Case Presentation: Termination Skills

Basic Data

Client Demographics 

The client selected for this presentation will be referred to as Marcus to protect his identity. Marcus is a 33-year-old African American male who identifies as male and uses he and him pronouns. He comes from a lower socioeconomic background and is currently unemployed, which he noted as one source of his stress: Case Presentation: Termination Skills.

Marcus completed high school but did not pursue higher education due to early substance use and imprisonment in his twenties. He seeks to build a more stable life and is interested in getting his general educational development and pursuing trading.

Presenting Problem

Marcus presented to counseling at Serenity Recovery Centers following a court-mandated referral due to a second driving under the influence (DUI) charge within five years. He stated that he initially did not feel he had a problem but began questioning his substance use after losing contact with his daughter and facing possible jail time. While he was resistant at first, he shared during the intake session that he wanted to make changes to stay out of jail and possibly regain custody of his daughter. His presenting problem is centered around substance misuse, strained family relationships, and low motivation.

Social Context

In our initial conversation, Marcus described a strained relationship with his family, particularly with his mother and younger sister, with whom he used to live. He has a four-year-old daughter but has not seen her in over a year due to a protective order filed by the child’s mother. He stated that he has no close friends and often feels isolated.

Marcus admitted that his former peer group consisted of individuals who also misused alcohol and drugs, which contributed to his behavior. He feels unsupported and is uncertain about rebuilding trust within his social circle.

General Impressions of the Client

Marcus presented generally untidily but was alert during the first session. He wore wrinkled clothing, had minimal eye contact, and seemed fatigued. His mood was subdued, and he often answered questions in a flat, almost detached tone, suggesting possible depressive symptoms. His effect was restricted, and while he did not express strong emotions verbally, his body language indicated discomfort.

He initially appeared guarded but gradually opened up as rapport was built. Marcus is a voluntary client who agreed to attend sessions to comply with court requirements, though his motivation for personal change is slowly emerging.

Termination Skills

Session Summary

During one of the past sessions, Marcus discussed an argument he had with his sister about their past behaviors while they were together. Marcus started the session by complaining that she had stopped talking to him and felt she was giving up on him. He expressed a feeling of guilt over previous arguments and alcohol and drug use but then went back to being defensive when addressing the incident. Later in the session, Marcus also expressed that he missed his daughter and asked whether she would even know him.

He was quiet and emotionally withdrawn but could say something short that showed conflict, like, “Maybe I do not need another chance.” At the end of the session, Marcus was exhausted and inquired whether individuals changed.

This session showed some common themes in Marcus’s storyline, including guilt and shame. His conversation demonstrated a conflict between his aspiration to change and feelings of worthlessness. There was also a pattern of blame-shifting, followed by insight, and then withdrawal into defensiveness.

These emotional shifts indicate an unresolved grief manifestation and unfinished trauma connected to family rejection and parental inability. This underlying process was related to a particular argument with his sister and broader themes of rejection and fear that he might be unlovable.

Substantially, the distinction between the content and process of this session is what was spoken about and what was underlying. Although Marcus allegedly discussed external conflicts, the process revealed his insecurity and fear of emotional connection. This resistance was not mere defiance but self-defense. This awareness made interventions more emphatic, which led Marcus to acknowledge that emotional security comes before behavioral shift.

Ending the Next Session with Intention

During the following session, I applied the structured termination process by placing a visual timer and keeping track of time unobtrusively. At 45 minutes, I faded softly by providing a verbal transition:” We are approaching the end of this talk in a few minutes.”

I offered a session summary through reflection, saying, “Today, you took time to discuss the burden of guilt related to your relationships and how it is serving to destroy your future.” I did not bring up any new issues, but I asked Marcus what he would carry away with him after this discussion. He told me that he was tired but also heard, which was emotional despite his previous guarded nature.

I learned the power of pacing and how minor clues can help establish structure in a way that does not interfere with the therapeutic relationship. The fact that I did this intentionally allowed Marcus to navigate the session’s emotional heaviness without feeling vulnerable. I observed that the structure helped me maintain my emotions and gave Marcus a sense of predictability. This aided in the strengthening of therapeutic safety and provided me with a more solid mindset of the regular, respectful ending of the sessions.

Evaluating Client’s Readiness for Termination

Evaluating the notes of the sessions and treatment plan of Marcus, he is getting closer to being ready to terminate. His first objectives were to avoid drinking alcohol, create a plan to get a General Educational Development (GED), and restore trust within his relationships. During a few sessions, Marcus has been drug-free for over 30 days, taken a GED preparation course, and sent a letter to the mother of his daughter requesting to see her under supervision.

These are quantifiable indicators of improvement in line with his goals. Significant increases in self-awareness, participation, and defenselessness are evident in session notes, indicating valuable inner change (Klussman et al., 2022). His initial passivity has been transformed into more purposeful planning, which justifies the consideration of termination.

Supervisor Consultation and Conclusions

Having assessed Marcus’s progress, I discussed this with my site supervisor to determine the suitability of termination. I observed that Marcus had been steadily meeting treatment goals and showing increased independence and clarity regarding his plans. The supervisor acknowledged that Marcus had made significant progress, particularly in terms of emotional intelligence and self-management. His willingness to analyze his past decisions without falling into a shame spiral was mentioned, and this demonstrates his readiness to terminate the counseling sessions.

