e003 1007:08p = AY , “ : pA Cornet Lashaurds (24) 250-024/ gpauead (epee Tode4 r2f2]2010 CHAPTER 12 Ny cede Glen Endings and Transitions roy $502) 7b 9930 To ChePiez | dle fonts If Puan Cee laShawincla Grnete Yahev. tan Inevitably, clinical work comes to an end. As often as possible, endings are planned and area natural part of stated contract. For exarnple, the einiciany and client in an employee assistance program may agree to meet for a fixed number of sessions, a social worke may agree to meet with a client only as long as the client is attending other specified programs, oF a college student may gracuate and no longer be eligible for services at the college counseling center. But endings can also happen in an unplannec! way. They may be the zesult of ur ted es, as when the client has to move away, the clinician becom: , the client dis- continues the relationship, or the agency closes. Endings may be initiated by the client or the clinician, Endings may seem to be a natural and timely closure to the work tor gether, or they may seem precipitous. Regardless of the reason, we try to Interviewing In Action 273 Bianca Cody Murphy, Carolyn Dillon Copyright 2003 Wadsworth / ThomsonDec03 1007077 = AY Carnet 274 Chapter 909 undestake a formal process of ending to assist the client in summarizing and integrating the wore with the clinician and to assist in planning forthe Fo, jure This formal termination process may be quite brief or may be carried out over a number of sessions. ‘Tonmination is the word traditionally used in clinical work to describe the process of ending, His a term conceived in a much earlier era of practice Renvily influenced by the psychoanalytic theory of therapy. Traditional ps choanalytic theory anticipated so thorough and productive a therapeutic x Structure of client cynamics, defenses, and character that work could be Terminated with the expectation of ttle future need for further work. We be- Ihave that termination represents a transitioning process by which clients mov= ing to other systems of support end problem solving (family, mutual aid {oups) often take the work and the relationship away with them a9 545 iaining inner resources available for use in the future, But we also recogmize that termination may not be the last time that the clinician sees the client. Clients with few resources, complex problems, or new objectives for work together sometimes return to see the same clinician with whom they ester Sjoly “terminated” or finished up. Therefore, although clinicians often use words such as fermination, eneiings, aud transitions, we believe that the process is often one of finishing work "for now.” If we think of fe and crs Prmnstances as forever fluid and dynamic, then the idea of cycles af tork at different points in time makes perfect sense in the lives of many people: Even Before We End: Foreshadowing {tis important that clinicians and clients have as much lea time as posstole to discuss ending and allove for the processing and digestion of the transition from this special form of caring and collaboration. Thus, whether or not there is 2 «pecified plan for encling, we occasionally foreshadow the ending during, the working relationship. This is particularly trae in work with clients whose many prior relational losses make separations or endings difficult. ‘An agreed-upon, planned! ending is the best way to wrap up work to- gether, as it provides many opportunities to review, compare expectations With realities, look ahead, and both regret and celebrate concluding this ¢ Cle of wark. When there is a projected date for an ending, we will fore shadow it by occasionally noting the date so that all can be alert to it and can plan the Jocus and pace of the discussion accordingly. Stage EXAMPLES Clinician A: Before we begin work taday, | wanted to review with you that it’s the end of March, just 7 weeks before my placement ends and [leave here to continue my education, Clinician B: We said we would finish up after Christmas, and since ‘Christmas is just S weeks away, I thought it might be good today to p2Dec 03 1007:07p Cornett AY 909 ps Eratingsand Transitions 275 look at where we are anc whether that still seems to be a good idea, If so, let's figure ont how we can plan ahead for it so it doesn’t just suddenly happen without us getting ready for it, especially here at the holidays. Clinician C. This is our fifth of eight sessions; what would you like 10 ac- complish by the time our meeting ends today?” When the contract is somewhat more open and continuing over time, cli- nicians may periodically review goals, accomplishments, and remaining, is- re frequently mention “when our work together is finished” to help clients keep the relationship and werk in perspective. Here time is well used as both boundary and incentive for efficient