Demystifying the Process: How to End Counseling
Just like the intake session, the termination session is a bit different than other sessions you have had. Experiencing a healthy good-bye is a powerful thing so it’s important to have a termination session. We want to provide you with a little of what to expect from it.
Terminating the Session
You’ve made it! You and your therapist have decided that it’s time to end therapy. The length of therapy can vary for everyone. There could be many reasons such as: you may have reached your therapeutic goals, you may have to relocate, or maybe you have just decided it is not the right time (although anytime is a good time for mental health!). Either way, you’re ready for your last session. Just like the intake session, the termination session is a bit different than other sessions you have had. Experiencing a healthy good-bye is a powerful thing so it’s important to have a termination session. We want to provide you with a little of what to expect from it.
Layout of the session
Generally speaking, there are several things that will happen during the termination session. First, expect to reflect on what work you’ve done in (and out) of the therapy room. The whole point of therapy is to get you to where you feel confident that you have the resources to live connected, happy, and fully on your own. If you don’t reflect on where you’ve grown, you will not realize how much strength you have and may doubt that you are ready for termination.
Once you’ve talked about your progress, your therapist may want to talk about what to do when you don’t have them around. Handling the world on your own maybe scary and so it’s good to talk through what you can do before something big happens. In fact, you and your therapist may decide to schedule a follow up session several months out just to check in and see how things are going.
Another topic that is sure to be discussed will be the emotions around ending the relationship. You may or may not have ever had someone by your side that unconditionally supports you. This type of relationship is a very intimate one that is unlike any other and realizing it’s going to end maybe a hard pill to swallow.
Why does it feel like the world is crashing down again?!
You may have been completely prepared for this day. Although it may be a time to celebrate any progress you have made, you may be having second thoughts. Do I need just a few more sessions? Is there work I still need to do before I end it? But wait, what about this huge emergency that just came up!? Take a breath. It’s normal to feel some anxiety about ending therapy. Losing a supporter may feel earth shattering, but remember this: You are the reason you have come so far. All your therapist has done is shown you the self-esteem you have within you.
But what if you really aren’t ready to end your journey of self-healing? A few things come to mind. First, you and your therapist will have spent some time talking about the ending of therapy already. It’s not just an “in the moment” decision and your input is what the decision has been based upon. Second, your therapist will not leave you to drown. If your work is not complete, then your therapist will have referrals for you. Finally, it maybe a test run. You could try out your new skills and if you need your therapist, they’ll be right back there with you.
Is it okay to…?
You may feel deeply appreciative for the guidance of your therapist during your time together. Many things may come up at the last session that you may have never thought of before. You may want to give them a special gift, ask to be their friend, or give your therapist a hug. Spending so much intimate time together with another human is bound to create strong bonds, so it’s not uncommon for you to have these ideas. Accepting a gift will depend on the therapist. What will happen (with us anyway- we can’t speak for all therapist in the world) will be a discussion about what the gift means. Gifts are often symbolic, and your therapist might want to explore what it means for you to give the gift and for your therapist to receive it. Asking to be a friend of your therapist might be disappointing. Although they truly like you as a person, they’re probably not going to be your “friend” or grab coffee and shoot shit (this a whole different blog post about why, but nutshell version is that it’s unfair to you). Lastly, giving your therapist a hug will likely be the therapist’s personal and professional preference. You might want to check that it's okay before you go in for the hug and, just as with the gift, your therapist may want to talk with you about what the hug means. We aren’t trying to dissect you every move, but just like you might not like chocolate cake; they might not like hugs.
Your therapist feels it, too!
When you and your therapist sit down and talk about the deepest and most vulnerable parts of you and your journey, it’ll have an effect on your therapist too. Although it might seem like they “always” have their stuff together, therapists are human too. They’ll likely be moved by your strength and determination. Your progress, no matter how large or small, is something that your therapist will want to celebrate.
Remember, this is not forever.
We don’t aim to be repetitive, but, what your therapist wants most for you is to feel like you have the capability and tools to face whatever life throws your way. This means that even though your therapist would love to see you and work with you more, the hope is that you can leave therapy and never have to come back. But, old habits die hard and life can be crazy and unpredictable. It is okay to come back to therapy if you need it (read: its’s not a sign of failure). In the event that you need therapy again (or you want to write a letter to update your therapist on your continued progress), your therapist will be there, ready to help you through life’s trenches. Life’s trenches are full of constant transitions, and your therapist gets that. We aren’t trying to cut all ties, but we were not meant to be a permanent part of your life.
The termination session can be emotionally charged. It may be a time of grief over the separation, happiness over the accomplishments, and nervousness over the future. Hopefully, you can spend the whole time talking about the progress you made and how you will handle life in the future. You may or may not want to show your appreciation of your therapist- both are fine! Maybe you’ll need a follow up session or maybe you’ll need referrals. No matter how the session goes, it’s important to remember that you are the reason you have come so far. You have put in hard work and have the strength to continue your journey. You are amazing.