However, another consideration was raised by the supervisor: whether Marcus would respond better to booster sessions or a step-down model featuring monthly check-ins. This input helped expand my perspective beyond achieving goals and considering long-term sustainability. In unison, we decided that though Marcus could initiate termination preparation, a phased exit would serve him well. We decided to start discussing termination during the upcoming sessions to normalize the process and allow Marcus to reflect on his progress.

We shared general views, but my supervisor paid much attention to relapse prevention and continuity of care, whereas I was concerned with goal attainment. This demonstrated how clinical decision-making benefits from multiple perspectives (Masic, 2022). It was helpful to think about the termination process not as a final stop but as a continuum of care. By framing termination as a transition rather than closure, the process becomes more empowering for the client.

Some clear signs indicating readiness to terminate included Marcus verbalizing pride in his progress, initiating discussions about plans without prompting, and exhibiting emotional regulation under challenging conversations. Conversely, minor signs suggesting ongoing care may be helpful, including occasional lapses into self-doubt and continued estrangement from some family members. These nuances support a collaborative plan for step-down termination.

Case with Limited Progress

Although Marcus has achieved significant improvement, not every client in my caseload has developed at a similar rate. With one of them, known here as Jane, there has been little progress despite regular attendance. Jane is a 42-year-old woman with issues of alcohol consumption and unresolved grief as a result of the death of her spouse.

Even after seven sessions, she does not use any of the coping strategies discussed and dwells on the same traumatic experience. Every session is emotionally monotonous and holds nothing new, which poses a question of stagnation.

The initial aim of treatment of Jane was to decrease alcohol consumption and work on grief processing. First, she was willing to utilize mindfulness strategies and agreed to keep a journal between sessions. This pace, however, lowered rapidly, and she has become detached emotionally, often giving ambiguous answers.

She complains that nothing is changing and refuses to participate in therapeutic exercises. Her present state signifies emotional flatlining where little action of change is being undertaken.

Ambivalence has been a significant setback in the case of Jane, and it has made her unable to participate in the therapeutic process fully. Although she often complains about being annoyed and tired of her current emotional state, she, at the same time, is also worried and hesitant to leave her grief behind, which she keeps closely connected with the memory of her deceased partner. This internal dispute seems to form a pattern in which emotional suffering becomes the undesired yet needed to sustain the connection with her loss.

Moreover, her problems are exacerbated by external conditions; Jane does not have suitable housing and often does not attend community recovery meetings because of unpredictable transportation. A combination of all these structural and psychological obstacles has probably led to her stagnation in the therapeutic process and her inability to implement coping strategies that have been addressed in therapy sessions.

In reflection, I noticed early on that there was a sign that Jane might progress slowly. She used to avoid eye contact, did not do her homework, or limit her substance use, even when such use had noticeable consequences. I interpreted this as typical resistance, but it was more a matter of ambivalence and perhaps unresolved trauma that needed to be addressed for change. I found considerable repetitiveness in the themes when I reviewed Jane’s session notes, and very little was added.

Although the emotional quality has been the same, the material has been fixed. This implies that the sessions offer emotional support but may not lead to therapeutic breakthroughs (Drageset, 2021). Perhaps it is time to discuss with my supervisor whether the methods need to be changed or whether sending Jane to a grief specialist is wiser.

Conclusion

To sum up, case termination is a delicate and ethically significant stage of counseling that should be approached carefully, clearly, and with the client’s active cooperation. In the case of Marcus, the willingness to terminate is backed by regular goal accomplishment, emotional sensitivity, and independence. By providing planned session management and supervision consultation, a transition plan can be formulated rather than an abrupt closure (Rockville, 2021).

Meanwhile, reviewing stagnant cases reminds counselors to reassess their solutions and consider possible changes or referrals to accommodate the client better. After all, effective termination should demonstrate both clinical and profound respect for the client’s willingness to grow outside of the therapy space.

References

Drageset, J. (2021, March 12). Social support (G. Haugan & M. Eriksson, Eds.). PubMed; Springer. https://www.ncbi.nlm.nih.gov/books/NBK585650/

Klussman, K., Curtin, N., Langer, J., & Nichols, A. L. (2022). The importance of awareness, acceptance, and alignment with the self: A framework for understanding self-connection. Europe’s Journal of Psychology, 18(1), 120–131. https://doi.org/10.5964/ejop.3707

Masic, I. (2022). Medical decision making – An overview. Acta Informatica Medica, 30(3), 230–235. https://doi.org/10.5455/aim.2022.30.230-235

Rockville . (2021). Part 1, Chapter 1, Clinical Supervision and Professional Development of the Substance Abuse Counselor. Nih.gov; Substance Abuse and Mental Health Services Administration (US). https://www.ncbi.nlm.nih.gov/books/NBK64848/

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Unit 8 Assignment: Case Presentation – Termination Skills
This is your final case presentation assignment. You will be discussing case termination in your clinical group supervision session this week. You will focus on the aspects of case termination. Case termination differs from terminating the session.

There are many things to consider when determining whether a client’s case should be terminated. Clients may make that decision as well. Sometimes this determination may be mutual. Sometimes, clients are resistent due to the familiarity of the relationship and they have become attached.

There may be some “transference” present. Complete the narrative on case termination. Work with your site supervisor to identify an appropriate case to complete this assignment.

See the attached document for complete instructions and grading rubric.

Notes:

• field experience site:
  • Name of Agency: Serenity Recovery Centers
    • Full address: 1094 Poplar Avenue Memphis TN 38105
    • Website:serenityrecovery.org