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Peer reviews

DQ#1: How and when do you begin preparing your client for discharge from therapy?

 

According the the policy at my site a client is able to get 17 sessions of treatment unless they self termination after missing three consecutive sessions at that point we create a termination summary.  As we start to get 3/4 of the way through the process we start to discuss  termination and start to gear them up to handle situation own their own, in some cases we have used the last 10 minutes of the session to go over techniques we have discussed or learn in the prior session a reminder of how to problem solve.  and towards the last session is provide them with information that they can use as a resource for them to problem solve  and to use and self help reminders.    

My response:

Deborah

Class,

Within the facility that I work at we have an Intensive Out Patient program (IOP). When a client is enrolled within our program they complete 8 weeks of three three-hour group sessions a week to make for a total of 24 sessions. Once a client has completed all 24 sessions along with their assignments, they will then step down to our standard Out Patient program (OP). OP is when the client only has to attend one group session a week. The duration of OP is different for every client. Once IOP has been completed we then make an assessment of how many weeks a client will need to stay in OP for. The shortest duration that I have seen has been five weeks with eight weeks being the longest. If a client relapses while in OP, we then step them back up to the IOP program. When a client is becoming discharged, we do a discharge plan with them where we help them create a plan for success. Once this has been completed and we begin the discharge process I will then update their treatment plan as well as complete their discharge summary within our medical program. 

My response:

Julie

How and when do you begin preparing your client for discharge from therapy?
When considering discharging a client the discharge process actually begins when they enter into counseling. Counseling considering discharging a client from therapy we would discuss the goals that have been set and reworked and accomplished as time went on and discuss goals that were not accomplished, this would be their treatment plan. As the client gets closer to discharge we will have to develop what will be happening after therapy, what is the aftercare plan. What also has to be taken into consideration the whole picture if they an issue that is chronic and reoccurring for example mental illness, have to consider what services are going to be needed. Important conversation and concise and clear communication must be had by all of the disciplinary team between family members and or caregiver who will be providing continual treatment when the discharging from therapy. Being part of a disciplinary team it is important to cross your T’s and dot you I’s so to speak. It would also be beneficial for the client to have emergency contact numbers. It also depends on where this client is going as well if they are going from a 24-hour supervision to a 16-hour supervision, maybe they are going home, it depends on the situation, but can the same.

My response:

Catherine

I have had the opportunity several times to discharge clients based on the no call/no show company policy. The policy is when a client misses two or more scheduled appointments the therapist is to call the client and provide information that they will become discharged and if they are interested in continuing services they will have to complete the intake process again while this information is recorded as a collateral note with the date, time, and if you personally had a conversation with the client and the response. In response to the next step of discharging follow the company process to complete a discharge summary, change status on demographics and update the rating scale with post/post out rate. Otherwise, if the client has made progress the conversation between the therapist and the client will need to take place and three good referrals that take the clients insurance should be provided. Lastly, reminding the client if they need to speak to someone returning to therapy is a healthy option.

My response:

Shenequa

DQ#2: What feelings do you have about discharging a client? Are you happy to see them go? Satisfied? Saddened? How do you address these feelings?

Hello Professor Krupp & Class,

In counseling, terminating a service to a client is a process that is carried out with significant and ethical implications. The Code of Ethics Standard 10:10 requires that a psychotherapy relationship be ended when the client is not benefitting from treatment, is not likely to benefit from it, or is likely to be harmed from it. I will not call seeing a client go “sad” but would say that the client would be “missed”. . The client then feeds off the therapist and not the therapist feeding off he client. If a therapist is feeling sad then there may be more issues that were not addressed during counseling. The therapist must remember that the relation with a client is artificial and one-sided. The client feeds off the therapist and not the therapist feeding off the client. The therapist knows a lot about the client and the client knows a little about the therapist. Yes it is sad to see a client say goodbye but the therapist should be happy to see them go off to live their lives. Honestly, I think that I would miss them and let them know how much I learned from them and the strengths I have seen within them. Yes, counseling can affect a therapist emotions but the trick is managing normal and natural feelings with the ending process.

My response:

Gloria

For me, I have to admit that I have been saddened and satisfied when certain clients have been discharged. I say that because in a selfish way, certain clients have been assets to group cohesion and success I facilitate. They are consistent in their participation and actively engage other members in healthy discussions about any given group topic. In addition I feel like their was a genuine relationship formed during the process, so I hope that the client can maintain their sobriety and repair all personal relationships that were share in sessions. So when they are discharged, I often wonder if the groups will be the same. At the same time when you work with a client from the initial intake and watch their growth and sustained abstinence over time, as the counselor, you are satisfied because that is like a success story and you have done what you were trained to do. I believe a successful discharge is the reward in this profession, so I’m happy and satisfied that a client is being discharged with the knowledge and tools to live a life of sobriety with nothing holding them back. They understand their sobriety is a day-to-day process and they are thankful that I was able to get them back on track when they weren’t able to do it themselves. The way I’ve tried to address these feelings was for one talk to my supervisor to see if this was normal. Secondly, when I know a client is about to be discharged, I tell them to keep me up to date on how things are going in their lives. I often joke about them not being afraid to stop by to say hello. I also let them know that if there’s anything I could do to help them out as far as a referral for employment or housing etc., to give me a call so they don’t feel like they are leaving to go back to living on an island in isolation. Hopefully they will see and understand the empathetic side of me if they have done so already.

My response:

Michael

Good evening Professor Krupp, and class,

It is every counselor’s desire to see their clients become an improved version of themselves. Towards the termination of the counseling sessions, it is expected for a counselor to feel bad about ending a relationship they have worked on for a long time. I am often saddened to see a relationship I have worked on for a long time come to an end. Sometimes, it is common to feel a connection with clients and get attached to them, which is unhealthy. This may affect my professional relationship with clients. According to Clemson et al. (2016), it is common to have a mixture of feelings when terminating a counseling session. However, therapists should ensure that they put up measures to remain professional in order to prevent the likelihood of having the effects being passed on to another client.

I handle the feelings of attachment by acknowledging these feelings and my indecision to end the sessions. I always keep in mind that my main goal as a counselor is to detach the personal from the business side and promote the client’s well-being. Ensuring that I undertake my obligations with utmost professionalism while showing care to the client will ensure that the client will view the relationship from a professional perspective. This will help me to view the client professionally and maintain boundaries; thus, minimizing the chances of attachment. I will review the skills that I have equipped the client with during the counseling process as they are critical in enabling the client to handle their problems self-sufficiently. The ability to handle problems on their own will reduce their neediness toward my services. This will also allow me to detach from them and remove the need to provide help. I ensure that I get the best from each client and that I help them to become improved versions of themselves. Healing will help me to see that I have achieved the treatment goal and reduced the desire to have them around to get more help.

Reference:

Clemson, L., Lannin, N. A., Wales, K., Salkeld, G., Rubenstein, L., Gitlin, L., … & Cameron, I. D. (2016). Occupational therapy predischarge home visits in acute hospital care: a randomized trial. Journal of the American Geriatrics Society, 64(10), 2019-2026.

V/r,

Rosa

Professor: Rosa

Rosa

I am glad you can acknowledge that it can be hard to close out a client you got close to. What do you tell yourself cognitively to help you and your client detach appropriately and professionally? What would you do to help a client that was having a hard time ending counseling with you?

My response: