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Issues to consider when changing jobs and terminating client relationships

By Brian Carnahan and Bill Hegarty July 11, 2016

If you are reading this article, you are most likely a licensed mental health professional. So imagine these two scenarios.

The first: You’ve just been offered your dream job. You can start tomorrow, without giving notice at your current job, correct?

The second: What if you are not happy at work? What if you have simply had enough? If you aren’t happy, you can just quit, right? You can pack up your belongings and head out the door to greener pastures.

The answer in both scenarios: Not quite.

Licensed mental health professionals are subject to strict laws, rules, and standards of ethical practice and professional conduct regarding “termination.” Termination refers to ending the therapeutic relationship with a client.

The end of the therapeutic relationship can occur for many reasons. For instance, the therapy Depositphotos_43929729_m-2015has achieved the expected outcomes or the client and therapist agree that the client should seek help elsewhere. Or, in many cases, the therapist is moving on to a different job or career and will no longer be able to serve the same clients.

Unfortunately, some therapists terminate inappropriately. They simply stop coming to work or walk out. This can leave clients in a difficult position. The abrupt termination of services can cause setbacks in client progress. An inappropriate termination can place pressure on remaining staff.

In Ohio where we work, improper termination appears to be more of a problem in agency settings than in private practice. It also occurs more frequently among newly licensed professionals. These licensees are often in their first professional jobs and may find it challenging to adapt to the demands of the work.

One of the main issues that the Ohio Counselor, Social Worker, and Marriage and Family Therapist Board sees regarding improper termination is the failure of licensees to complete all of the required client documentation, including case notes, mandated reports, informed consents and releases of information. When licensees leave an agency or practice without completing their required client documentation, they have compromised the client’s continuity of care. How will the next therapist know what has worked and what has not worked with a specific client?

For example, a client may have shared important experiences with a therapist that informed the direction of the therapy. The client may not trust the new therapist enough yet to repeat that information, and without documentation, the therapeutic relationship and client’s progress could be undermined.

In one case, a licensee promised a client that he would submit documentation prior to a court hearing regarding the client. When the licensee terminated his employment, he didn’t complete the documentation or alert anyone else of the need for the documentation to be forwarded to the court.

Holding a professional license means that you might have to place the needs of others before your own. Therefore, leaving a job or otherwise ending a therapeutic relationship requires planning.

Unfortunately, there are going to be times when licensees and their supervisors just don’t agree on things, and licensees may feel that they can’t stand their job any longer. The key is to think of your clients’ needs.

No matter the reason for termination, licensed mental health professionals must ensure that their clients have notice of the pending end of a therapeutic relationship and are provided with options for continuing treatment. These options might include a referral to another agency or mental health professional or transitioning to a professional in the same agency or practice. The requirement to terminate appropriately ensures that clients who may have significant issues are not harmed by an interruption of service.

Although this article is mainly directed toward individual professionals, those who manage others must also be mindful of their obligations regarding termination. Supervisors who demand that an employee leave immediately, either as the result of a dismissal or in response to a resignation, should recognize that they may be causing an ethical situation by not allowing the therapist to terminate with clients properly.

Additionally, those who manage agencies should consider how the work environment and its expectations may be impacting its employees. Are the expectations and demands such that it is difficult for therapists to work effectively and productively, possibly leading them to walk off the job?

As always, licensees should know the laws and rules of the jurisdiction in which they work. Ignorance of the laws and rules is not a defense if a licensee terminates improperly. Licensing boards publish these regulations online, and training from board staff and continuing education providers is also available.

If you think you need to quit a job, first consult your supervisor (both your work supervisor and training supervisor if you are under training supervision). Together, you may be able to address the issues that are prompting you to consider leaving your job. Even if the problems cannot be resolved, you will have guidance for following your licensing board’s laws and rules and those that your employer might impose.

Once you determine that leaving your job is the best option for you, follow basic employment norms, such as giving notice, maintaining civility and being available to help with any transition needs. Expect to work with your supervisor to create a transition plan. If it is not a proper “plan,” be prepared to update your supervisor on your current work and caseload.

