of therapy may continue throughout the life span of individuals and families.
  • Termination is a phase of each patient’s treatment. If possible and appropriate, plan for it, prepare for it, process it. Additionally, each clinician should consider termination in light of their theoretical orientation and treatment approach, each patient’s/client’s diagnosis and treatment needs, and any relevant diversity factors that might impact the process.

  • RIVERDALE Star KJ Apa is Basically Archie in Real Life #archie #andrews,archie #comics,kj #apa,riverdale,the #cw


    RIVERDALE Star KJ Apa is Basically Archie in Real Life

    When The CW first announced it was going to make a live-action Archie show, the long journey to finding the perfect Archie Andrews began. But the network wasn t looking for the Archie Andrews straight from the pages of the iconic comic books—his version had to be different. Instead, Greg Berlanti s vision of Riverdale was one of a strange-yet-addictive mix between the eerie and dark murder mystery Twin Peaks. the high school and relationship drama of Gossip Girl with Archie comics characters at the center of it all.

    After a painstaking search, Riverdale finally found its Archie Andrews in up-and-coming New Zealand actor KJ Apa. No, he s not a natural redhead but he wears the shade just fine now thanks to the modern wonders of hair dye, which he rigorously applied first on a weekly basis and then every two weeks— It s pretty gnarly, I don t know how some girls get their hair dyed all the time, he told Nerdist on set in Vancouver. The 19-year-old brings the classic character to life for a new generation, as the girl-obsessed teen becomes a hot football star with a secret desire to trade in his jersey for a guitar. And while Apa may not be a ginger in real life, he s pretty much the perfect Archie in every other way.

    Reading the pilot, when I was just about to start shooting, something that stood out to me was we both—me and Archie—are struggling between music and [sports], Apa said. When I was in school, I had to decide if I was going to do music, because I was on a half scholarship at school, and rugby. Rugby was a big part of my life for a while, and I had to stop because of acting. So I had three things that I was just like, what s going to happen? I had to stop playing rugby because you can t play rugby and act as well, so I was forced to stop doing that. My dad loves rugby, and he was gutted to have me not play anymore, after playing my whole life. That was something that I could easily relate to with that.

    That connection to the character helped Apa when it came time to audition for The CW s newest drama. While auditioning for pilots can be a daunting experience for any aspiring actor, Apa was coming from New Zealand to a whole new country, making it that much more difficult.

    I had just arrived in LA, on the [audition] weekend in January, Apa said. I got an email for this audition [during pilot season] and I went in [for it]. I [auditioned for] David Rapaport, he s the casting director. Then they called me back two weeks later. At that point I d forgotten about the audition, and I went into the room and did it [again], and he kind of looked at me, and was like, Have you been in here before? And I was like, Yeah, I came in two weeks ago. And he just left the room.

    He paused to laugh, then continued, I was like, Oh, okay. He had gone into the room to speak to someone, then he came in and he was like, Can you come back in like two hours? Then I left kind of stoked. I knew it was a good thing. I went to a café, got a coffee, came back after about two hours, and then read it again with him in front of [executive producers] Roberto [Aguirre-Sacasa], Sarah Schechter, and a couple other guys. The screen test was two days after that.

    Since music is such a big part of Archie s life on Riverdale. Apa also had to prove he had the musical chops to bring him to life.

    I took my guitar in and sang them a song, Apa said. I played Mary Had a Little Lamb by Stevie Ray Vaughan, in front of this whole studio of people. I was so nervous. Then John Goldwater, he owns the whole Archie franchise, he told me after that screen test, Oh yeah, we ll see you soon. They called me the day after and said that I d gotten it.

    Apa remembered how great it was getting that fateful call while he was in the car and his manager was calling him at the same time, but he wasn t surprised by the news at all. I kind of had already knew after John spoke to me, Apa said. But I didn t say anything, because I didn t want to get my hopes up for nothing.

