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New Perspectives on Ethics, Session 4 with William Doherty: Comment Board

 

william_doherty_lrgToday’s session with William Doherty, the fourth in our ethics webinar course, will cover the subject of terminating therapy in an ethical manner, in a different format. He’ll use cases from HBO TV series “The Sopranos” and “In Treatment” to illustrate effective and ineffective ways to terminate therapy when clients are no longer benefiting.

We hope that after this informative and entertaining session, you’ll have a clearer understanding of helpful and unhelpful ways to terminate therapy and how to handle it ethically.

What do you think was most relevant about today’s session? We encourage you to take a few minutes now to share any related experiences, and to comment on what was most applicable to you or most interesting.

Please consider what struck you the most about today’s session and to think about everything you’ve learned so far about ethics, and comment below. As always, we invite you to please include your name and hometown with your comment. Thank you all for your participation.


02.07.2011   Posted In: P002 New Perspectives: Ethical Standards for the 21st Century Practitioner   By Rich Simon
22 Comments
     

    • ↑ 0 ↓ avatar Merrilee Gibson 02.08.2011 06:59
      Thank you VERY much. Excellent presentation, and the technical problems were fixed, as well (hurray!). I felt Dr. Doherty's presentation was very clear, on theme, focused, hands-on approach practical point of view. All sessions have presented helpful and valuable information; I personally felt this was the best one so far.
      Merrilee, San Mateo, Califonria
      Reply
    • ↑ 0 ↓ avatar Luella Terry 02.08.2011 07:08
      Thank you for a wonderful presentation. It was a good reminder to all of us who have been in the field for a while as well as those who are newer to this field. Thank you also for fixing the technical problems. It was so delightful to hear comments from both of you.
      Luella, Mesa, AZ
      Reply
    • ↑ 0 ↓ avatar Dale Pavich 02.08.2011 07:14
      A refreshing perspective on the power balancing process in psychotherapy. Thankfully the technical glitches have been fixed so the problem of talking over one another did not occur this session. The use of the "In Treatment" video clip was a great example of the ethical transgressions common among clinicians, and nicely woven into the discussion on pitfalls in this aspect of our work. The only subject I thought could have been addressed was the issue of money and how clinicians rationalize continued treatment for financial reasons. How can this topic be incorporated into the conversation here? Or can you refer me to some resource materials addressing this rather gnarly issue on ethical considerations in therapist-initiated termination.
      Dale Pavich, Santa Barbara, California
      Reply
    • ↑ 0 ↓ avatar Cynthia Kelly 02.08.2011 07:15
      I enjoyed and was challenged by this presentation. Who among us hasn't secretly wished that a difficult client would just go away? Dr. Doherty's strategies for terminating or discussing terminating the therapeutic relationship were very helpful, humane, and positive. This has been an excellent webinar with nitty-gritty, germane perspectives on issues not commonly discussed in an ethics course.
      Cynthia K.
      Chester Springs, PA
      Reply
    • ↑ 0 ↓ avatar Diana Sillence 02.08.2011 07:49
      Thanks, Simon, for "fixing" the shared audio portion of the presentation. That alone was awesome. Thank you Dr. Doherty for your expertise in sharing the different ways that a therapeutic relationship can and should end prematurely and how to handle it. The reminder to "check in" with the couple and see how things are going in the I-thou relationships. Excellent!
      Diana Sillence, Lutz, FL
      Reply
    • ↑ 0 ↓ avatar Wayne Carpenter 02.08.2011 09:23
      An excellent presentation. The idea of checking in with clients to see if the treatment is effectively meeting the clients' needs has been well addressed by Scott Miller and his colleagues. He makes the case for using a simple scale at the end of each session (the Session Rating Scale) wherein the client is asked to rate the session on 4 dimensions: 1)feeling heard, understood, & respected, 2)worked on and talked about what the client wanted, 3)the fit of the therapist's approach, and 4)overall sense of the session. This type of feedback aids in collaboration, spots potential trouble areas to be addressed, and allows the therapist to make modifications to his/her approach. Likewise, an Outcome Rating Scale is administered at the beginning of each session wherein the client rates the past week in 4 areas. Thus, the therapist and client get a weekly snapshot of therapeutic progress that can be easily charted over time.
      Reply
    • ↑ 0 ↓ avatar Val Beck Sena 02.08.2011 11:15
      An excellent presentation on an overlooked topic. Therapy gets messy even for the most experienced of us. As an experienced (32 years) therapist/supervisor I never in my wildest dreams anticipated the experience I had with a client. I work from a home office with a separate entrance for clients. I had just begun seeing a middle aged woman whom seemed at first quite frantic but then calmed and and engaged. At the end of the second session she said that she knew she and I were just alike and she'd like me as her best friend. This was said, not surprisingly, as I was showing her out of the office. As my next appointment was waiting I said we'd talk about it the following week. The session was on a friday the middle of December. That Sunday as my husband and I were decorating the Christmas tree, we discovered we needed a few things and I went off to the store. I was gone about an hour. When I walked into our living room there was my client decorating the tree and my very confused husband pacing around. Privately my husband told me My Client showed up at the front door, introduced herself as a new friend of mine, and told him she was great at decorating Xmas trees.

      As I ushered my client to the door (diagnosis having been made) I dreaded our next session. My fury surprised me. I had seen many NPDs and Borderline clients and could usually spot that "off" quality in the first session. I certainly was not seeing these patients in my home-office. I just wish I had had Dr. Doherty to consult with then.