use of work. sues and Mi Initiating Endings and Transitions Whotever the reason for or nature of the ending, there are several skills the clinician can use to vase the process of change for the client, maximize gains to date, and forward the transition to other supportive connections and ac- tivities. Because the skills used to end the work are much the same as those also used in transitions and breaks, we begin by elaborating ending skills ‘and then demonstrate hows these skills can be adapted for planned and un- planned transitions and interruptions in the work. EXERCISE 12.1 When Clinicians Should Initiate Endings Before reading more about endings, pouse to identify some of your ideas about them. In your jourel, describe the circumstances in which you think the clinicion should ‘niliate the ending of the cliicof relotionship, Clini Sometimes the eliician initiates the process of ending. This may be appro- priate in a number of situations. For example, the clinician may initiate end- ing because the goals have been accomplished and itis simply time to end. their work together. The beginning clinician always first consults with his 0: her supervisor as to the appropriateness of ending before raising the subj with the client Where possible, it seems best to initiate conversation about ending early in a given session so that the client does not feel that the clinician wants to end the relationship because of something the client has just revealed or done. Whenever we suggest the possibility of ending for now, itis important ian-Initiated EndingsDec03 1007077 = AY 909 pa Comey 276 Chapter 12 to leave room for the client's responses and, in the absence of any immedi- ‘ate ones. fo keep an eye out for nonverbals and indirect themes. The following are several useful ways in which the elinician can intio- duce the topic of termination when the goals of the relationship have been met EXAMPLES Cinician A; Anno, things have gone so well for a while now. | thought today we might think about the possibility of our bringing our work together to a close. Clinician B: Miguel, you've been wondering when our work will be through. Should wwe decide on a date, far enough away to give you 2 few more weeks to reestablish yourself back in the community? Clinician C: By spring, Brian, T expect you'll be ready to try things with- out seeing me every week, I'd like us to keep things as they are for now, fo support you through the holidays, but we might plan on ‘ending our work together in March. We may aiso initiate ending the relationship if we believe that, although the client could still use some assistance, we are tunsble tv help becavise we do not have the expertise necessary to work with the client on a specific issue. ‘Leos working with e woman atte fami planing clinic. We rere set about Bete control methods ied STD preoention. She disclose that sic ha bien sexualy ebased. Aenean det this woul Be av simpretan topic for ler to explore, ut Peccainly sun {rm 0 wrk sont. Fraferrad fcr to.c more knowostgeable mental health coenselor sat the cline When we feel that we can no longer werk with » dient because the client’s issues are beyond cur expertise, we must carefully make a referral Tris can be difficult because the client may feel rejected or rekictant to sce another clinician. Using the prior example, the clinician might proceed in the following way EXAMPLE tis Yen: Serafina, I was thinking about what you told me at our last meeting about what happened to you in your family: Client: Yeah. Ciinicimt: | think that having been sexually abused must have beea an awful experience that you haven't gotten much help for Client; You're the first one I told about it. Clinician: | appreciate your confidence in me. Clinician: Well, we were finishing up our work apout pirtn contro! ana safe sex practices, so we would be stopping anyway. I know it can be hard to think about saying good-bye to someone with whom you've shared so much Client: Yeah, 1 always hate good-byes. Clinician: What Lwould like to do is to set up a meeting for you with Brenda. [ would meet with you for one last time after you've seen her to find out how it goes and to say good-bye. EXERCISE 12.2 Thinking About Ending In your journal, cocord your reactions to the preceding scenario. Hew do you think the client fee s? How do you think the clinicion feels? What would you heve done ciffeceny?Dec 03 1007:08p AY 909 ps Cont Endings and Transitions 279 cfiont end well, putting as positive a spin as possible on the work and the da- ision to leave. This avoids contributing to the client's potential feelings of failure or guilt. In addition, we try to keep the door open for future work or referrals, EXAMPLE Clinician: Well, it sounds as if you're really feeling that this is the time to stop, You've used the relationship well