    Now that he s deep into filming the first season of Riverdale. Apa has enjoyed seeing all the ways in which The CW series is differing from the comics, making a whole new Archie for the world to meet. When it comes to what viewers will be most surprised by, Apa thinks 100 percent, it’s how dark it is.

    [You ll see] how subversive and how moody everything is, Apa said. Our director Lee [Toland] Krieger played a massive part in that. All the different shots, all the effects our effects guys are so amazing with all the mist and stuff, all the time. The Vancouver weather is also great for it, it s always raining here. That is probably the biggest element, because the old comics are really happy, everything is great, this perfect world, but this is really dark and subversive.

    Riverdale premieres Thursday, January 26 at 9 p.m. on The CW.




    APA Resolution on End-of-Life Issues and Care #cheap #hotels #near #me

    #end of life care issues


    APA Resolution on End-of-Life Issues and Care

    Whereas the nature of dying and death has changed across the twentieth century, occurring primarily in an institutional setting rather than at home (Benoliel Degner, 1995); and

    Whereas death has become more frequently the result of chronic illness (Battin, 1996); and

    Whereas medicine and technology have evolved to the point where the terminal period can be significantly prolonged (Field Cassel, 1997); and

    Whereas there are many more people living longer with terminal diagnoses and thus having more time to make end-of-life decisions; and

    Whereas end-of-life decision-making is complex, involving areas of ethics, religion, medicine, psychology, sociology, economics, the law, public policy, and other fields; and

    Whereas the population of the United States is aging, resulting in larger numbers of people who may request psychological support in making end-of-life decisions; and

    Whereas in the United States there is significant social stratification related to cultural, ethnic, economic, gender, and religious differences; and

    Whereas this diversity in our society leads to an equally diverse range of views regarding end-of-life care and decisions;

    Whereas reasonable, well-informed people starting from different values and priorities concerning what is valuable at the end of life can and do hold different positions regarding end-of-life care and decisions; and

    Whereas autonomy is an important guiding principle in the law and in medical, ethical, and psychological aspects of decision-making, but in and of itself is insufficient to capture the full range of complex medical, familial, social, financial, psychological, cultural, spiritual, and legal issues involved in end-of-life decision-making; and

    Whereas there is increasing public support for control over end-of-life decisions but this support is weakest among groups who express concerns about being pressured to die (i.e. older adults, people with less education, women, and ethnic minorities) (Blendon, Szalay, Knox, 1992); and

    Whereas in the United States medical end-of-life decisions are made in a context of serious social inequities in access to resources such as basic medical care; and

    Whereas some evidence suggests that there are fluctuations in the will to live (Chochinov, Tataryn, Clinch, Dudgeon, 1999) and in wishes regarding life-sustaining treatments (Weisman, Haas, Fowler, 1999); and

    Whereas pain and clinical depression are frequently under-treated, which can lead to suffering that may result in requests for, or assent to, medical interventions that affect the timing of death (Foley, 1995); and

    Whereas more people are aware of the possible benefits to be gained by using psychological services to help them make end-of-life decisions; and

    Whereas psychology has been largely invisible in the end-of-life arena; and

    Whereas psychologists have many areas of competence, including assessment, counseling, teaching, consultation, research, and advocacy skills that could potentially contribute to the science of end-of-life care and to the treatment and support of dying persons and their significant others; and

    Whereas psychological research on end-of-life issues is limited in comparison with the magnitude of the issue; and

    Whereas there have been no systematic efforts to educate psychologists about end-of-life issues; and

    Whereas psychologists in clinical practice have not typically been involved in end-of-life decisions to the degree that they could be; and

    Whereas psychologists could assume a significant role in helping health care providers to understand and cope with the concerns and needs of dying individuals and their families; and

    Whereas psychologists could be instrumental in supporting public education efforts to raise awareness of issues related to dying, death, grief, mourning, and loss;

    Therefore, be it resolved that the American Psychological Association, an organization committed to promoting the psychological well-being of individuals across the life span, should redress psychology’s historical under-commitment to end-of-life care by actively promoting and supporting psychology’s involvement in end-of-life care. In order to advance this involvement, be it further resolved that the American Psychological Association:

