Closing a Practice: Practical, Ethical & Clinical dimensions

By Janet T. Thomas, Psy.D.
March 31, 2015

Closing a practice: practical, ethical and clinical dimensionsOpening a psychology practice is a monumental endeavor requiring energy, drive and determination. The skills required for clinical work are necessary, but not sufficient for initiating and sustaining such an entrepreneurial endeavor. In addition to attending to the practicalities, independent practice demands continual marketing and self-promotion to remain in the forefront for referral sources and accessibility to prospective clients.

Terminating a practice requires a complete reversal of the momentum cultivated. This phase requires knowledge of tasks and challenges associated with the practical, ethical, clinical and personal dimensions of discontinuation. Closing a practice, like opening one, requires careful planning, diligent effort and emotional preparation.

Practical Considerations

Once the decision to close is made, the process begins with setting an end date and working backward to determine the timing of other steps. Notification of clients is among the first considerations. The amount of notice depends on circumstances precipitating the closing. Serious illness or acceptance of a new position, for example, may necessitate minimal notice. When the departure is planned, psychologists can establish a timeline taking into account the types of treatment they provide and client needs.

That timeline may range from six weeks to six months, and may be more protracted with longer-term clients, as in a psychoanalytic practice. How far to go in notifying former clients also will vary.

Other notifications include referral sources, liability insurance companies and licensing boards. NPI numbers must be deactivated and provider agreements terminated according to contractual requirements

Many authors offer suggestions about managing the emotional (McGurk, 2005) and practical aspects of closing a practice (Blakelee, 2014; Heller, 2007; Holloway, 2003). The NASW Center for Workforce Studies provides a helpful checklist for private practitioners (2012).

Ethical Considerations

Ethical responsibilities to clients continue through closing a practice and the termination of therapeutic relationships. For example, APA Ethical Standard 10.10 states that, “prior to termination, psychologists provide pretermination counseling and suggest alternative service providers” (2010, p. 14). Ethical Standard 3.12 requires psychologists to “plan for facilitating services in the event that psychological services are interrupted” (APA, 2010, p. 7).

Notification includes providing information about plans for maintenance, storage and access to records (Standard 6.02). Likewise, the termination process has implications for confidentiality and informed consent.

Clients must authorize communication with future treatment providers (Standard 4.05) and be informed about factors that may influence decisions about participating in current treatment, such as the psychologist’s plan to close.

Clinical and Personal Challenges

Client needs, including those related to therapist self-disclosure, session content and time of termination, are generally paramount in psychologists’ clinical decisions. A decision to close a practice, however, is based on the psychologist’s needs, a significant departure from normal practice. Additionally, psychologists have their own emotional responses. They may experience anxiety, guilt, ambivalence, excitement and sadness.

Psychologists must manage these feelings, distilling out what would be helpful to share with each client. Clients may experience anger, disappointment, indebtedness and gratitude, all with potential to stir emotions in the psychologist. One retiring psychologist commented, “It’s really hard when you are grieving yourself, and you have to listen to your professional eulogy hour after hour.” (P. L. Layton, personal communication, Sept. 19, 2014).

Another challenge involves the potential for accelerated clinical work. Impending termination may awaken past losses or clients may talk about issues that they had put off, feeling that this will be their last opportunity. Former clients who receive notification letters may request another session to say goodbye or to resume treatment.

One psychologist described her work during the weeks preceding her retirement as “some of the most emotionally intense work I have ever done.” (C. O. Geiger, Oct. 3, 2014).

Consultation with colleagues at this stage is helpful, if not imperative. Psychologists approaching their final sessions may experience impulses to transgress normal boundaries in an unconscious effort to avoid facing clients’ disappointment or their own feelings.

Holding the therapeutic frame with every client through the very last session is critical. Failure to do so risks undoing the positive impact of work done. After closing their practices with careful thought and planning, psychologists can begin the transition into the next phase of their lives.

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