349 | When to End: Evaluating Client Readiness for Termination

0
00:00:00,460 --> 00:00:04,309
You're listening to the Play Therapy Podcast with Dr. Brenna Hicks,

1
00:00:04,469 --> 00:00:08,220
your source for centered and focused play therapy coaching.

2
00:00:08,550 --> 00:00:08,710
Hi,

3
00:00:08,770 --> 00:00:09,789
I'm Dr. Brenna Hicks,

4
00:00:09,800 --> 00:00:10,510
The Kid Counselor.

5
00:00:10,609 --> 00:00:12,590
This is the Play Therapy Podcast where you get

6
00:00:12,590 --> 00:00:14,979
a master class in child-centered play therapy

7
00:00:14,979 --> 00:00:17,219
and practical support and application for your

8
00:00:17,219 --> 00:00:18,969
work with children and their families.

9
00:00:19,270 --> 00:00:20,379
In today's episode,

10
00:00:20,989 --> 00:00:24,940
we are discussing client readiness to terminate.

11
00:00:26,250 --> 00:00:28,280
I've been getting this question a lot,

12
00:00:28,569 --> 00:00:31,520
and I know in the Art of the Session series,

13
00:00:31,850 --> 00:00:33,119
we walked through

14
00:00:33,490 --> 00:00:35,319
from the very beginning moment

15
00:00:35,610 --> 00:00:36,810
through the end of the session,

16
00:00:36,849 --> 00:00:40,520
but we did not walk through wrapping up with a family completely.

17
00:00:41,470 --> 00:00:43,250
We talk about this in coaching quite a bit,

18
00:00:43,560 --> 00:00:48,509
but I want to make sure that we have a sense of when natural termination

19
00:00:48,869 --> 00:00:50,000
should be occurring,

20
00:00:50,430 --> 00:00:52,779
and I suspect that many

21
00:00:53,400 --> 00:00:54,909
play therapists in general,

22
00:00:54,990 --> 00:00:56,709
not necessarily CCPTs,

23
00:00:56,750 --> 00:00:58,979
but I think many play therapists in general

24
00:00:59,310 --> 00:01:02,430
are having really high attrition rates and really early termination.

25
00:01:02,950 --> 00:01:06,169
And I suspect that's because of a lot of reasons,

26
00:01:06,529 --> 00:01:09,779
but we need to make sure that we are

27
00:01:09,779 --> 00:01:14,650
aware of when clinically speaking it makes sense to terminate

28
00:01:15,019 --> 00:01:18,650
and try to make sure that we provide the amount of time

29
00:01:18,650 --> 00:01:21,739
necessary for the child to address everything that they need to.

30
00:01:22,269 --> 00:01:24,870
So I want to make sure that we dive into that before we do,

31
00:01:24,959 --> 00:01:27,940
I want to just do a little reminder.

32
00:01:28,319 --> 00:01:30,269
Many of you have been reaching out and asking,

33
00:01:30,519 --> 00:01:31,599
where can I find out about this,

34
00:01:31,680 --> 00:01:32,790
where can I find out about this,

35
00:01:32,860 --> 00:01:36,639
and that's probably on me for not being more clear and more consistent.

36
00:01:37,169 --> 00:01:39,440
If you go to playtherapynow.com,

37
00:01:39,650 --> 00:01:41,720
that is the hub for all things

38
00:01:41,930 --> 00:01:42,879
CCPT.

39
00:01:43,330 --> 00:01:44,959
So you can sign up for the newsletter there,

40
00:01:45,129 --> 00:01:46,959
you can look into coaching programs there,

41
00:01:47,089 --> 00:01:50,400
you can find out about the CEUs through CoreWell,

42
00:01:50,569 --> 00:01:52,319
you can find out about upcoming

43
00:01:52,569 --> 00:01:54,720
live in-person conferences and,

44
00:01:54,730 --> 00:01:56,440
and speaking scenarios,

45
00:01:56,730 --> 00:01:57,260
all of that,

46
00:01:57,410 --> 00:01:58,620
playtherapynow.com.

47
00:01:58,779 --> 00:01:59,000
Sorry,

48
00:01:59,050 --> 00:02:00,190
I don't say that enough.

49
00:02:00,290 --> 00:02:00,690
OK.

50
00:02:01,230 --> 00:02:01,819
So,

51
00:02:01,830 --> 00:02:03,260
let's talk through,

52
00:02:03,510 --> 00:02:04,669
how do we know when a client

53
00:02:04,870 --> 00:02:05,660
should be terminating.