ABOUT THE AUTHOR
Molly Lyons
Molly is currently in her final year of the Master of Science in Clinical Counseling at Central Methodist University (CMU) and is a student intern at The Counseling Hub and Boone County Mental Health Coalition, where she will assess and provide mental health interventions and resources for individuals and groups in Boone County schools. She obtained her Bachelor of Science in General Psychology with a minor in Child Development from Central Methodist University directly before enrolling in the counseling program. Prior to pursuing her counseling degree, Molly received an Associates of Science in Early Childhood Education from Moberly Area Community College.
Molly has experience in the Counseling Center at MACC's Columbia campus, providing counseling services for students around the topics of identity crises, school-related stressors, depression issues, and coping with anxiety. Molly has co-facilitated Safe Zone trainings which introduce its members to the LGBTQ+ community terminology and basic information. Molly has also completed on online course in LGBTQ+ Counseling Competencies (College and Career Readiness) through the American Counseling Association (ACA). Molly is an active member of both the ACA and the Association for Multicultural Counseling and Development (AMCD).
Molly enjoys working with diverse populations and seeks to always be open to new learning experiences. She works best with individuals who are trying to discover who they are and how they relate to their world, as well as others in their world. Molly believes that a person’s external factors can provide both barriers and resources towards growth and that one must discover these in order to thrive.
Clearing Up the Process: The Intake Session
You’ve done it! You have scheduled your first appointment. Now, what happens during that first session? Here’s a preview to help you gather why the session is the way it is. From the intake forms to the second you reschedule, we wanted to provide you with a little of what to expect.
You’ve done it! You’ve signed up for therapy and are awaiting the next chapter of your story to begin. You may have been to therapy before (or maybe you haven’t), but either way, it can be nerve wracking. Finding someone you fit with and (generally) it being someone you have never met can be daunting.
What should you wear? What should you say? Should you cry at the first session? How much do you really want to tell your therapist? What if you don’t like your therapist?
These questions are ones that people may ask themselves before their first session. The first session is unlike the following sessions, and therefore it can feel like a strange encounter. The first session is known in the “counseling world” as the intake session. The purpose of the intake session is for the therapist and you to create the most whole and accurate picture of you as possible. In other words, this is a time where your therapist goes over all there is to know (as if that’s possible in one session) about you to help gather a picture to help you both out. One way in which your therapist gets to know you is through the use of forms. There are probably going to be a lot of forms you must fill out. These could include informed consent, intake forms, release of information, questionnaires, and so on.
Informed Consent
This is the most important document that you want to read with a careful eye. We aren’t trying to slide anything past you, but we really want you to know what it says. An informed consent is super important to not only the therapist, but for you as well.
Essentially, the document lays out the framework for the legal and logistical parts of therapy. The informed consent will likely be packed with information such as social media policies, mandated reporting laws, what will happen to your file if your therapist expires, payment arrangements, cancellation policies, confidentiality statements, and anything else that your therapist may think is important.
Intake Forms
This is likely to be the form that takes you and your therapist the most time to digest. The purpose of the intake form is to get as much information as possible about you that could inform the therapeutic process. For our team, the intake is online so you can take your time thinking of the answers! Then, we go over it together.
So many different domains are associated with mental health therefore your intake form is probably going to be longer than any other form you must fill out. Most of the time the form will begin with questions to gather basic information; What’s your name? Where do you live? What is your birthday? How do you identify your gender? Race or ethnicity? Therapists know that age, gender, and ethnicity can influence certain disorders differently than persons of differing age, gender, and ethnicity. Also, in the first part of the intake, you will find questions that inquire about work, living arrangements, and education. Our mental health can negatively influence these areas of our lives and it is good to know if these areas are ones that can be positively influenced by therapy. The next sections are not necessarily in this particular order; however, they are all generally included in the intake forms.
Relationships are invaluable as social supports during times when you may feel like you are not feeling like you. Your intake form will want to know about all the types of relationships you have had since you were a child. Did you have supportive parents or siblings? If not, who were your role models? Do you have friends that you can talk to when you are feeling down? Do you have a significant other? If so, do you feel happy with that relationship? Do you have a relationship with spiritual or religious beliefs? All these various relationships can be important when discussing what supports you when you are not in the therapy office.
Being honest with your therapist is crucial. Therapists know how difficult it can be to talk about hard things you may have experienced (i.e., neglect, childhood abuse, family or parent substance abuse, couples conflict), but they also know how much of a need it is and relief it feels to get it off your chest. Although that doesn’t all (i.e. getting it out) come within the first session, we are prepping for the opportunity ahead of you!
There will be questions about previous therapy. Your therapist will want to know if you have been in therapy before. Did someone refer you to therapy? Were you ever hospitalized for psychiatric purposes? Do you take any psychotropic medications? If so, what are they? Most likely, your therapist will inquire what you liked and disliked about previous therapists and what previous goals were. Your therapist may also want to know what you expect from your new therapy. How long should it last? What do you want to see change from the beginning to the conclusion of therapy? Last, your therapist will want to know in your own words why you are coming in. What exactly is happening so that you sought out therapy? Knowing what you have accomplished in previous work and what you expect from current therapy will inform your therapists approach.