summarizes way client has ‘used it). While you may want to do some more work later, this feels to you like itis enough for now. Fd be happy to help you or make a seferral if you decide that you want to do more work on this in the future ‘There are times when the clinician is concerned that the client is seli= sabotaging, or playing out an oid pattern of breaking off relationships just when they are working, The clinician may want to raise the possibility that such dynamics may be at work. The cient may disagree, but at least the cli- nician has left the client with something to think about. The clinician may not feel good! about this sort of ending, but itis important to recognize that decisions still rest with the client, ard sometimes clients can learn things ‘through the process of ending that they cannot learn within the relationship. EXAMPLE Clinician: Wayne, 'm worried that you may be doing with me what you've described doing so many times before: thet whenever you get close to somebody, you take off Client: What's it to you? Clinician: If at some point you don’t let somecne in and keep them in, 1 wotty you're going to be lonely for the rest of your life, You've al- ready fold me how much that hurts, Cliest: Uhawe to see on my oven how it goes. Outside Forces May Precipitate Ending Clients or counselors may also have to initiate ending because of extemal cir- cumstances. Insurance limits may necessitate an ending, Clients may no longer be able to afford the care being offered. A signi that the client end the rvlationship. Unexpected events can result in a client Lees Mni9U ave TERI aE Muvug aLvL ae ween just when things are “getting hot” or when they are on the verge of making, significant change. They, too, may use compelling language to justify their leaving. Loria 1998 @ scan iti ome to the awnien’s citer for counseling about her rele anship wats am abuisioe husbamr. She was Deyinnisg do uae mbt the possbiity of Fevog hie aid fad even aster ne to Hook into some shelters for womer che were vie= tims of domestic violence. Lortada and T ad fer nce for abour 3 sas relien sae anuncwriend that se thuglt sho neat to stop comag becouse se couldn't get 2 baby sitter for ier T-year-old child ane he ans “justo un Fear keep coming” We tole abou he ify she was fig Ce eas te it so liad wo stie), but as ae explored SPAR EE ae Ueee CC ue eeDec 03 1007:08p AY 909 ps Enuings and Transitions / 283 work together specifically around that ending, The subject of ending is Ben- ty yet confidently broached as a natural and inevitable pert of life and work Clients with serious cognitive limitations may not be able to grasp the ‘meaning of the concept of ending or understand the nuances af a discussion focused on ending. Sometimes the best that the clinician can do is to employ calendar or chart and mark off sessions so that there isa visual indicator of time moving ahead and, finally, running out. Ofter a loved ane close to the client and skilled in communication with him or her can accompany the client and translate the clinician’s intent and tasks to be done. As time and ability permit, the clinician will aate with the cl there are beneficial steps to be taken during ending time: dealing with reac tions, reviewing accomplishments and remaining issues, planning ahead, and making any necessary arrangements to ease the way for the < Sometimes this introduction of focused ending work is an occasion for relict and excitement; at other times, the client may react with shock or dismay. EXAMPLE Clinician: Well, Roland, we are coming to the end of our work together Giient: 1 can’t believe how quickly the time has gone. Clinician: Me either Cliewt: So we're “terminating,” What do we do when we are fi Clinician: Well, | think it's a good time to remember where you were ‘when we first met, to think about what we have done and where {you are now in rwlation to the issues you came in with, I's also a time to think about how you may handle things in Ue future. We get to see if there are any Ioose ends that we want to talk about before ‘you leave, and finally, we say good-bye rishing? Acknowledging and Exploring Reactions to Ending: “How Does It Feel?” Clients who see dentist or an internist a number of times do not usually “work through” the ending of their work together. Even alter a lengthy hos- stay, the staff do not usually ask, “How do you feel about our dis- charging you” or “Did you have feelings about the people who assisted you while you were here?” A formal termination process is a phenomenon par ticular to clinical relationships, andl many clients may nor be used to focu ing so intensely on ending a professional relationship. In addition, both chients andi clinicians may be surprised at the intensity of their emotional re- actions to ending.