There will be occasions when a speech pathologist needs or wants to end the therapeutic relationship with a client. However, this isn’t an easy thing to do. Knowing how to do this in a professional way that doesn’t cause any distress for either the speech pathologist or the client can be quite challenging.

Why do therapeutic relationships end?

There can be many reasons why a speech pathologist considers that the therapeutic relationship needs to end. It may be because the needs of the client won’t be met by that speech pathologist and they should be seeing someone else who has the knowledge and expertise they require. It may also occur because the relationship has become strained or difficult and therefore it’s no longer effective. A speech pathologist may inform a client that services are not able to continue if there are concerns relating to safety, or because the client has not complied with their obligations, such as payment of outstanding invoices, or other practice/organisational policies that the speech pathologist has provided to them.

Speech pathologists need to know they can end a therapeutic relationship. In some cases it may not just be that they’re able to end the relationship, it may be something they must do as it’s in the speech pathologist’s and/or the client’s best interests.

Provision of speech pathology services within consumer directed models of funding/care can be challenging. A client may have expectations that will never be met by any speech pathologist, they may not have had much contact with any allied health services in the past and have limited understanding of ‘how it works’. A speech pathologist has an ethical obligation to provide all the information a client will need to understand their communication, swallowing or mealtime support difficulties and how speech pathology may be able to assist them to improve their function or support them. This may mean that information needs to be provided in a variety of ways, with frequent checks of the client’s understanding and support to develop a positive therapeutic relationship.

Communication is key to maintaining positive therapeutic relationships. A speech pathologist has an obligation to ensure they have provided information in a way the client can understand and has discussed any questions or addressed concerns in a professional and respectful manner. Sometimes however, this still does not result in the development of a positive and beneficial relationship and the speech pathologist must consider how to proceed.

Tips for ending a therapeutic relationship

• If there’s tension or conflict arising within the therapeutic relationship, discuss these with the client early. Not doing this allows problems to escalate which makes them harder to manage and de-escalate later. Managing these problems early also allows the speech pathologist and the client to potentially improve the relationship, meaning it may not need to end.

• Records should be made of any discussions with the client (this includes phone calls and emails) about difficulties within the therapeutic relationship and suggestions to end the relationship. Unfortunately, there will be occasions when the client is unhappy with ending the relationship and they may feel they’ve been treated unfairly. The speech pathologist should keep of record of all conversations had as evidence they’ve addressed all concerns respectfully and professionally.

• Reasons for ending the relationship should be provided to the client so they understand why this action is being taken. Understanding the reason is most likely going to lead to them being accepting of the decision. However, what information is provided is at the discretion of the speech pathologist. For example, if a parent is non-compliant with home practice, the speech pathologist should provide sufficient information for the parent to understand why home practice is important and the lack of progress if none is completed, however, stating that the parent is very difficult to work with may not assist that understanding.

• Provide the client with information regarding other speech pathology services available in their area, keeping in mind specific requirements or limitations the client may have, e.g. other practices that offer school/home/residential facility visits etc.

• If a referral to another speech pathologist is made, the specific reasons why this speech pathologist is being recommended should be explained, such as this person has specific skills which would better meet the needs of the client. When recommending that a client see a colleague for their specific knowledge and skill, the speech pathologist must have personal knowledge of the colleague’s expertise. Speech pathologists should refer to information about referrals in Speech Pathology Australia’s (SPA) Policy and Procedure Manual found on the SPA website. Speech pathologists are reminded that they will breach client confidentiality if they share reasons for ending the therapeutic relationship with the new treating speech pathologist. If there are specific concerns regarding the behaviour of a client or family members, speech pathologists should seek independent legal advice about what can or cannot be provided to the next clinician.

Support and assistance can be sought from Speech Pathology Australia, they can be contacted on 1300 368 835.

Ending therapeutic relationships in Speech Pathology