The commencement and termination of a therapeutic session depend on the therapist and the client. Therefore, boosting trust is important (Beaton &Thielking, 2020). The built trust is essential in allowing the next therapeutic steps to follow because of the initial connection established (Bradford, 2018). Nevertheless, termination is a foreseeable step, and it is precious that the process goes well (Australian Counselling Association, 2022). Therefore, marking the end of a psychotherapy cycle.
Outline and Discuss Strategies Used in Commencing a Therapeutic Counselling Relationship with the Client
Meeting a client for the first time is often welcomed with prejudice, especially by the client. Therefore, introducing a client to the session is a vital phase. According to Bradford, youths in Australia, especially between 12-25, face mental health problems. However, they are unwilling to visit the therapists because of the low acceptance of therapeutic assistance due to a lack of belief in what a therapist can do to help their situation (2018). A desirable first therapy session creates a connection, and accurate reflections on mental health are adopted (Bradford, 2018). According to Beaton and Thielking (2020), in their research about Australian psychologists’ perspective on psychological treatment for Australian women aged 18-25 suffering from post-traumatic disorder, they established that creating trust between the therapist and the young women is essential and necessary for the psychotherapy process.
Additionally, incorporating open-ended questions is a better way to foster a positive connection with their client. Besides, a therapist can create a less daunting environment where they ask non-confronting questions, making their client more comfortable. Then follow up with questions regarding what they expect at the end of the session. Furthermore, it is vital to allow them to know the extent their treatment is bound to take and the expected result (Bradford, 2018). Thus, ensuring they are at ease with the session because they have gained the trust and are aware they are in a non-judgmental zone.
After creating a good rapport, it is essential to be confident and respectful throughout the session. As a therapist, the ultimate goal is to ensure there are set therapeutic frameworks and boundaries, ensuring a context within which the session revolves around (Bradford, 2018). Additionally, being honest is also a form of respect for a client. Therefore, when deliberating an evaluation, honesty is upheld, as the client can perceive the deceit (Bradford, 2018). According to Quirk, allowing a client to control the session, particularly the dialogue, is crucial. Let them determine the flow and direction of their thoughts and feelings, enhancing the therapist’s respect and support (2020).
Understanding that the session is all about the client is vital. Therefore, allowing the client to express themselves without fear is paramount. Some of the activities therapists include; providing enough time to a client and allowing silence from time to time (Bradford, 2018). Furthermore, silence is necessary for thought processing, allowing the client time to consider their answers as some questions could be invasive and unappealing, causing discomfort (Bradford, 2018). Silence is optimal in a session as it encourages clients to state their thoughts and control their feelings. It similarly allows the therapist to process the information they have received to create a more appropriate response and evaluation (Quirk, 2020).
Moreover, not being the expert is necessary for this step because it allows the therapist to analyze the situation with what the client is expecting (Bradford, 2021). Additionally, practicing active listening skills and maintaining eye contact ensures the session is about the client. Other gestures include the therapist’s body language, which should be approachable and open. One should avoid shifting and instead sit calmly. Ensuring that facial expression does not fail is another essential technique, ensuring the aura is hospitable. (Bradford, 2021; Quirk,2020).
Additionally, the tonal variation should feel comfortable and precise. Nevertheless, avoid instances where questions or responses can be confusing (Quirk, 2020). Following the recent pandemic, most clients and therapists started using videoconferencing rather than traditional face-to-face therapy sessions. However, most clients were pessimistic about the process because they believed there would be a lack of empathy from their therapist. According to research by Kysely et al., the strategy was efficient, and most clients could feel their therapist’s empathy and understand their issues (2020) internally.
Confidentiality is complex and often makes many clients in need of therapeutic services shy away. However, it is necessary to assure the client’s confidentiality from the onset. According to Lamont-Mills et al. (2018), confidentiality is an ethical practice and necessary in the counselling process. Additionally, informed consent is an aspect that ties with confidentiality and involves the voluntary participation of the client in psychotherapy. Moreover, it is also necessary to state the times the confidentiality code may be broken and ensure clients are comfortable with the reasoning (Lamont-Mills et al., 2018). Ensuring proper communication of instances where confidentiality breaches may occur if necessary, as these are among the issues arising from client sessions (Lamont-Mills et al., 2018). Additionally, it is necessary to ensure the confidentiality agreement is not only verbal, but it should also written as it is vital (Patterson et al., 2018).