—the more so if the contacts were initially mandated by ‘others or laden with ather complexities. For many clients. the ending phase of work is a great opportunity to celebrate their achievements, to honor aDec031007:097 = AY 909 pT Cometh Enilings aud Trsitions 287° Client: Well, we still have our tensions, I thought she would be so re- lieved that my anxiety attacks were gone that everything would be great with her. But she still gets on my case sometimes. (They con- tinue to talk about his home and work life.) Foreshadowing the Future: “Where Are You Heading?” As part ofthe ending process, the clinician andl client explore what the client anticipates and what kinds of issues might arise for the elient in the future. They discuss how the client might respond to old familiar challenges if they should arise again. To double-check on skated understandings, the clinician often asks the client to recount what he or she will do in e particular crisis and to review mote specifically whom he or she will rely on in the future for support, advice, and comfort to buttress and maintain growth. EXAMPLE Clinician: What will you do 2. months from now if you find that the am iety attacks come back? Client: Well I certainly hope they don’t. I thought 1 was better. Clinician: 1 hope they don’t, too, but in case they do, it’s important to know what you would do to handle them. Client: Well, 1 guess I would go back to that self-talk exercise you gave me and 1 would use the tapes. Clinician: And if that doesn’t work? Client: 1 would call you. Would that be okay? Clinician: Of course it would. Checking for Unfinished Business: “Is There Anything We Should Cover Before Closure?” The clinician and client always double-check to see whether there is any- thing they need to take care of before ending. We keep an eye out for things CRITE i Cave ce hm ee boned oF thought of hate a litte visualization Huse with clionts when we are ending. Las thom to imagine tat they ae walking down tho stairs afer leaving my office forthe las tinteand to snk alnout wether or not there is anyihing else they would have lke to have sid to me but ‘hid. Uinoite hers to say it wor. de that they would like to do further work. However, clinicians must be «careful that they do not make promises they cannot keep. Aware of the way situations and schedules can change, we do not promise that we wil) always, be available to work with clients in the future. Ideally, we can suggest that the agency and others like ourselves will be available if we are not, giving the client alternatives in case the familiar service or agency closes for good. Giving and Receiving Mementos Sometimes the clinician gives a gift to the client at the end of the relationship 45 a memento or symbol of the work together. For example, we may give a client who is beginning to fee! her own strength a magic wand representing IPAS a AeDec031007:097 = AY 292 Chapter 12 CLIP 12.2 Tosks ond Skills of Ending 909 proceed without the clinician, Whereas earlier ending disenssions may have had a graver or mote affective coloration, the final good-bye is ust ally more interactive and upbeat—a positive send-off after much good ‘work together. Sometimes @ quiet celebration or other ritual (e.g., an ex: change of small gifts) will be used to focus on the good-bye as a kind of celebratory launching, While we recognize that the final good-bye may be sad, we always at- tempt to refocus clients on achievements and possibilities (Fortune, 198: We find it hetpfut to say that we'll be picturing them doing someting they've longed for and intended to do, such as graduate, stay clean and sober, or parent successfully. The clinician attempts to have clients remem- ber him or her as someone who is permanently in their comer, who belizves jn them, and who is rooting for them. EXERCISE 12.6 Saying GoodBye Divide inio small groups. Practice in pairs the final moments of saying good bye ‘and exiting. Praciice several kinds of good-byes, including from public places, from office seiings, fom a clients apartment, or after @ shared subway ride fol lowing @ meeting of cnother agency. Discuss your experience and feelings as both cliricion and client. What have you learned from this exarcice? @ Follow-up and Evaluation CTinicians may conduct follow-up evaktations after the end of clinical work ‘These evaluations may be formal, involving tests and other assessment measures 23 discussed in Chapter 6, or they may be informal check-ins. Follow-up evaluations can occur 1 month, 6 months, or even years after the initial work. At times, these follow-up meetings may serve as a reinforcer of the previous work together, reminding clients of the strengths and resources they have and the skills they developed during the conrse of the clinical re- lationship. Often the client will discuss how he or she is able to-use the