54
00:02:05,709 --> 00:02:06,180
Well,

55
00:02:06,629 --> 00:02:09,220
if we're following the child-centered process,

56
00:02:09,550 --> 00:02:11,740
which is every 5 sessions with the child,

57
00:02:12,350 --> 00:02:13,740
we're meeting with parents

58
00:02:14,080 --> 00:02:15,470
for a parent consultation.

59
00:02:16,160 --> 00:02:17,949
So we play 5 sessions,

60
00:02:18,080 --> 00:02:21,029
we schedule a completely separate consultation with parents,

61
00:02:21,320 --> 00:02:26,350
and then we determine whether or not we are going to do another round of 5 or whether

62
00:02:26,720 --> 00:02:30,470
we're satisfied with the progress and we're going to start wrapping up.

63
00:02:30,800 --> 00:02:30,990
Now,

64
00:02:31,000 --> 00:02:31,789
obviously,

65
00:02:32,119 --> 00:02:35,979
we would not be expecting to be in the we're ready to wrap up

66
00:02:36,240 --> 00:02:40,160
section of treatment until probably at least 25 weeks.

67
00:02:40,979 --> 00:02:42,410
Maybe even a little bit longer.

68
00:02:42,539 --> 00:02:43,250
We know

69
00:02:43,460 --> 00:02:49,710
the average based on meta-analytic data is 30 to 40 sessions with the magic number,

70
00:02:49,779 --> 00:02:50,300
if you will,

71
00:02:50,380 --> 00:02:51,369
being 37.

72
00:02:52,600 --> 00:02:54,149
So with that understood,

73
00:02:54,210 --> 00:02:55,880
if we're 10 sessions in,

74
00:02:56,250 --> 00:02:59,639
it is highly unlikely that the child is ready to wrap up

75
00:02:59,970 --> 00:03:05,119
and so part of it is understanding the average and understanding that

76
00:03:05,410 --> 00:03:06,960
we're in this for

77
00:03:07,169 --> 00:03:08,350
a longer duration.

78
00:03:08,410 --> 00:03:09,960
This isn't a six week

79
00:03:10,169 --> 00:03:11,240
kind of approach,

80
00:03:11,850 --> 00:03:13,289
but we also need to,

81
00:03:13,320 --> 00:03:14,410
as we meet with parents,

82
00:03:14,610 --> 00:03:15,970
get an assessment from them.

83
00:03:16,089 --> 00:03:17,690
How do they think things are going?

84
00:03:18,009 --> 00:03:20,199
do they feel satisfied with progress?

85
00:03:20,910 --> 00:03:23,149
Are they content with wrapping up?

86
00:03:23,320 --> 00:03:25,259
It's a collaborative discussion.

87
00:03:25,839 --> 00:03:28,669
If you believe that the client is meeting criteria.

88
00:03:28,720 --> 00:03:30,270
So then that leads us to

89
00:03:30,479 --> 00:03:33,440
how do we know when a client is meeting criteria.

90
00:03:34,429 --> 00:03:37,699
I filter through 4 considerations,

91
00:03:38,350 --> 00:03:40,070
and they are two clinical,

92
00:03:40,160 --> 00:03:41,419
two environmental.

93
00:03:41,550 --> 00:03:43,020
So the 1st 2 clinical.

94
00:03:43,970 --> 00:03:46,720
Have there been no new themes emerging

95
00:03:47,169 --> 00:03:48,169
in recent weeks?

96
00:03:49,259 --> 00:03:50,820
If a child has been

97
00:03:51,179 --> 00:03:52,889
consistent in the playroom

98
00:03:53,139 --> 00:03:56,289
and no new thematic play has been popping up.

99
00:03:57,110 --> 00:04:00,110
That is an indication that the child might be ready to terminate.

100
00:04:00,240 --> 00:04:04,229
The second clinical is of the persistent themes.

101
00:04:04,360 --> 00:04:07,229
So whatever themes the child is still working on,

102
00:04:07,479 --> 00:04:09,110
are there no shifts,

103
00:04:09,440 --> 00:04:12,160
no consistent or significant shifts

104
00:04:12,520 --> 00:04:13,330
in the theme.

105
00:04:13,440 --> 00:04:16,428
So if the child is continuing even toward the end

106
00:04:16,720 --> 00:04:17,390
to

107
00:04:17,600 --> 00:04:18,869
do self-esteem work,

108
00:04:18,880 --> 00:04:19,869
that would make sense.

109
00:04:19,959 --> 00:04:23,519
We would anticipate a child might continue self-esteem work all the way through.

