Reading H

The boundaries for ending counselling are imprecise. In a sense, lifeskills counselling has its ending built into its beginning. To look at it another way, the ending of formal counselling is the beginning of independent self-helping. Counsellors and trainees should start termination discussions before the final sessions and aim for convergence either then or by the final session. Throughout counselling, trainees and clients collect information relevant to termination decisions. The following are sources of and kinds of relevant information.

Client Self-Report

Clients may perceive themselves as better able to cope with problems. They may think they have attained their mind skills and communication/action skills goals. They may feel more confident and less prone to negative emotions. They perceive they no longer require the support of counsellors and can maintain skills.

Counsellor Observation

Over a series of sessions, counselling trainees may notice improvements in how well clients use targeted mind skills and communication/action skills. These observations come from various sources: the counselling conversation, role-plays and other structured activities, and from probes about how well clients use skills outside counselling. Trainees may observe clients feeling happier and more relaxed. They no longer have symptoms that brought them to counselling – for instance excessive anxiety. Problems that previously seemed insurmountable now seem manageable in that clients now can use better skills in responding to such problems. In addition, they seem to understand the targeted skills well enough to maintain them.

Feedback from Significant Others

Significant others in clients’ lives give clients feedback that they are different, or have changed, or make comments such as ‘You never used to do that before.’ Sometimes the feedback may come direct to a counselling trainee: for instance, from counsellor’s aides, spouses, bosses or parents.

Attainment of Measurable Goals

Clients can have easily measurable goals. For example, they may pass an examination or driving test. Other examples include losing a stipulated amount of weight and maintaining the loss over a given period, cutting down on smoking and maintaining the reduction, keeping off alcohol, or only spending a certain amount of money each week. Clients’ goals can be both objective and subjective, for instance making a given number of friends in a set period of time. The given number and set period are objective, whereas the definition of friends is subjective.

If trainees and clients consistently obtain positive information from all four of the above sources, their decision about when to end is easy. However, if positive changes are recent, it may pay to ‘wait and see’ whether clients maintain them. Inconsistent information, either from within or between different sources, merits further exploration.

Sometimes counselling trainees and clients have limited choice over when to end counselling, for example when clients leave town, when terms end, and when counselling addresses specific forthcoming situations such as important examinations or a wedding speech. On other occasions, trainees and clients have more choice about when to end. The following are some possible formats for ending counselling.

Fixed Ending

The counselling trainee and client may have a contract that they work for, say, eight sessions in one or more problem or problematic skills areas. Advantages of fixed termination include lessening the chance of dependency and motivating clients to use counselling to best effect. Potential disadvantages include restricting coverage of problems and insufficient thoroughness in training.

Open Ending When Goals Are Attained

With open endings, counselling concludes when counselling trainees and clients agree that clients have made sufficient progress in attaining their main goals. Such goals include managing specific problems better and developing improved skills to address current and future problems. An advantage of open endings is that of flexibility, such as when counsellors and clients uncover deeper or different issues to address than the ones for which clients originally came for counselling.

Faded Ending

Here the withdrawal of counselling assistance is gradual. For example, instead of meeting weekly, the final sessions could be at fortnightly or monthly intervals. Faded endings have much to recommend them when clients are learning mind skills and communication/action skills since they provide more time to ensure that clients have adequately internalized their changed skills.

Ending with Booster Session(s)

Booster sessions, say after three months, are not to teach new skills, but to check clients’ progress in consolidating skills, to motivate them, and help them work through difficulties in taking away and using trained skills in their home environments.

Scheduling Follow-Up Contact After Ending

Counselling trainees can schedule follow-up phone calls or postal and email correspondence with clients. This performs some of the same functions as booster sessions, enabling trainees to obtain feedback on how successful counselling was in assisting clients to maintain their skills. Then, where necessary, they can take appropriate action.