leam- ng, from the clinical relationship in other arenas with other problems. EXAMPLE Client: Well, it’s been 6 months since Isaw you. Clinician: How's it been going, Roland? (The clinician explores Reland’s anxiety attacks and how he is doing at work and with Brenda.) Client: You know, Brenda has gone back to school. The other night she ‘was 2 wreck about an exam she had to take. I taught her those re- Taxation exercises you taught me, and she calmed down. It was neat tobe the helper for once. psDec031007:10p = AY Comet 909 po Endings and Transitions 293 Clinician: I'm glad they were helpful, What a great thing you did for ker. Client: Yeah, I'm pretty proud that I can use what [ leamed here. @ Planned Breaks, Interruptions, Transfers, and Abrupt Endings Planned Breaks Sometimes a clinician and client will decide together that a great deal has ‘been accomplished and that itis now time for a planned break, during which the client will go for a time without face-to-face visits with the clinician. Io advance of this break, they schedule a future appointment in which fo re- view the client's interitn experience and to decide only then whether further professional assistance is indicated. Sometimes these planned breaks are a art of the termination process. At te clubhouse, day program for people who hace boon in an ipatien® psychiatric osptal, we havea gradu termination process. We slowly decrease the umber of drys ‘hat the client cams to the clubhouse until they are coming only once 2 week. After a wil, we wil suggest that the member take a T-month “sacation” froma te center bit always sep a followup vist to see chat the expcrience wes like, Ofer a cient wll {ake rpeated “oacations” before he or she fly feos rend to lame for good. Interruptions ‘There are times when the work between clinician and client is interrupted, oceasioning a need for immediate work on the process of ending contact, ther temporarily or permanently. A clinician or client may become ill, preg nant, take a long trip—all of which may require an interruption at some point, although a retum is anticipated. {iad been working as «rehabilitation counselor at a nursing home for 3 years niten my husband gota sabbatice! from his college teaching job. He was offered a 6 montis fellow ship in Mortara, and we decided that I would job hia there. toa lave froma ray job, ‘and let me tell you, it zoas hard to sy good-bye to ail the elients. [wasn’t sure which of theo: would sill be there whez J returned. | reassured the clients that Etwouid be re turning in September. [told them where Treas going, ad | said Froould tik of then ‘The use of a symbolic object is helpful in sustaining a feeling of connee- tion between the client and the clinician. This is especially true with children, who may need 2 concrete reminder of the clinician’s existence. When the college interns leave the preschool for aubvter br, we actually use it as lear ing experienc. Kalina mas going home to Hira, so ee took outa world map and showed the cheldrox zahere Kalina was going. We brought in pictures of Hawaii arid had Rolin send postcards eack week. That way the children woul remember her ten she resarmes. Even when the interruption or break is anticipated o: ime limited, client and clinician may go through 2 process similar to other endings. We prepareDec031007:10p = AY Cornett 298 Chapter 12 909 the client for the interruption, leave room to talk about the feelings the in- termuption evokes, and aitempt to get closure for the work completed thus far, We must remember that, although we plan to return, itis possible that the client may not be there when we do so. In fact, a clinician might not return. Accouple of years ago, how therapists were murdered ‘hile they were on vention. Fas ‘one ofa tem of clinicians that stepped in 0 work with ther clients after their deaths. If rally brought tome to me hou importa i to realize that ou cans never promise you wil be back. You can promise you will try, but never that you will aks Be there Transitions to Another Clinician At times, the client may be transferred to another clinician. This can happen during a planned interruption, in which case it is anticipated that the origi- nal clinician and client will reconnect. Itcan also happen when the client will be seeing another clinician after terminating with the original clinician. If the client is terminating, the clinician ean offer to speak with the new clinician. This can help facilitate the new work and help the clinician lean, about the client and perhaps avoid old pitfalls. Some clients will like to have {2 sense of continuity in the work, and they may hope that this conversation will prevent them from having to repeat everything with the new clinician. Other clients may refuse permission for the clinicians to speak with each other, preferring