110
00:04:24,059 --> 00:04:26,309
Are there no major shifts

111
00:04:26,600 --> 00:04:28,040
within the self-esteem work?

112
00:04:28,100 --> 00:04:29,239
It's pretty consistent.

113
00:04:29,320 --> 00:04:30,510
It's pretty stable

114
00:04:31,119 --> 00:04:34,750
and also that there are no new themes emerging at all.

115
00:04:34,959 --> 00:04:37,510
So if we can say yes to those two,

116
00:04:37,799 --> 00:04:40,010
then we would move to the environmental,

117
00:04:40,239 --> 00:04:43,220
which is regulation in all environments.

118
00:04:44,239 --> 00:04:44,760
At school,

119
00:04:44,820 --> 00:04:46,109
at home with you,

120
00:04:46,320 --> 00:04:47,869
with peers at church,

121
00:04:48,000 --> 00:04:48,869
at baseball,

122
00:04:49,160 --> 00:04:49,910
at

123
00:04:50,119 --> 00:04:53,230
the neighborhood cookout on the weekend,

124
00:04:53,440 --> 00:04:55,190
wherever the child is,

125
00:04:55,640 --> 00:04:57,750
the child is regulated

126
00:04:58,239 --> 00:05:02,079
in all environments and here's a little caveat

127
00:05:02,559 --> 00:05:03,049
if

128
00:05:03,320 --> 00:05:04,429
the parent says,

129
00:05:04,839 --> 00:05:05,040
well,

130
00:05:05,489 --> 00:05:06,230
everything is really,

131
00:05:06,279 --> 00:05:07,309
really good,

132
00:05:07,519 --> 00:05:09,910
we're just still having a lot of problems at school.

133
00:05:10,640 --> 00:05:10,799
OK,

134
00:05:10,920 --> 00:05:13,359
that's not regulation across all environments.

135
00:05:14,459 --> 00:05:18,220
So just because we have regulation in almost all environments,

136
00:05:18,510 --> 00:05:21,500
if there is still an environment in which the child is struggling.

137
00:05:22,410 --> 00:05:26,410
We can justify that the child may not be ready to terminate yet.

138
00:05:26,899 --> 00:05:27,929
So that's important.

139
00:05:28,059 --> 00:05:30,500
It's regulation across all environments and then

140
00:05:30,500 --> 00:05:33,989
that that lends itself toward more conversation because

141
00:05:34,260 --> 00:05:35,350
if it's just at home,

142
00:05:35,380 --> 00:05:36,309
for example,

143
00:05:36,579 --> 00:05:38,649
it might be a relational fracture

144
00:05:39,059 --> 00:05:40,829
in the parent-child relationship.

145
00:05:41,380 --> 00:05:42,649
If it's just at school,

146
00:05:42,899 --> 00:05:44,010
it might be

147
00:05:44,579 --> 00:05:47,529
a relational issue between the teacher and the child.

148
00:05:48,239 --> 00:05:50,869
So we need to start looking into,

149
00:05:50,920 --> 00:05:51,309
OK,

150
00:05:51,480 --> 00:05:53,750
can we pinpoint what might be creating

151
00:05:54,399 --> 00:05:56,070
the issue in that one

152
00:05:56,559 --> 00:05:57,510
still environment

153
00:05:57,679 --> 00:06:00,980
that has not seen the regulation that other environments have

154
00:06:01,320 --> 00:06:04,750
and then the fourth and final question that we ask.

155
00:06:05,510 --> 00:06:05,519
I

156
00:06:06,540 --> 00:06:11,380
are the original concerns for which the child was put into therapy?

157
00:06:12,459 --> 00:06:13,089
Are they

158
00:06:13,420 --> 00:06:14,410
reduced or resolved?

159
00:06:15,230 --> 00:06:16,920
So if the child was really anxious,

160
00:06:17,079 --> 00:06:18,390
has anxiety gotten better?

161
00:06:18,579 --> 00:06:20,049
If the child was really aggressive,

162
00:06:20,200 --> 00:06:21,549
has aggression gotten better?

163
00:06:22,089 --> 00:06:23,429
We're looking at

164
00:06:23,920 --> 00:06:26,359
how much have the concerns.

165
00:06:27,200 --> 00:06:28,399
Reduced or resolved.

166
00:06:29,529 --> 00:06:30,390
And so

167
00:06:30,700 --> 00:06:33,570
we need to evaluate the two clinical.

168
00:06:33,859 --> 00:06:35,760
We need the parents to evaluate

169
00:06:36,100 --> 00:06:37,809
the two environmental.