      Val Beck Sena
      Cincinnati
      Reply
    • ↑ 0 ↓ avatar George Essif 02.10.2011 10:45
      Thank you for providing these presentations. They are so useful
      Jay Essif, Lancaster,Pa
      Reply
    • Not available avatar 02.11.2011 04:41
      Thank you for a very useful session. What was not addressed was termination imposed by organizations when not in private practice. As an EAP counsellor, I must introduce the issue of termination right from the start and continually check in with clients to evaluate progress. I appreciate the validation of this approach as Dr. Doherty suggested he does this even in a practice that doesn't have session limitations. I applaud his point that we, as therapists, must look at our own role in clinical relationship breakdowns as much as we encourage clients to take responsibility for their part in their personal relationship dynamics.
      Reply
    • Not available avatar 02.11.2011 06:28
      We can't get in on the rebroadcast. Trying all Friday morning.
      "movie not loaded"
      Reply
      • ↑ 0 ↓ avatar jody jessup 02.19.2011 12:38
        I had trouble on Friday as well via Firefox. When I went in through Explorer all was well. Can't explain it.
        Jody, Baileys Harbor
        Reply
    • Not available avatar 02.12.2011 05:10
      Terrific discussion of an often trying and very difficult issue in therapy. Thought the clinical examples including use of the TV clip was excellent. Best webinar so far! Thanks for fixing the technical problems from last time.

      Richard, NY
      Reply
    • Not available avatar 02.12.2011 10:03
      Thank you for an excellent presentation. Dr. Doherty's knowledge and sharing on the topic kept my interest peaked throughout. I realized how the discussion of termination can be an awkward experience for client and therapist alike. Avoidance of "the elephant in the livingroom" might well be part of the reason the client is in therapy to begin with.
      Reply
    • ↑ 0 ↓ avatar Susan Noble 02.13.2011 14:50
      Wow!! What a treat! So validating to know that I'm not alone in my frustrating situations. I was trained to use evaluation frequently throughout therapy and have found it very helpful for referral or termination or shift in therapy as well as positive recognition for change (sometimes not obvious to T or C). I just wish I could recognize my discomfort as "crisis" earlier. I was so excited to hear you say to find someone to consult with that would focus on "my part" in the relationship problem! So helpful in order not to "blame" the client. Thank you so much for your insight and collaborative approach. You presented a very "artful way" to deal with difficult situations,
      The audio portion sound was awesome and the video trick with "In Treatment" was a real treat...a first for me on line. Thanks for the correction.

      Susan
      New Orleans
      Reply
    • Not available avatar 02.14.2011 00:37
      Great, thorough and helpful with practical examples of how to dialogue with a client about effectiveness. I appreciate the Physician model of collaboration/consultation to help client receive the best suited care for their needs which may not be with me, but how to steer them into that situation if discussions on effectiveness doesn't result in moving forward early on. snordquist, Idaho
      Reply
    • ↑ 0 ↓ avatar Sandra Nordquist 02.14.2011 01:04
      I do not know where to sign up and take the CE course exam for this Ethics course and am having difficulties contacting the support system...go figure. This seems to be the only place I can contact anyone with questions regarding this course..so sorry...I know it is me! Help, please..anyone...Anyone..Ferris Bueller...anyone...snordquist@proactiveadvantage.com
      Reply
    • Not available avatar 02.14.2011 10:37
      There was so much I appreciated about this session. Dr. Doherty has a wonderful ability to bring us into the therapy room and give us useful, humane guidance. I too appreciated how respectful and non-pathologizing his approach is. I also feel the approach he described takes shame out of the picture for both therapist and client. Excellent.
      Reply
    • Not available avatar 02.14.2011 15:35
      I liked the examples especially about using 'crisis' in the relationship to terminate. On the other end of 3rd party limited sessions would be relationships where termination is not entirely reasonable - esp from child/family issues. I work in an agency for voluntary services but clients may be pressure at times to perform to 'prevent' DSS/CPS involvement. Negotiating through these crisis times can be more difficult with some clients than others, with the goal of preventing child welfare involvement being a goal.
      Reply
    • ↑ 0 ↓ avatar Ruth Gibian 02.14.2011 18:23
      Really and truly appreciated the technical glitches being solved -- this allowed real dialogue to unfold. Hurrah to the techies who made it happen!

      While I was very interested in the ideas presented about clinically sound termination practices, including those in sticky situations (and found Doherty's perspective compelling), I wished for more direct connection to ethics. Clinically sticky situations are different than ethically complex situations, and while they may overlap, the distinction wasn't made here. I agree that the examples of handling the clinical relationship poorly do indeed reflect mistakes, but are they ethical mistakes or clinical mistakes?

      Ruth
      Portland, OR
      Reply
    • ↑ 0 ↓ avatar jody jessup 02.19.2011 12:44
      This was an issue I have not given due consideration to so I appreciate the topic being presented so clearly. Great information which I will heed as I push on in my private practice.
      Jody, Baileys Harbor
      Reply
    • ↑ 0 ↓ avatar Liz Forbat 06.11.2011 07:59
      I really enjoyed the humour and vignettes from his clinical practice to illustrate the main issues. I was particularly captured by his use of research evidence too - in terms of the example given of the number of 'yes, but...' dialogue in initial sessions which led to early termination of therapy. Food for thought, both in terms of actioning collaborative practice but also other areas for research around the features which determine timings of terminations. Thanks Webinar crew for putting this together, and thanks of course to William Doherty for sharing his thoughts.

      Liz,
      Edinburgh, UK.
      Reply
    • Not available avatar Theresa Kestly 06.18.2011 10:44
      I loved the flow and depth of this presentation. I especially liked the initial concept of no one healer being a person of last resort. Thanks so much for the wisdom and humility of how best to approach termination issues. Best presentation, so far, for me.
      Theresa
      New Mexico
      Reply
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