Ethical considerations for complex termination.

Abstract

Guidance exists for the mental health clinician approaching termination, the bulk of which pertains to mutually agreed upon, planned cessation of treatment that occurs as a collaborative process between client and clinician. Challenges arise, however, when facing a client's or clinician's unexpected decision to terminate, necessitating thoughtful analysis of ethical responsibilities, balanced with the acknowledgment that complex termination does not necessitate unreasonable extensions of clinicians' professional obligations. The ethics codes of the mental health professions each provide general guidance that may be used to flexibly respond in such contexts. This article first reviews this guidance as a foundation for exploring complex termination circumstances, followed by considerations for navigating ethical quandaries therein. General guidance is then provided for proactively preparing for termination, whether anticipated or not. Clinical Impact StatementThis article explores complex termination scenarios, balancing attention to clinicians' ethical responsibilities, expectations for client behavior, client and clinician autonomy and well-being, and context. Vignettes are used to illustrate ethical standards in action, as well as the challenges inherent in complex termination circumstances.