1. Addressing Premature Termination in Play Therapy
Amy Ray LPC, NCC, Registered Play Therapist

2. Objectives
Increase knowledge of common reasons for premature termination of play therapy
Develop strategies in play therapy to help prevent premature termination
Learn ways to address premature termination in play therapy

3. Phases in Play Therapy

4. Components of Termination Phase
Process feelings related to therapy ending
Relapse Prevention (take home item?)
Celebration of Achievements

5. Why is the Termination Phase Important
Association for Play Therapy Best Practices
Value of the Therapeutic Relationship (Gil & Crenshaw, 2016)
Modeling
Encourages Autonomy
Relapse Prevention
Avoid Misinterpretations

6. Somewhere between 40 to 60% of children stop therapy too soon
Somewhere between 40 to 60% of children stop therapy too soon. (Gil and Crenshaw, 2016)

7. Individuals that Can End Therapy
Guardians
Client
Therapist

8. Common Reasons for Early Termination
Unmet Expectations
Previous History with Therapy
Lack of Investment in Child’s Therapy

9. Common Reasons for Early Termination
Limited Resources
Prevention Strategies
Time
Money
Transportation
Help the family understand the time commitment at intake
Be aware of your policy regarding financial hardships & free or reduced services in your area
Be familiar with transportation assistance for appointments

10. Common Reasons for Early Termination
Moving too quickly or Moving too slow

11. Common Reasons for Early Termination
Changes
Relocation
Change in custody
Behavioral concerns might increase before improving

12. Common Reasons for Early Termination
Disclosure Remorse

13. Common Reasons for Early Termination
Transference and Countertransference
Client
Therapist
Transference
Countertransference

14. Common Reasons for Early Termination
Resistance
Fear of change
Fear of vulnerability
Lack of understanding play therapy
Lack of trust
Feelings of inadequacy
Cultural differences

15. Reframing Resistance
View as ambivalence, uncertainty, hesitancy, and reluctance (Gil & Crenshaw, 2016)
Understand reasons the client may be guarded or hesitant in participating in therapy
Loss of control, need for predictability
View resistance as a part of the process (Van Fleet, 2000)

16. Activities for Reluctant Clients
Three Doors (Crenshaw)
Heart Symbol Strategies (Crenshaw)
Magic Key (Crenshaw)
Role Reversal
Helping the therapist help others

17. Guardian Initiated Potential Reasons
Therapy isn’t meeting their expectations
Change in custody
Relocation
Time constraints
Financial difficulties
Transportation
Cultural differences
Lack of understanding about therapy process and/or play therapy
Previous history with therapy
Caregivers not engaged in or threatened by the therapy process

18. Guardian Initiated Prevention Strategies
Address caregiver expectations at first appointment
Educate about the process of play therapy and what play therapy is
Involve all guardians in child’s therapy when possible
Advocate for at least one termination session
Explain therapy as a commitment
Know your policy for handling financial hardships
Know resources for reduced or free services
Note and monitor any barriers to treatment
Try to understand the family’s values and cultural background
Understand some hesitance is part of the therapeutic process

19. Client Initiated Therapy not meeting their expectations Death
Child or Adolescent is hesitant or “resistant” to therapy

20. Therapist Initiated
Code of ethics prohibit therapist from abandoning clients (ACA Code of Ethics & Association for Play Therapy Best Practices)

21. Therapist Initiated Situations Ideal Response Change in employment
Relocation
Health Concerns
Death
Know options you can present to the client to continue treatment
Have notes and treatment plan up to date
Transition sessions with new therapist
Assigned custodial of records

22. When Abrupt Termination Occurs
Contact family or client if adolescent by phone to check in
Advocate for one session to review/terminate
Offer referrals
Termination letter
Look for closure for yourself (Gil and Crenshaw, 2016)

23. References
Gil, Eliana & Crenshaw, David. (2016). Termination Challenges in Child Psychotherapy
Association for Play Therapy Best Practices: ns/Best_Practices__- _Sept_2016.pdf?hhSearchTerms=%22best+and+practices%22