170
00:06:38,679 --> 00:06:42,339
And that's part of the discussion at the five-week consultation.

171
00:06:42,869 --> 00:06:44,549
And if everyone says,

172
00:06:44,910 --> 00:06:47,019
I think that the child's ready to wrap up.

173
00:06:48,809 --> 00:06:51,519
Then we begin the termination phase.

174
00:06:52,309 --> 00:06:53,970
And let me be really clear,

175
00:06:54,339 --> 00:06:55,760
we don't just say goodbye,

176
00:06:55,859 --> 00:06:59,220
just because the child has quote met goals.

177
00:07:00,579 --> 00:07:02,529
We have 4 phases

178
00:07:02,859 --> 00:07:04,380
and one of them is termination,

179
00:07:04,390 --> 00:07:05,489
that's intentional,

180
00:07:06,140 --> 00:07:09,130
just like we don't bypass the initiation phase,

181
00:07:09,380 --> 00:07:11,809
we also don't bypass the termination phase.

182
00:07:12,059 --> 00:07:13,850
So then we begin a countdown,

183
00:07:14,220 --> 00:07:17,970
we prepare the child for the ending of therapy.

184
00:07:18,140 --> 00:07:20,850
There's a lot that goes into that final phase.

185
00:07:21,579 --> 00:07:23,070
We need to help kids have a happy,

186
00:07:23,100 --> 00:07:24,010
healthy goodbye.

187
00:07:24,260 --> 00:07:26,059
We need to ensure that they have time

188
00:07:26,059 --> 00:07:29,100
to mentally and emotionally and psychologically prepare.

189
00:07:29,829 --> 00:07:32,100
For the ending of the therapeutic process,

190
00:07:32,549 --> 00:07:34,950
and we reassure them that it's never a forever

191
00:07:34,950 --> 00:07:37,220
goodbye and they can always come back and see us

192
00:07:37,510 --> 00:07:38,779
and all of those things,

193
00:07:38,950 --> 00:07:41,299
but it's still something the child has to process.

194
00:07:41,630 --> 00:07:44,029
So we give them time to do that and we're intentional.

195
00:07:44,350 --> 00:07:46,079
And then on the final session,

196
00:07:46,309 --> 00:07:48,589
it becomes a celebration and it's

197
00:07:48,869 --> 00:07:51,510
a hallmark moment for the therapist and the child

198
00:07:51,510 --> 00:07:54,260
and that's a really special final time together.

199
00:07:55,179 --> 00:07:56,589
But we can't get there

200
00:07:57,040 --> 00:07:58,470
until we're intentional

201
00:07:59,000 --> 00:08:02,950
about evaluating whether or not it makes sense to bring up termination.

202
00:08:03,600 --> 00:08:05,559
Every single time you meet with a parent,

203
00:08:05,570 --> 00:08:07,140
at every 5 weeks,

204
00:08:07,359 --> 00:08:08,779
you're going to

205
00:08:09,559 --> 00:08:14,029
Get a sense of whether or not parents still feel that things are a struggle

206
00:08:14,359 --> 00:08:18,869
or whether they feel like things have improved and they're pleased with the outcome

207
00:08:19,239 --> 00:08:22,850
that will give you a really helpful indication of whether or not

208
00:08:23,119 --> 00:08:25,510
you need to consider is termination appropriate.

209
00:08:26,000 --> 00:08:27,649
Sometimes parents are thrilled,

210
00:08:28,160 --> 00:08:29,190
sometimes parents will say,

211
00:08:29,260 --> 00:08:29,760
oh my gosh,

212
00:08:30,160 --> 00:08:30,760
everything's amazing.

213
00:08:30,839 --> 00:08:31,899
I think we're done,

214
00:08:32,159 --> 00:08:34,599
and you're seeing huge things in the playroom.

215
00:08:35,460 --> 00:08:39,299
So you would then advocate for the child that the child is not done,

216
00:08:39,539 --> 00:08:41,219
and we would not want to pull a child

217
00:08:41,219 --> 00:08:44,130
out of therapy right in the middle of significant work

218
00:08:44,429 --> 00:08:45,539
and thematic play.

219
00:08:46,750 --> 00:08:47,780
Other times

220
00:08:48,080 --> 00:08:51,260
we feel like things are actually really consistent

221
00:08:51,260 --> 00:08:53,090
and steady and calm in the playroom,

222
00:08:53,140 --> 00:08:56,979
and we think that maybe the clinical termination criteria has been met

223
00:08:57,219 --> 00:08:58,210
and a parent says,

224
00:08:58,380 --> 00:08:58,900
oh gosh,

225
00:08:58,979 --> 00:09:01,080
we're still having a ton of issues.

