As therapists, we are given some interesting, and often conflicting, information about terminating treatment. Many training programs encourage actively working toward termination, and some approaches even limit sessions to a specific number that should be done in order to yield results.
While I am always a fan of a plan, we are working with humans, not carburetors. Not everyone will follow a specific protocol, as human behavior is very difficult to predict. This can be very evident when it comes to therapy.
Each client is unique just as each therapist is unique. This will lead to each therapeutic relationship differing and needing to be addressed in an individualized way. Deciding the course of therapy is no different. Therapy doesn’t have to only end in termination or transfer. For many clients, maintenance therapy is the best course of action.
What is Maintenance Therapy?
If you ask ten therapists what maintenance therapy looks like, you are likely to get ten different answers. There is a reason for this, it is unique to each client and to each therapist. What is most important is that it is tailored to your client’s needs.
Many clients may prefer termination when they have met their treatment goals, however, this may not be the best fit for everyone.
Maintenance therapy allows clients to stay connected to you as their therapist, though the frequency of their sessions will change. For many of my clients, I work gradually toward this as they meet their goals and their symptoms improve.
For example, those that see me multiple times per week due to the severity of symptoms would start to have sessions weekly. As improvements continue, sessions may happen every two weeks, then monthly, then perhaps spaced out even more.
The beauty is in the flexibility of this type of treatment. As clients improve, sessions will become more spaced out. If clients experience an increase in symptoms, life stressors, trauma, or life changes, they can return to more frequent scheduling. It is based on what the client needs at any given time.
If you are thinking that maintenance therapy sounds a lot like what you already do, you’re probably right. Client-centered treatment is oftentimes the most effective and this is at the heart of maintenance therapy.
Benefits of Maintenance Therapy
Choosing to continue to see clients rather than terminating treatment once they have met their initial goals can have a lot of benefits for clients. I am not suggesting that you pressure clients to remain in therapy longer than they would like or to see clients when it is not medically necessary. What I am encouraging you to do is take a hard look at what your client needs and whether maintenance is right for them.
The word “termination” can be powerful. When we talk to clients about ending treatment it can seem finite, no matter how much we may stress that they can return at any time. Leaving the door open by spacing out the frequency of sessions can be the most effective way to support your client’s recovery.
If we think about how attachment works, this can make a great deal of sense. When we feel that we have a safe base then it is easier to venture out, take healthy risks, and embrace growth. If your clients know they can maintain sessions with you, they may be likely to continue working toward their goals, use skills, and try new things.
Having regular sessions can also help to create accountability. Clients often report that this helps them to continue their journey toward growth and maintain healthy habits.
There are many additional benefits to maintenance therapy; these are simply some of the more common ones. While there are many benefits, it isn’t right for all clients.
When to Maintain
Continuing therapy isn’t the right choice for all. This is often most effective for clients with whom you have made a great deal of progress and have a good rapport. Clients that feel connected to you and have symptoms that are likely to return also benefit from this. For example, depressive symptoms tend to cycle. Having a strong therapeutic base is often essential for proper treatment.
Choosing maintenance is not always the best choice if you feel your client needs more to truly improve, though you either don’t know how to provide that or they simply don’t want to do it. This isn’t truly maintenance therapy– it may be more like delaying the inevitable. If you feel you are not the best fit for your client then it can be helpful to have an open discussion about this and assist them in finding a therapist who may be a better fit.
Maintenance may not be a good choice if your client is ready to terminate and is simply frightened to do so. This is especially true for those that have a hard time letting go and moving forward. In these cases, termination may be best. Clients can always return in the future if they need to, though successfully completing treatment may be part of their growth process. It is important to approach each client’s situation individually and find what is the best approach for them.
To Sum It Up
Maintenance therapy has a lot of benefits, though it is not for every client. Be sure to assess each client’s situation to decide what may be the best course of action for them. This isn’t different from treatment planning, however, it is an avenue we often fail to consider.
Termination or transfer aren’t your only options. Many clients benefit from maintenance. Explore what is best for your client’s recovery and challenge yourself to think outside the box. Allowing healthy, therapeutic attachment can make a world of difference.
Practice what you preach, my therapist friend. See you next time.
*If you are interested in becoming an independent contractor with CCS and you are a licensed therapist in North Carolina, send your cover letter and resume to the following email: Applicants@CarolinaCounselingServices.com
