Why the Last Sessions of Therapy Matter More Than You Think

Clinicians spend years learning how to assess, engage, and build a therapeutic alliance. Far less attention is given to how therapy ends—yet termination is one of the most clinically powerful and ethically consequential phases of treatment.

Darlene, a therapist in private practice says, “A former client ran into me years later and said, ‘I don’t remember everything we talked about—but I remember how therapy ended. That’s when I realized I could do hard things and survive them.’” Endings linger. They shape how clients integrate growth, carry insight forward, and remember the therapeutic relationship itself.

When endings are rushed or avoided, the risk of client harm increases—and so does professional liability. When endings are intentional and well-structured, they can consolidate gains, reinforce resilience, and model healthy separation.

The Hidden Ethical Risks of Poorly Managed Endings

Ending therapy is not a neutral administrative act. Ethical missteps most often occur at the margins: staying too long, ending too abruptly, or avoiding direct conversations about closure altogether.

One clinician we interviewed for our book “Letting Go of the Work You Love: A Workbook for Therapists to Prepare for Retirement, Close a Practice, and End a Career with Integrity”

described realizing—too late—that she had continued seeing a stable client for years out of mutual comfort. “We were both avoiding the goodbye,” she reflected. “When I finally named it, the client said, ‘I thought you needed me more than I needed you.’”

Failure to terminate can quietly foster dependency and blur boundaries.

At the other extreme, one therapist recalled ending treatment abruptly due to burnout, assuming the client would “be fine.” The client later reported feeling abandoned and destabilized. Premature termination, even when unintended, can fracture trust and undermine progress.

Planned vs. Unplanned Termination

Some endings are anticipated and collaborative; others arrive unexpectedly due to illness, crisis, relocation, or therapist retirement. Each requires a different clinical stance.

In planned endings, therapists can slow down and ask reflective questions: What has changed? What will you take with you? How will you know when you need support again? In unplanned endings, ethical practice often means clear communication, timely outreach, and thoughtful referral, rather than silence or avoidance.

Attachment dynamics often intensify here. Therapists commonly report unexpected emotions like grief, relief, and guilt that surface only as the end approaches. These reactions are not signs of failure; they are signals to pause, reflect, and act intentionally.

High-Risk Closures Require Extra Care

Ending therapy with high-risk clients demands particular attention. One therapist described working with a chronically suicidal client who reacted to termination by escalating distress. “Planning the ending took months,” she said. “But when it came, he said, ‘You didn’t disappear. You helped me land.’”

High-risk closures require proactive planning, coordination with supports, appropriate referrals, and meticulous documentation. Ethical care lies in neither disappearing nor over-functioning but in providing continuity, clarity, and containment.

Boundaries at the Threshold

Many clinicians recognize the “doorknob disclosure”—important material raised just as the session ends. One therapist described a client who waited until her hand was on the door to say, “I’ve never told anyone this before.” These moments often signal fear of separation or unfinished emotional business.

Ending well involves honoring the meaning of such disclosures while maintaining boundaries, naming their importance, and setting a clear plan for closure rather than impulsive extension.

Ending as a Healing Intervention

Termination is not simply the absence of therapy: it is an intervention in itself. Final sessions can include reviewing progress, naming strengths, and normalizing mixed emotions. Some therapists use summary letters or “future-self” reflections to help clients internalize the work.

As one client wrote to her therapist months later: “The way we ended therapy taught me that endings don’t have to mean abandonment. That lesson stayed with me.”

Ending well is not an afterthought. It is a clinical skill, an ethical responsibility, and a final opportunity to reinforce healing—for clients and clinicians alike.

Want to read more? See Letting Go of the Work You Love: A Workbook for Therapists to Prepare for Retirement, Close a Practice, and End a Career with Integrity by Lynn Grodzki and Margaret Wehrenberg (PESI 2025).