226
00:09:01,219 --> 00:09:01,900
This is happening,

227
00:09:01,979 --> 00:09:02,849
this is happening.

228
00:09:03,020 --> 00:09:03,500
OK,

229
00:09:03,659 --> 00:09:07,679
so then we're going to hold off on termination because we haven't

230
00:09:07,940 --> 00:09:10,140
reached the environmental criteria that we need.

231
00:09:10,929 --> 00:09:14,650
This is why this comes up in discussion in the consults.

232
00:09:15,520 --> 00:09:16,390
There's no

233
00:09:16,679 --> 00:09:21,190
random decision that's made on behalf of the therapist or the parent.

234
00:09:21,719 --> 00:09:21,919
OK,

235
00:09:21,960 --> 00:09:22,739
I think we're done.

236
00:09:23,739 --> 00:09:25,340
It has to be collaborative,

237
00:09:25,419 --> 00:09:26,479
it has to be intentional,

238
00:09:26,539 --> 00:09:27,739
it has to be thoughtful,

239
00:09:27,979 --> 00:09:30,809
and we can use those four questions as a guide.

240
00:09:31,260 --> 00:09:33,020
So I hope that that is helpful.

241
00:09:33,099 --> 00:09:37,250
I hope that that gives you a little bit of confidence in the process

242
00:09:37,580 --> 00:09:38,179
and

243
00:09:38,619 --> 00:09:39,419
keep in mind,

244
00:09:39,469 --> 00:09:42,260
I know I'm kind of going on a real quick tangent,

245
00:09:42,309 --> 00:09:43,340
but it's related,

246
00:09:43,380 --> 00:09:44,210
I promise.

247
00:09:44,739 --> 00:09:45,169
When

248
00:09:45,309 --> 00:09:48,809
we set expectations in the very first consult,

249
00:09:49,419 --> 00:09:50,929
that's how we help parents

250
00:09:51,200 --> 00:09:52,349
wait out the process.

251
00:09:53,030 --> 00:09:58,299
If we're not clear and articulate and confident and communicative in that first

252
00:09:58,580 --> 00:09:59,820
time that we meet with them

253
00:10:00,059 --> 00:10:02,940
and set expectations and help them understand the process

254
00:10:03,109 --> 00:10:04,900
and walk them through what they can expect,

255
00:10:05,030 --> 00:10:06,500
if that is missed,

256
00:10:06,909 --> 00:10:09,950
it's real hard to keep them signing up for 5 more,

257
00:10:09,960 --> 00:10:10,429
5 more,

258
00:10:10,469 --> 00:10:11,219
5 more.

259
00:10:11,750 --> 00:10:14,270
So this really comes back to we're talking about termination,

260
00:10:14,309 --> 00:10:17,739
but this actually comes back to the very first meeting we ever have with parents

261
00:10:18,010 --> 00:10:19,109
setting the stage.

262
00:10:19,770 --> 00:10:21,760
For us getting to the termination process.

263
00:10:21,929 --> 00:10:24,570
We don't want kids to get yanked 8 weeks in.

264
00:10:25,780 --> 00:10:27,780
We don't want kids to get yanked 12 weeks in.

265
00:10:28,669 --> 00:10:32,250
And it's up to us to make sure that we are being clear

266
00:10:32,659 --> 00:10:35,289
and that we are helping parents understand what's to come,

267
00:10:35,700 --> 00:10:38,940
so that they will trust us and trust the process and trust the model.

268
00:10:39,820 --> 00:10:44,400
And it all goes back to those early conversations as well as making sure

269
00:10:44,690 --> 00:10:46,840
that we can evaluate termination appropriately.

270
00:10:47,979 --> 00:10:48,179
All right,

271
00:10:48,299 --> 00:10:48,820
I love y'all.

272
00:10:48,900 --> 00:10:49,580
If you want to reach out,

273
00:10:49,739 --> 00:10:51,809
please do brenna@thekidcounselor.com.

274
00:10:51,859 --> 00:10:52,640
I'll talk to y'all soon.

275
00:10:52,780 --> 00:10:52,979
Bye.

276
00:10:54,150 --> 00:10:56,909
Thank you for listening to the Play Therapy Podcast with Dr.

277
00:10:57,070 --> 00:10:58,020
Brenna Hicks.

278
00:10:58,190 --> 00:11:00,179
For more episodes and resources,

279
00:11:00,270 --> 00:11:05,030
please go to www.playtherapypodcast.com.