Premature Ending

Clients can and do leave counselling before counselling trainees think they are ready to do so. Sometimes clients just do not come to their next appointment with or without warning. However, under-confident trainees should be careful about automatically interpreting this as a wish to end counselling. There may be good reasons why a client misses an appointment. When clients build up a track record of good attendance, they almost invariably have sound reasons for missing an appointment. Where trainees have yet to amass sufficient evidence to interpret missed appointments accurately, after waiting for an appropriate period for clients to make contact, one option is to enquire tactfully if they wish to schedule another appointment.

What may seem premature ending to counselling trainees may seem different to clients. Beck and his colleagues cite as reasons for premature ending rapid relief of symptoms, negative reactions to the therapist, and lack of sustained improvement or relapse during treatment (Beck et al., 1979). Premature ending may also take place where there is a mismatch between the kind of counselling relationship that counsellors offer and the kind that clients expect (Lazarus, 1993). Trainees who clumsily handle clients’ doubts about and resistances to counselling increase the likelihood of premature termination.

Further reasons why clients leave prematurely include pressure from significant others, laziness, defensiveness, lack of money and fear of being trapped by counsellors or by trainees unwilling to ‘let go’ or who have their own agendas such as mixing religious proselytizing with counselling. In addition, counselling sometimes ends prematurely because trainees are insufficiently invested in their clients. Reasons for this include fatigue and burnout, personality clashes and finding certain clients unattractive or uncongenial.

Counselling trainees may consider it premature if clients leave counselling feeling able to cope with immediate problems, but having insufficiently consolidated the relevant mind and communication/action skills for dealing with future problems. Sometimes clients initiate this kind of end. However, increasingly counsellors and clients are under pressure from managed care providers and/or agency policies to engage in time-limited counselling that may lead to training in targeted skills being insufficiently thorough. Nevertheless, counsellors and clients may still have done some useful work together. Former clients may now possess insights about the skills needed to cope with future problems and also be more inclined to seek assistance in future, if needed.

Sometimes clients reveal their decision to end to counselling trainees who are of the opinion that this is not the wise thing to do. Dryden and Feltham (1992) assert that counsellors should respect the right of clients who wish to end abruptly to do so, and avoid trying to persuade or coerce them to change their minds. When a trainees and client have developed a good collaborative working relationship, they can calmly discuss the advantages and disadvantages of terminating at that time and still leave the final decision entirely to the client.

Prolonged Ending

For various reasons, either counselling trainees or clients or both may be reluctant or unwilling to end counselling. Here I focus on trainee reasons for extending counselling longer than might be justified. Though unlikely in the lifeskills counselling model, some trainees insufficiently prepare clients throughout counselling to face the fact of its termination, thus making it harder to end counselling when the time comes. Sometimes trainees waste time and allow the counselling process to drift rather than stay sufficiently focused on appropriate tasks.

There are also many ‘shadow’ reasons why counselling trainees may consciously or unconsciously prolong counselling. Such reasons include appreciative and admiring clients who feed the trainee’s narcissism, trainees being erotically attracted to clients, and financial considerations attached to extending counselling. Sometimes trainees and clients establish and maintain patterns of communication that can lengthen the counselling process, for example powerful trainees breeding passive clients or both parties becoming friends rather than engaging in a professional relationship.

The main task in ending counselling is ‘the consolidation of what has been achieved in terms of some durable benefit for the interviewee’ (Sullivan, 1954: 41). Many skills that counselling trainees use in the ending phase build on skills that they have used earlier. With clients who come for brief, focused counselling, trainees and clients may be forced to compromise in what they achieve in the ending phase of stage 3 of the lifeskills counselling model. The following are some skills for enhancing consolidation of self-helping skills when ending counselling.

Make Transition Statements

During counselling, counselling trainees may make statements indicating its finiteness: for instance on the usefulness of homework assignments for developing self-helping skills to use after counselling. Such comments may encourage clients to make the most of their regular sessions and the time between them. Trainees can also introduce the topic of termination with one or more transition statements which clearly signal that counselling is coming to an end (see Box 24.1).

