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How to Terminate the Noncompliant Client
Counseling is a collaborative relationship in which counselors work with clients to find solutions and achieve life goals — the client’s goals. Sometimes, though, problems aren’t getting solved, the client isn’t following the treatment plan, and the counselor is feeling frustrated. What then? Termination may be the best answer, but only if you end the relationship properly.
The Code of Ethics of the American Counseling Association (ACA), prohibits “abandonment” of a client.1 But as long as continuation of treatment is arranged, you may end a counseling relationship when: You feel you can’t be of professional assistance to the client, or you believe the client is not likely to benefit from further counseling or is even being harmed. You may also terminate a client relationship if you feel endangered, or the client is not paying agreed-upon fees. Whatever the reason, avoid making the client feel you have abandoned him or her. A client who feels abandoned may become angry, which can lead to disciplinary complaints and lawsuits.
What makes a counseling relationship go sour? Consider this scenario: You’re a counselor with a behavioral approach who assigns homework exercises to help your client overcome social anxiety or free himself of compulsive rituals. The client agrees to follow your instructions but fails to do so, citing countless reasons for his failure to perform the exercises you’ve recommended. David Kaplan, PhD, chief professional officer of the ACA, noted that though such a client is often labeled “noncompliant,” he “is simply a client who, for his own reasons, doesn’t do what you want him to do.” This client, for example, may have scheduling problems that he has been reluctant to reveal. You can avoid such a situation, Kaplan suggested, by making your approach clear to prospective clients in the informed consent brochure you give them at your first encounter. Or, if the relationship has been established, you can offer an alternative approach—as long as you are qualified by training and experience to do so.
Other scenarios also can lead to termination— and referral to another therapist. Suppose, for example, you find your personal or religious values standing in the way of professional objectivity in working with a pregnant teenager who is considering abortion and doesn’t want to tell her parents she’s pregnant. You may have an obligation to suggest a referral to a counselor who can be more objective. 2 Or suppose you simply find the client extremely unpleasant, which makes it impossible to help because your objectivity has been compromised.
Steps you’ll need to take
Once you make the decision to terminate the relationship, it’s important to take certain steps to ensure that the client doesn’t feel abandoned. Avoid initiating termination when the client is in a crisis. Also, be sure to give adequate notice of your intentions—at least 30 days and possibly more—so as to make sure the client’s care is successfully transferred to another provider.
Take as many sessions as the client needs to process the end of the relationship, as long as treatment is not jeopardized. Explain to the client who won’t do his homework, for example, that your approach doesn’t seem to suit his needs and offer a referral. Make your views on abortion and parental notification clear to the pregnant teenager, and suggest that she talk to someone with a different outlook. Take the blame for the impasse with the client to whom you have an aversion.
Give the client a list of appropriate referrals, at least three—and more if possible. Make sure referrals are located within a reasonable distance and check that the counselors’ credentials and approach are suitable for the client’s needs. Facilitate the referral in any way you can, perhaps by offering to make the initial contact. Ask for the client’s consent to transfer records. Follow up the face-to-face termination sessions with a letter stating your intention to terminate and listing your referral recommendations.
When you do it the right way, termination won’t feel like abandonment because it won’t be abandonment. And, you’ll be ethically and legally in the clear.
1. American Counseling Association. Code of Ethics, Section A.11. www.aca.org (Sept. 2, 2006). 2. Herlihy B, Corey G. ACA Ethical Standards Casebook, 6th ed. Alexandria, VA, ACA, 2006. Bookmark and Share
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