    Promote and encourage research and training in the area of end-of-life issues within psychology programs at all levels; and

    Encourage and promote the development of a research agenda on end-of-life issues; and

    Support efforts to increase funding for research associated with end-of-life issues; and

    Encourage psychologists to obtain training in the area of ethics as it applies to end-of-life decisions and care; and

    Promote and facilitate psychologists’ acquisition of competencies with respect to end-of-life issues, including mastery of the literature on dying and death and sensitivity to diversity dimensions that affect end-of-life experiences; and

    Encourage practicing psychologists to be aware of their own views about the end of life, including recognizing possible biases about entitlement to resources based on disability status, age, sex, sexual orientation, or ethnicity of the client making end-of-life decisions; and

    Encourage psychologists to be especially sensitive to the social and cultural biases which may result in some groups and individuals being perceived by others, and/or being encouraged to perceive themselves, as more expendable and less deserving of continued life (e.g. people with disabilities, women, older adults, people of color, gay men, lesbians, bisexual people, transgendered individuals, and persons who are poor); and

    Support interdisciplinary efforts to increase the competency of psychologists and other health care professionals in end-of-life issues; and

    Promote quality end-of-life care including palliative care, access to hospice services, support for terminally ill people and family members, accurate assessment of depression and cognitive capabilities of dying persons, and assistance with end-of-life decision-making; and

    Advocate for access to, and reimbursement for, professional mental health services for seriously ill individuals and their families; and

    Promote and support public policies that provide for the psychosocial services for dying individuals and their families; and

    Support psychologists who wish to participate in ethics committees dealing with end-of-life issues; and

    Support psychologists as they work cooperatively with caregivers, medical providers, and multidisciplinary teams to enhance understanding of the psychological aspects of dying and death and to improve quality of care for the dying; and

    Endorse the following principles on end-of-life care as articulated in the Institute of Medicine Report entitled Approaching Death: Improving Care at the End of Life (Field Cassel, 1997):

    • Care for those approaching death is an integral and important part of health care;
    • Care for those approaching death should involve and respect both patients and those close to them;
    • Good care at the end of life depends on clinicians with strong interpersonal skills, clinical knowledge, technical proficiency, and respect for individuals, and it should be informed by scientific evidence, values, and personal and professional experience;
    • The health community has a special responsibility for educating itself and others about the identification, management, and discussion of the last phase of fatal medical problems;
    • More and better research [in the areas of biomedical, clinical, psychosocial, and health services] is needed to increase our understanding of clinical, cultural, organizational, and other practices or perspectives that can improve care for those approaching death;
    • Changing individual behavior is difficult, but changing a culture or an organization is potentially a greater challenge — and often is a precondition for individual change.


    Battin, M. P. (1996). The death debate: Ethical issues in suicide (pp. 175-203). Upper Saddle River, NJ: Prentice-Hall.

    Benoliel, J .Q. Degner, L. F. (1995) Institutional dying: A convergence of cultural values, technology, and social organization. In H. Wass R. A. Neimeyer (Eds.) Dying: Facing the facts (pp. 117-141). Washington, DC: Taylor and Francis.

    Blendon, R. J. Szalay, U. S. Knox, R. A. (1992). Should physicians aid their patients in dying? The public perspective. Journal of the American Medical Association, 267, 2658-2662.

    Chochinov, H. M. Tataryn, D. Clinch, J. J. Dudgeon, D. (1999). Will to live in the terminally ill. Lancet, 354, 816-819.

    Field, M. J. Cassel, C. K. (Eds.). (1997). Approaching death: Improving care at the end-of-life. Washington, DC: National Academy Press.

    Foley, K. M. (1995). Pain, physician-assisted suicide, and euthanasia. Pain Forum, 4, 63-178.

    Weisman, J. S. Haas, J. S. Fowler, F. J. (1999). The stability of preferences for life sustaining care among persons with AIDS in the Boston Health Study. Medical Decision Making, 19, 16-26.