Prevent and Retrieve Lapses

Two issues that become important after ending counselling are how clients can deal with difficult situations on their own and how they can get back on track if they have a lapse. During counselling, clients will often have anticipated and coped with difficult situations in their outside lives. Where necessary, in the ending phase, they can identify future difficult or high-risk situations where they might fail to use their improved skills and consequently become discouraged. Counselling trainees and clients can then conduct role-play rehearsals in how to deal with these difficult situations.

Clients can learn the distinction between lapses and relapses. Where appropriate, trainees can help them to develop retrieval skills so that if they make a mistake or have a lapse they can revert to using their improved skills rather than relapse. When clients use poor skills, this is not the time for self-denigration and engaging in black-and-white thinking in which they tell themselves they have lost their improved skills for all time. Sometimes trainees can work with clients to develop appropriate self-talk for handling lapses, underachievement and failure. Box 24.2 provides an example of self-talk for a client working on managing his temper at home that could be put on a reminder card or recorded on cassette.

Review Progress and Summarize Learnings

Clients can become not only their own counsellors, but their own trainers. In the final session, counselling trainees and clients may review the client’s progress to date and discuss ways of maintaining and improving clients’ skills after termination. Furthermore, trainees should emphasize the importance of clients continuing to monitor how well they use their targeted skills. They should also inform clients that learning can continue after the end of counselling, just as it can continue after leaving school or university.

Counselling trainees can encourage clients to persist with their changed thinking and behaviour by continuing to point out associations between attaining wished-for outcomes in real life and using their improved skills. With some clients, trainees may engage in cost-benefit analyses, possibly on the whiteboard.

Throughout counselling, trainees can check clients’ understanding of the skills they are learning by asking them to summarize their principal aspects. During the ending phase, trainees and clients may use summaries to review the skills taught during counselling. Where appropriate, trainees can ask clients to record their summaries on cassette as reminders. Another idea is for clients to keep cassette recordings of their final sessions.

Explore Arrangements for Continuing Support

Self-support is the main way that clients can receive continuing help. However, given the likelihood of difficulties and lapses in maintaining targeted skills, counselling trainees should think through how clients might receive ongoing support. The following are some options.

Further Contact with the Counsellor

Possibilities include scheduled booster sessions, follow-up sessions at clients’ request, and either scheduled or unscheduled phone calls and emails. Trainees can discuss with clients how they view further contact with them.

Referral for Further Individual Counselling

Though clients may have made considerable progress with the problems and problematic skills for which they came to counselling, they may still require further professional assistance. For many reasons counselling trainees may decide to refer such clients to other counsellors: for instance, their time may be limited or another counsellor has special expertise in an emerging problem area.

Using Outside Supports

In Chapter 19 I mentioned the counsellor skill of assisting clients to identify and use supports as they improve their mind skills and communication/action skills. Many of the supports clients identify during counselling should be available afterwards. In addition, in the middle and ending sessions of counselling, trainees can encourage clients to view identifying and using supports as a useful self-helping skill. One way of using others as supports is to encourage them to give honest feedback in non-threatening ways. Such feedback can be either confirmatory, indicating that former clients are on track in using their improved skills, or corrective, informing them that they have wandered off course and need to get back on track (Egan, 2002). Open acknowledgement by others of positive behaviour changes can motivate clients to keep improving their skills.

Continued Support from Counsellor’s Aides

During the ending phase, counselling trainees can contact their aides to receive assessments of clients’ progress outside counselling. Trainees can also work with aides to identify ways in which they can continue supporting clients once counselling ends.

Sometimes three-way meetings between counsellors, clients and aides are desirable. For example, at the end of a series of counselling sessions designed to help an elementary school child become more outgoing, teacher, child and trainee school counsellor might together plan how the teacher could continue supporting the child.

