GOOD PRACTICE Winter 2014 3
should typically provide patients who need additional
treatment with contact information for several appropriate
alternate service providers. A letter to the patient is
generally an appropriate way to convey this information.
Many states have adopted the APA Ethics Code or similar
ethical standards or rules for professional conduct for
psychologists. Furthermore, some states have adopted
specic statutes or regulations prohibiting abandonment of
patients or have case law prohibiting abandonment. In other
words, psychologists are both ethically and legally required
to handle terminations in a way that does not constitute
abandonment of a patient.
For example, the New York Rules of the Board of Regents
§ 29.2 states: “Unprofessional conduct [for psychologists
and other listed health professionals] shall also include…
abandoning or neglecting a patient or client under and in
need of immediate professional care, without making
reasonable arrangements for the continuation of such care, or
abandoning a professional employment… without reasonable
notice and under circumstances which seriously impair the
delivery of professional care to patients or clients.”
According to Younggren & Gottlieb (2008), “Abandonment
represents the failure of the psychologist to take the clinically
indicated and ethically appropriate steps to terminate a
professional relationship” (p. 500). Although psychologists
may become concerned when they need to unilaterally
terminate therapy, legal and/or state board actions against
psychologists for abandonment appear to be rare (Younggren
& Gottlieb, 2008). Usually, the real question is how to handle
transitions in a way that best promotes the patient’s welfare –
whether the transition is complicated or not.
To avoid allegations of abandonment, Knapp et al. (2013)
offer the following advice: “The general risk management
rule is not to terminate against the wishes of patients if they
are in life-endangering crises. If therapists decide to terminate
treatment, they should give adequate notice and provide
referrals for other treatment opportunities if more treatment
is needed” (p. 204). In addition, careful documentation,
obtaining clinical and/or legal consultation as needed, and
advance planning are all helpful in reducing risk. If you are
concerned about a possible allegation of abandonment,
however, you should consult with your malpractice insurer’s
risk management service or a knowledgeable attorney.
Termination as a process
To handle termination as smoothly as possible, it helps to
think of it as a process and begin planning for termination at
the outset of treatment. Topics such as the expected course of
GOOD PRACTICE Spring/Summer 2014 3
REFERENCES AND RESOURCES
American Psychological Association. (2002). Ethical
principles of psychologists and code of conduct.
Available at
www.apa.org/ethics/code/index.aspx.
American Psychological Association Practice
Organization. Are You Prepared for the Unexpected?
Available at
www.apapracticecentral.org/business/
legal/professional/secure/will.aspx.
American Psychological Association Practice
Organization. Checklist for Closing Your Practice.
Available at
www.apapracticecentral.org/business/
management/tips/secure/closing.aspx.
American Psychological Association Practice
Organization. Dealing with threatening client
encounters, Good Practice, Winter 2012, available at
http://apapracticecentral.org/good-practice/index.aspx
American Psychological Association Practice
Organization. Duty to Protect. Good Practice, Fall
2013, available at
apapracticecentral.org/good-
practice/secure/duty-to-protect.pdf
Campbell, L., Vasquez, M., Behnke, S. & Kinsherff,
R.(2010). APA ethics code commentary and
case illustrations. Washington, DC: American
Psychological Association.
Knapp, S., Younggren, J.N., VandeCreek, L., Harris, E.,
& Martin, J.N. (2013). Assessing and managing risk in
psychological practice. Rockville, MD: The Trust.
Sonne, Janet L., (2012). PsycEssentials: A pocket
resource for mental health practitioners, Washington,
DC, US: American Psychological Association.
[Chapter on “Terminations” at pp. 245-249.]
The Trust. Sample Informed Consent Form. Available at
www.apait.org/apait/download.aspx?item=INF.doc;
Vasquez, M. J. T., Bingham, R.P. & Barnett, J. E. (2008).
Psychotherapy termination: Clinical and ethical
responsibilities. Journal of Clinical Psychology, 64(5),
653-665.
Younggren, J. N., & Gottlieb, M. C. (2008). Termination
and abandonment: History, risk, and risk
management. Professional Psychology: Research and
Practice, 39(5), 498-504.