Ensure that there exists a delicate balance between coddling and being pushy. A balance should exist, whereas a therapist is not too pushy or overprotective of the client. To avoid being pushy, allow the client to express themselves on their own merits, and that could include silence to allow for thought processes (Quirk, 2020). Additionally, being authentic ensures that the client is not overprotected. Therefore, outlining the truth is critical in enhancing and ensuring that clients benefit the way they should (Bradford, 2018). Telling the truth at times might bring rapture to the relationship; however, it is necessary as a therapist to solve and make it clear for the client to understand why the views are the way they are.
The counselling structure comprises five main areas: establishing a relationship, evaluating a problem, setting goals, providing counselling intervention, and finally, terminating the treatment session (Quirk, 2020). When establishing a relationship as the initial process, it is essential to adopt a psychosocial dialogue (Bradford, 2018). In the second phase, problem evaluation can be achieved by tracking the session and looking for desired outcomes (Bradford, 2018). When providing counselling intervention, a therapist has to use a focus technique to ensure all challenges presented by the client are covered (Quirk, 2020). When approaching the end, it is vital to elaborate to the client on the achievements attained during the process and end the process when it is ethically correct (ACA,2022; Barnett, 2016).
The use of clear and concise questions should be adopted to ensure that the client is not further confused about their treatment process. Adopting an open-ended question is vital and allows the client some flexibility and enhances the relationship between a client and their therapist (Quirk, 2020). A psychotherapist should establish questions that not only helps the client to express themselves but also helps them identify the points of intervention in the feedback ensuring the overall treatment approach has been obtained (Quirk, 2020). Clutterbuck affirms that questions asked are ultimate in ensuring the effectiveness of the process. Subsequently, the question choices are necessary for building a client’s self-reflective ability (2020). According to their results, most participants indicated that asking various questions keeps the session going and allows for a change in perspective, further allowing the clients to synthesize the question deeply (Clutterbuck, 2020).
Maintaining professional boundaries will help in the commencement of the therapeutic relationship and the termination process. Therefore, avoiding misconduct in counselling sessions should be done (Australian Counselling Association, 2022). It will make it easier for both the therapist and the client, thus boosting the community assurance in the role of a counsellor and even other counsellors (ACA, 2022). The therapist should clearly state their boundaries throughout the psychotherapy process and categorically state the nature of the relationship with the client. Therefore, the relationship should not conform to other forms of relationship, either sensual or non-sensual (ACA, 2022).
Outline and Discuss Strategies for Terminating a Therapeutic Relationship with a Client
According to Barnett (2016), there are six steps to follow to ensure ethical and professional termination of a session with a client to ensure they do not feel abandoned. Such steps include; addressing the termination issues from the inception. Therefore, it allows the client to understand what reasons will lead to immediate termination of the treatment, which might be client-cause or therapist-cause (Barnett, 2016). The following process establishes a goal that should be achieved during the treatment. Once that goal has been achieved, the client can understand why the session is approaching termination. Thirdly, creating psychotherapist interruptions could be planned or unplanned; an example of a planned interruption is childbearing, and an unplanned interruption is death or illness. The fourth step would be to consider other occurrences that might arise from the client’s side or other interruptions. The next step is clearly explaining to clients what abandonment means and letting them know they are not being abandoned but terminating the session. Finally, discuss the client’s ongoing progress. At this point, create an activity summarising the therapy process (Barnett, 2016).
The therapist may terminate the session when the psychotherapist is no longer offering the desired help; then, the session is terminated (ACA, 2022). Ad counsellors should see that the client is taken care of in unforeseen circumstances. Consequently, it should be done by ensuring a clear explanation is given on why the therapy might not continue (ACA, 2022). Additionally, allowing the clients to reach into their ethos, giving them a chance to feel what they want, including feeling rejected, and finally referring them to a therapist who will be in a position to help them with their ongoing problems (Good Therapy, 2019).
