A lot of therapists lately have been asking me when they should fire a client. First, let me just say that I rarely fire clients and it’s something I take very seriously. Also, a therapist should not fire a client like they would fire an employee. You should be sensitive to the client’s feelings at all time and minimize harshness as much as possible. It’s not about “getting rid of someone bad”. It’s about helping them get a therapist that’s better suited for them. In other words, you shouldn’t fire a client to help yourself, you should fire a client to better serve the client. I also feel that a lot of firings could have been avoided by better screening the client before you agree to work with them. Ask the client why they are seeking therapy and be certain to ask them questions specifically having to do with issues that you’ve found you’ve had difficulty dealing with in the past. I’ve found that you can usually tell just within a 30 minute phone call whether it’s going to work out or not. That being said, here are some guidelines I’ve created to help you determine if you should fire a client or not. Of course, final judgement in this matter should be between you and your supervisor.
1. You are not licensed to treat their issue: For example, I am a LMHC. My license allows me to treat a variety of conditions, but substance abuse is not one of them. If I discover during the course of treatment that a client has a drug issue, I will transfer them to a therapist that specializes in substance abuse issues. This also includes issues that our outside my expertise and scope of practice.
2. The client is not making progress with you and is unlikely to in the future: Sometimes we just don’t click with a client. Despite our best efforts, they just don’t get better and most likely they will never get better under our care. Perhaps this is because the client is uncooperative or highly resistant to therapy. Perhaps it is because we just don’t have enough expertise for their particular issue. If it seems likely that the client will not improve under our care, it is unethical to continue working with them.
3. The client or a client’s associate puts you in danger: A few years ago a therapist in Attleboro, MA was killed by a client’s girlfriend because she thought the therapist was trying to break them up. If a client or your client’s associate makes you feel threatened, you should fire the client. You’re a therapist, not a police officer. There is no reason why you should put yourself in harm’s way. This is the reason why I will not work with anyone in a domestic violence situation.
4. The client cancels or no-shows excessively: I have this written explicitly in my office policies. How much is excessive? That depends on you. I have no set number of cancellations that I go by, but if it feels excessive to me, it is. If a client is missing sessions, they are not receiving good care. It is also not fair for anyone on your wait-list.
5. The client crosses boundaries: If you have set boundaries with the client but they repeatedly break them, it may be time to let them go. In order for therapy to work, it requires a few things: open and honest communication, mutual respect, and professional boundaries. If a client can’t or won’t do those things, therapy simply wont work and it would be unethical to continue with the client.