to start with a clean slate. When the client will be seeing another clinician, the original clinician can help the client prepare for work with the new clinician. EXAMPLE Clinician: Last week you told me that you and Brenda are going to see a couples therapist after we finish our work together: Client: Yeah, Brenda wants to work on “our communicatio calls it. Clinician: What do you think that will be like? (They explore Roland’s pations and fears.) Hinician: Do you think you will talk about our work together? Client: Idon't know. Clinician: T want you to know that I feel fine about your talking about what worked and didn’t work in our relationship. Sometimes peo- ple feel that they are betraying their old counselor if they talk to their new counselor about stuff they did or feelings they had with their old counselor, It can help future work to explore with your new counselor—both the things that helped and those that didn’t Was she p10Dec031007:11p = AY Cameth 909 pt and Transitions 295 IF the client is seeing another clinician only temporarily and anticipates continuing with the original clinician, the two clinicians usually speak, but again, only after the client has given written permission, which is kept in the client's file. It can ease transitions if the original clinician introduces the client to the “covering” clinician before leaving. The covering clinician can often feed useful information about the rela- tionship back to the original clinician, although being careful never to com- pete to be the “better helper.” Any concems or questions that the covering ian has about the work should be shared directly with the clinician than with the client. The covering clinician becomes a team member and assumes the same ethical and legal obligations as though he or she were the primary clinician. When one of ay partners was taking ur extented vacation, she asks me to see a client ‘of hers. She deseribed the client as sortzone who wns very sy aid had a hard tie tale ing. T-0as guite surprised when I mct the cles, coho seemed anything but shy. After 1 Jad met wit hi couple of times, Loki him that Uhad expected hott be mucl more reticent because Ht was how his therapist ied described him to me. He told me thal he (felt very uncomfortable taking $0 any women, specially professional women, Fie was comfortable talking with me because I ras a man. We explored the icsue and discussed how he might ruse the issue wits his therapist shen she returned. When she did retura, she tld me how great i oes hat ler client had seen me. He liad tiked with her about what we had discuss, and it really changed the mature of Hair soork together. She threatened to go away agin so that I could “do consulfations” with all her clients, ‘Transitions to Family and Community Support Systems ‘When clients end therapy, they often continue to receive support and caring, from their naturel helping networks such os family, friends, neighborhood resource centers, religious or spiritual communities, or mutual aid groups. Taylor and colleagues (Taylor, Ellison, Chatters, Levin, & Lincoln, 2000) have delineated the vital roles that Black churches play in providing con- nections, activities, emotional support, and guidance. Delgado (1997) has noted that small businesses and Latino-owned beauty parlors act es social and informational support centers in Latino communities. Community centers and clubs, after-school programs, literacy and citizenship initiatives, cultural associations, and neighbachood action groups also offer opportuni ties to lessen isolation and strengthen individual and family esteem and pride. ‘Acclinician’s knowledge of and solid relationship with a wide variety of these resources are important in helping clients connect with these networks as they transition from the clinical relationship. Some of these programs and support centers may have staff who reach out to clients. Sometimes the cli- sn may explain what services are offered and even accompany clients to ‘their first contacts with community resources. Lum (2000) considers the abil- ity to connect clients with meaningful resources to be a bedrock of clinical competence in working cross-culturally. Ideally, the clinician uses theseDec031007:11p = AY Comet 296 Chapter 12 909 resources throughout the work together and not only as the clinical elation ship draws toa close Abrupt Endings So far, we have spoken of a termination or ending process. Sometimes such ‘a process may nol be possible. The client may abruptly leave a session, sim- ply not show up, or cancel future appointments. [fa client stops coming, we ‘usually attempt some sort of outreach: a phone call, a letter, or in some cases, a home visit. Decisions about outreach should be discussed with a supervi- sor. If the client does not retum, we can try to get some closure through a let- ter of termination, EXAMPLE Dear Juan, Thaven't heard from you since our last meeting on July 23. I have tried to contact you by phone and letter. 