Offending or making a client unhappy is another reason clients claim against their therapists (Good Therapy, 2021). It is essential to follow the following strategy; avoiding defensiveness as the client is always right. Additionally, the overall role of a therapy session is often to support the clients. The second step to follow suit is listening to their response and elaborating why therapy has to end without blaming or accusing the client. When the client reproaches a therapist for offending them, then take summaries and consider stating them in the termination letter (Good Therapy, 2019). Therefore, it ensures a good rapport between the therapist and the client.
Terminating a therapeutic session can often be premature. However, a premature termination is not often looked forward to as this is, in some capacity, ethically wrong. Research carried out in Australia showed that despite more men seeking mental health services, most of them did not see it through to the end (Seidler et al., 2021). The results showed that the masculinity role and bias attached to men going to therapy were among some of the reasons for premature therapy ending. Other reasons include lack of connection with the therapist, age, and belief that therapy lacked advancement for some participants (Seidler et al., 2021). Nevertheless, therapists must insist on attending the therapeutic session to the end (Seidler et al., 2021).
Conclusion
To sum up, both the commencement and termination of therapeutic relationships are vital and intertwined and necessary for achieving the said goals for a client. Similarly, the client and therapist are integral in ensuring the needed results are achieved. Additionally, the methods applied depend on the treatment when commencing and terminating the therapy process.
References
Australian Counselling Association. (2022). Codes of ethics and practice of the Australian Counselling Association. 1-17.
Barnett, J. (2016). 6 Strategies for Ethical Termination of Psychotherapy: And for avoiding abandonment. Society for the Advancement of Psychotherapy. https://societyforpsychotherapy.org/6-strategies-for-ethical-termination-of-psychotherapy/
Beaton, J., & Thielking, M. (2020). Chronic mistrust and complex trauma: Australian psychologists’ perspectives on the treatment of young women with a history of childhood maltreatment. Australian Psychologist, 55(3), 230-243.
Bradford, S. (2018). Loneliness: Is this Australia’s next public health epidemic? Engaging Young People in Therapy. Australian Psychological Association. InPsych40(4). https://psychology.org.au/for-members/publications/inpsych/2018/august-issue-4/engaging-young-people-in-therapy
Clutterbuck, D. (2020). The Coaches’ Handbook. J. Bassmore (Ed.), Questions in coaching (pp. 92–103). Routledge.
Good Therapy (2019). How to Navigate the Termination of Therapy with a Client. https://www.goodtherapy.org/for-professionals/business-management/private-practices/article/how-to-navigate-the-termination-of-therapy-with-a-client
Kysely, A., Bishop, B., Kane, R., Cheng, M., De Palma, M., & Rooney, R. (2020). Expectations and experiences of couples receiving therapy through videoconferencing: A qualitative study. Frontiers in Psychology, 10 (2992), 1-14. https://www.frontiersin.org/articles/10.3389/fpsyg.2019.02992/full#:~:text=https%3A//doi.org/10.3389/fpsyg.2019.02992
Lamont-Mills, A., Christensen, S., & Moses, L. (2018). Confidentiality and informed consent in counselling and psychotherapy: a systematic review. Melbourne: PACFA. 1-21.
Patterson, J., Williams, L., Edwards, T. M., Chamow, L., & Grauf-Grounds, C. (2018). Essential skills in family therapy: From the first interview to the termination (3rd ed.). Guilford Publications.
Quirk, K. (2020). The Basic Skills of Counselling: What is counselling? Upskilled. https://www.upskilled.edu.au/skillstalk/counselling-skills
Seidler, Z. E., Wilson, M. J., Kealy, D., Oliffe, J. L., Ogrodniczuk, J. S., & Rice, S. M. (2021). Men’s dropout from mental health services: Results from a survey of Australian men across the life span. American journal of men’s health, 15(3), 15579883211014776.
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