If you are in private practice, you may be working directly with clients to make referrals. To ensure compliance with laws and rules, these referrals should be legitimate referrals to other competent professionals. Directing the client to call his or her insurance company is not sufficient. We suggest exploring additional literature and training regarding communicating with clients about termination in situations in which therapists think they can no longer help or that clients have reached their goals.

Be sure to leave complete case notes. The therapist following you will thank you, and you will be helping to ensure that clients receive the help they need as promptly as possible. Values of professionalism would also suggest that you finish any other required paperwork that will help to facilitate client care. This may include informing collaborating professionals of your transition so that they can adjust accordingly.

For example, if you regularly collaborate with a psychiatrist regarding a client, the psychiatrist should be informed that you will no longer be working with the client. This allows the psychiatrist to adjust his or her treatment of the client if necessary, perhaps changing the frequency of appointments until the client has adjusted to the new therapist. The same could be said of school personnel when working with children. Perhaps the school regularly reached out to you when things were getting out of hand. It would be important for the school to be informed of your departure so that it could make plans accordingly.

Leaving a workplace or ending a professional relationship is never easy. Licensed mental health professionals have unique obligations, based on laws and codes of ethics, to ensure that the needs of their clients are met when the therapist can no longer work with them — no matter the reason. By following the guidance outlined above, therapists can help ensure that they meet their professional obligations while also helping their clients.

 

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Brian Carnahan is the executive director of the state of Ohio’s Counselor, Social Worker, and Marriage and Family Therapist Board. Contact him at brian.carnahan@cswb.ohio.gov.

Bill Hegarty is deputy director and manager of investigations for Ohio’s Counselor, Social Worker, and Marriage and Family Therapist Board. Contact him at bill.hegarty@cswb.ohio.gov.

 

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Related reading: For more on the termination of the therapeutic relationship, see Counseling Today‘s recent article “The loss of a meaning relationship

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

9 Comments

  1. Tamara Suttle

    Thanks so much for addressing this issue. I’ve blogged about this some on my own website and have done a considerable amount of consulting with counselors who have made the decision to close or relocate their practices. Your post is an excellent addition to resources and I’m happy to share it with my followers.

    Reply
  2. Keith Myers

    This is a great article on an issue that isn’t often discussed. I recently left an agency that I’ve been working with for over a year and really struggled with having that talk with some of my clients. This process can be an emotional one for the therapist as well! I enjoyed this.

    Reply
    1. Brian Carnahan

      Requirements may vary based on the jurisdiction in question. In Ohio, Counselors must indicate to clients that they can continue receiving services at the same practice or agency when the Counselor terminates employment. If the Counselor provides referrals, among those referrals, one may be to the Counselor’s new practice or agency.

  3. Jasmine

    What if the decision to leave is due to hostile environment because of the office manager and they don’t give any response as to how to go about sharing your decision to leave with your clients? Basically stopping you from communicating with them? Ethically, what else can you do?

    Reply
  4. Betty Hatfield

    My daughter, a licensed child therapist, gave her work notice and wanted to tell her clients’ parents with 3 wks notice of the change, but her businesses boss/owner threatened my daughter that her license is on the line and breaking Hippa for my daugter to notify these parents, which does not seem correct at all. The boss kept saying to her, “you should have told me” and asked her how much she is being offered at her new position, which my daughter did not tell her saying, “i feel uncomfortable telling you that”, to which her boss stated, “How much? $85,000 with benefits?” But my daughter did not tell her. Then the boss said, “You should have told me!” My daughter told her 3 weeks which for an hourly employee was not appropriate in my book(I am a retired nurse). Then when the boss started raising her voice claiming my daughter was being irresponsible, my daughter said and wrote in her letter her plan was to let parents know so that there would be transparent transition of plan of care for their childrens’ plans of continuation of care just with another therapist. Her boss also said the place where my daughter is going will cause her license to be in jeopardy which is off-based. Please advise me if i should say anything to my daughter.
    Sincerely,
    Mrs Hatfield

    Reply

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