Group Counselling and Training

Some clients might benefit from joining groups in which they can practise and develop targeted skills. Peer self-help groups provide an alternative to professionally led groups. Counselling trainees can also discuss opportunities for client participation in courses or workshops run by themselves or others

Further Reading and Audiovisual Material

Some clients appreciate the support provided by further reading, self-help audio cassettes and videotapes. On their own initiative or by request, counselling trainees can suggest appropriate sources.

In addition to the major task of consolidating self-helping skills, there are other tasks when terminating counselling. How counselling trainees handle them varies with length of counselling, the nature of problem(s) and problematic skills, and the counsellor–client relationship.

Deal with Feelings

When using the lifeskills counselling model, most counselling contacts are short to medium term. Because collaborative working relationships are very important, the relationship is not the central feature of counselling and there is less likelihood of clients feeling angry, sad, anxious and abandoned than when ending longer-term relationship-oriented counselling. Instead clients often feel better able to cope with problems because of their improved skills, and experience a sense of accomplishment and optimism.

Clients’ feelings when ending counselling fall into two main categories: feelings about how they are going to fare without counsellors and feelings toward counsellors and the counselling process. Many clients are ambivalent about how they will cope after counselling. On the one hand, they feel more competent, yet on the other hand they still have doubts about their ability to implement skills. Counselling trainees can facilitate open discussion of clients’ feelings about the future. Looking at how best to maintain skills also addresses the issue of clients’ lingering doubts. Other clients will feel confident that they can cope now on their own, which is hopefully a sign of work well done.

Clients may also wish to share feelings about the counselling process. However, they should not allow themselves to get involved in lengthy discussions of unfinished emotional business. Nevertheless, trainees should allow clients the opportunity to share feelings about their contact with them. They may obtain valuable feedback both about how they come across and about clients’ reactions to different interventions and aspects of the counselling process. Trainees may humanize terminating by sharing some of their feelings with clients: for instance, ‘I enjoyed working with you’, or ‘I admire the courage with which you face your situation’, or ‘I’m delighted with your progress.’

End Counselling Ethically

Saying goodbye or the formal leave-taking ‘should be a clean-cut, respectful finish that does not confuse that which has been done’ (Sullivan, 1954: 216). Last as well as first impressions are important. Counselling trainees should aim to say goodbye in a businesslike, yet friendly way, appropriate to professional rather than personal relationships. By ending counselling sloppily, trainees may undo some of their influence in helping clients to maintain their skills.

There are a number of key ethical issues surrounding ending counselling. For example, counselling trainees need to think through their responsibilities to clients after counselling. Too much support may engender dependency, too little may fail to carry out professional obligations. Each case must be judged on its merits. Another ethical issue is what trainees should do when they think clients have other problems on which they need to work. I suggest tactfully bringing such views to clients’ attention.

A further set of ethical issues surrounds the boundary between personal and professional relationships. Most professional associations have ethical codes about providing counselling services. Counselling trainees who allow their personal and professional wires to get crossed when terminating are not only acting unethically, but can make it more difficult for clients to be counselled by them if the need arises in future. When considering any post-counselling personal relationships with clients, trainees should be guided by ethical codes, their conscience, the advice of their supervisors and respected colleagues and, above all, by their own view of the client’s best interests.

Evaluate One’s Counselling Skills

When counselling ends, counselling trainees have many sources of information for evaluating their counselling skills. These include attendance, intentional and unintentional feedback from clients, perceptions of client progress, session notes, possibly videotapes or audio cassettes of counselling sessions, clients’ compliance and success in carrying out homework assignments, and feedback from third parties such as supervisors.

Counselling trainees can make a final evaluation of their work with each client soon after ending regular contact. Questions trainees can ask include: ‘To what extent did the client manage her/his problem(s) better and improve her/his skills?’ and ‘How well did I use the skills for each stage and phase of the skilled client model?’ If trainees defer such an evaluation for too long, they risk forgetting valuable information. When evaluating their counselling skills trainees should beware of their characteristic perceiving errors; for example, they may be too hard or too easy on themselves. What they seek is a balanced appraisal of their good and poor skills to guide their work with future clients.