1 will assume that you have made the decision to stop our work at this time. If you decide that you would like to retum to get more closure on cour work or if you feel that Ican be of help to you in the future, please feel free to contact me at the agency Ithas been a pleasure getting to know you. hope that you will have success in getting your GED as you planned. Sincerely Rebecca Schwartz ™@ The Clinician Feels the Loss Abrupt endings are particularly difficult fora clinician, but all endings evoke feelings in us. As the time to end approaches, we may find that, like the client's feelings, our own feelings may come out in behavior. We may lose our appointment books, double-book a client who is ending, or find our- selves feeling sad, anxious, of relieved. Clinicians working in health or hospice settings often encounter the very ‘moving experience of working closely with clients with terminal health con- ditions, These clients know they have little time left and understandably do rnot want to lose a clinician with whom they are able to shaze whatever they ‘wish about their dying. Linder special circumstances, a clinician who wishes to may arrange with the agency to continue to meet with a dying client even after leaving the agency and other clients. Consultation with a supervisor ‘can help resolve dilemmas around whether and with whom to continue and p12Dec031007:12p = AY Cornett CLIP 12.3 Clinicians’ Reflections 909 Endings and Transitions 297° how to arrange to keep seeing a client until death occurs. This is clinical work at its most human, charecterized by flexibility, availability, and re- spectful adaplation to the needs of clients and loved ones. As clinicians, we form attachments to our clients and can have great in- vestment in their well-being, just as they are often strongly invested in the work with us and in our presence, caring, and encouragement. Tais is a ha- :man relationship of some intensity as well as a working partnership, and its attenuation or ending affects clinicians as well as client. { hnted ending with Charysse. 1 had literally wntchad ier grow up. Sie had bees in the “after sciool progen at he center ilen F mya a rer counselor, and U had conched her on the basketball tenn, Th sl'd boon one ofthe ids im te alcohol and drug group, av she eventually became ¢posr couaselor. Now, se was having a baby and moving to Des ‘Moines with Rafe. 1 knew him, to.) When our last meeting was over | walked into supervisor's ofice aed just cri. Twas so happy for her and for the new Wife she cas ring, But ons so sad to see her go. @ Conclusion Whether planned or unplanned and whether initiated by client, clinician, or outside forces, the ending of the clinical relationship provides an opportu- nity for new leaming and growth. Good endings can help clinicians and clients increase their relational capacity, knowledge, and sensitivity. Both can take the work and the relationship away with them as internalized and sus~ {aining inner resources, available for use as long as there is memory. ‘Chapter 13 highlights the ongoing education and self-care that clinicians ‘need to remain fit and effective in work with clients It elaborates many pro- fessional issues and challenges that await clinicians over the course of along and active career. MI Suggested Readings Burther readings on termination include: Baird, Brian N. (1996). The internship, practicum, and field placement handbook: ‘A guide for helping professionals. Upper Saddle Rives, Nf: Prentice Vall (Gee Chapter 12: Closing Cases.) Fair, Susan M., & Bressler, Joanna M. (1992). Therapistinitiated termination ‘of psychotherapy. Tite Clinical Supervisor, 19, 171-189. Fisch, Richard, Weakland, John, & Segal, Lynn. (1982). The tactics of chan Doing therapy briefly. New York: Jossey-Bass. Fortune, Anne E, (1987). Grief only? Client and social worker reactions to ter~ ‘mination. Cia! Social Work fourval, 15, 159-171. Gutheil, J. A. (1993). Rituals and termination procedures. Suits College Stud ies it Sociat Work, 63, 163-176. p13Dec03 100712) = AY 909 pd Cope tt 298 Chapter 12 Levinson, Hilliard. (1977). Termination of psychotherapy: Some salient is- sues. Social Casework, 58, 480-489. ‘The following are good resources on transferring clients to another clinician, Robinson, Floyd F, Hitchinson, Roger L,, Barrick, Ann Louise, & Uhl, Angela 'N. (1986). Reassigning clients: Practices used by counseling, centers. jour nal of Counseling Psychology, 33, 465-468. ‘Wapner, J. H., Klein, J. G,, Friedlander, M. L,, & Andrasik, FJ, (1986). Trans- erring psychotherapy clients: State of the art, Prjessional Psychology: Re- search and Practice, 6, 492-496.