Typically, towards the end of the intake form, your therapist will want to know if there is anything else that you want them to know about you. This is a great opportunity for you to expound on any of the answers your previously provided. Also, towards the end of the form, your counselor will ask you to write your strengths. You are so strong and have come so far in life! Your therapist will want to know how you have made life work and then help you find even more strengths within yourself.
Release of information
Although release of information may not be discussed in every intake session, it is good to know about.
A release of information is a form that allows your therapist to speak with other professionals you may visit. In the therapy world when many professionals come together to help the health and well-being of an individual it is called collaborative care. Your therapist may ask you if you would like your other health-care professionals to be able to communicate with them. Collaborating with other professionals can enhance the effectiveness of therapy in many ways. Therapists often spend more time with clients than other health professionals. Because of this inequal amount of time, therapists can act as an advocate for their client if there are any concerns.
If you agree to a collaborative care approach, you will be signing a release of information. On a release of information form there should be specific information; who can the therapist speak with, when the form will expire, and what you can do if you decide to retract the form. As mentioned previously though, it might not be discussed in session because it might not be of interest to you. This is not required.
Questionnaires
Not as if you have had enough papers to fill out, your therapist may ask you to fill out some questionnaires. These questionnaires may be completed at different time intervals such as weekly, monthly, or every three months. Questionnaires serve a purpose, but the purpose may vary.
First, to get a baseline. For therapists, they cannot know where to go if they don’t know where you are. A baseline is an understanding of where you currently are so that your therapist can help you move to where you want to be.
Second, questionnaires can potentially help identify what it is that you are experiencing. Sometimes it is hard to tell whether or not it’s anxiety, depression, obsessions, and so forth. Tentatively identifying what you are experiencing helps inform treatment.
Last, questionnaires can identify when you may need immediate help. It can be very uncomfortable to talk about thoughts of suicide or homicide, but it’s important to talk about it. Research has consistently backed up that directly questioning is the best way to help an individual who is at an extreme end of harming self or others. When you indicate that those thoughts are present, it’s important that your therapist can help you right away.
So now… Let’s talk about it!
So, you have filled out the mountains of forms. You are ready to go in and spill your guts to your therapist. Before you do, it is important to know that the first session will mostly be information gathering. This will not be a normal therapy session. I repeat: this will not be a normal therapy session. This session is to gather more information from you, really a sense of who you are (and for you to meet and get a sense of your therapist), provide you an opportunity to elaborate on any of your answers on your intake form. During this session you may often feel the need to focus on the critical aspects that drew you to therapy; but, as urgent as those feel, you probably won’t get the chance to talk about them in depth. Not that your therapist doesn’t want to hear about the things you’re coming in for! They totally do (or should if they are a good fit).
They are also tasked with getting the biggest view of you as possible, that way they can pinpoint how to move forward and help you find what works for you. If you come in and talk about your problem before your therapist can fully understand you as a person, they may not be able to provide you the most individualized help. The intake session can feel like a weird encounter. You may hear your therapist say, “That sounds really important, and I want to come back to that, but for now, I need to know…” You are also welcome to say, “I know that we have to get through all this stuff, but I want to make sure we talk about…” That way your therapist knows that a specific topic is very important to you.
In summary, there are a lot of forms. These forms give your therapist a clear understanding of who you are so that both of you can make the most informed decisions as possible. You need to carefully read through the informed consent document and decide if there are any release of information forms you would like to fill out. Also, be prepared for more questions as your therapist may want to use a questionnaire. Finally, be prepared to talk about all the forms. The intake session can be quite nerve wracking, but hopefully, you will have a positive experience and you are able to begin your journey towards health!
About The Author
Molly Lyons- Counseling Intern
Molly is currently in her final year of the Master of Science in Clinical Counseling at Central Methodist University (CMU) and is a student intern at The Counseling Hub and Boone County Mental Health Coalition, where she will assess and provide mental health interventions and resources for individuals and groups in Boone County schools. She obtained her Bachelor of Science in General Psychology with a minor in Child Development from Central Methodist University directly before enrolling in the counseling program. Prior to pursuing her counseling degree, Molly received an Associates of Science in Early Childhood Education from Moberly Area Community College.
Molly has experience in the Counseling Center at MACC's Columbia campus, providing counseling services for students around the topics of identity crises, school-related stressors, depression issues, and coping with anxiety. Molly has co-facilitated Safe Zone trainings which introduce its members to the LGBTQ+ community terminology and basic information. Molly has also completed on online course in LGBTQ+ Counseling Competencies (College and Career Readiness) through the American Counseling Association (ACA). Molly is an active member of both the ACA and the Association for Multicultural Counseling and Development (AMCD).
Molly enjoys working with diverse populations and seeks to always be open to new learning experiences. She works best with individuals who are trying to discover who they are and how they relate to their world, as well as others in their world. Molly believes that a person’s external factors can provide both barriers and resources towards growth and that one must discover these in order to thrive.