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Termination of Counseling - Doorknob Statements

A ploy that is often used by clients who do not want to deal with an issue or challenge in their life is to reveal something pivotal or shocking in the last five minutes of a counseling session as he or she is getting ready to walk out the door of the office. This happens more often than you may think and can present the counselor with an interesting challenge. What is the appropriate way to handle this kind of revelation? Why did the client wait until the last five minutes to reveal this information, if it was so important? How should the counselor handle this information? The ability to consider appropriate responses and the best way to deal with this situation will give you another important skill to become an effective counselor.

Review the case studies below before completing the assignment.

case #1

David, a 15-year-old, has been your client for the last 2 months. He is struggling with his parents' recent divorce and has gotten into trouble skipping school. David has cut himself off from his friends and has been complaining of a variety of vague and unsubstantiated illnesses. You are working with him to adjust to these recent changes in his life. During your last counseling session, David appeared more withdrawn. For the past few weeks, you have attempted to work with David's mother to get him into a child psychiatrist for a medication evaluation to help him with some challenging symptoms. David finally has an appointment and will see the doctor next week. As your counseling session draws to a close, David thanks you for being his counselor. As he puts his hand on the doorknob to leave he says, "Don't worry about me, I won't be any problem anymore."

Case #2

Melissa is a 40-year-old woman who has recently lost her 20-year-old son who was a soldier in Iraq. She has always been a pacifist and has never harmed anyone in her life. She did not support her son joining the Army and his death has been very difficult for her to live with. She appears very angry in her sessions and spends most of her time in session ranting about the U.S. Government. This week, having recently received another letter from the military regarding her son's survivor benefits, she becomes enraged during her counseling session. At the conclusion of the session she says, "All I want to do is let the Pentagon feel my pain; they need to suffer like I am." Melissa, then, angrily storms out of the office.

case #3

Eva is 75 years old and has recently been diagnosed with a reoccurrence of cancer she had in her 50s. Despite this bad news, she has appeared positive in her counseling sessions even though she appears to have increasing pain and symptoms. The doctors have told her she cannot take any more radiation treatments, because she has met the limit she can take in her lifetime. Eva is taking a variety of pain medications to help her cope with significant pain. She is dealing with end-of-life issues in her counseling sessions and working through some unfinished business she has in her life. As she gets up to leave this counseling session she hugs you and says, "You have been the one bright spot in all these weeks, thank you for all you have done for me."

Case #4

Shawn is a 35-year-old male with whom you have worked for the last 18 months. He recently lost his job due to company downsizing. He is very talented and has a lot of experience. He does not think he will have a problem finding a new job but is upset that less talented individuals with more seniority were able to keep their jobs despite the fact that he had always received excellent evaluations for his work performance. Even though he believes he will find a new job, he is frustrated about his present situation. He reports that he spent a lot of time with his coworkers outside of work, and really enjoyed his job and the atmosphere. Shawn spends a lot of time talking about how much he misses everyone at work. As he leaves his counseling session he states, "Maybe if one of those idiots that still has a job has an unexplained accident they might beg me to come back."

Assuming that you are the counselor in each scenario, explain how you would respond to the client.
Describe at least one personal or professional challenge you think you would encounter when ending a session with a client who discloses a critical piece of information at the end of a session. Be sure to include specific steps you would take and why you would take them.

Solution Preview

(1) Assuming that you are the counselor in each scenario, explain how you would respond to the client.

Research suggests that the best way to terminate therapeutic sessions is to have a session planned for a wrap up to transition the client to the end of therapy (Joyce, Piper, Ogrodniczuk, & Klein,.2007). However, there may be times when session termination may cause tension when the client abruptly raises a question after the end of a session, "Statements made by clients at the very end of the session, as they are getting up to leave, or while they are walking out of the door, are commonly referred to as doorknob statements" (Sommers-Flanagan and R. Sommers-Flanagan, 2003, p. 161). They note that such statements may be prompted by several factors such as: (a) clients may still have anger, (b) experience disappointment, or (c) a number of other strong emotions at the end of a session.
In other words, the client may have unresolved feelings and may wish to continue the session with the doorknob question. In addition, according to Joyce et al (2007), in any therapeutic relationship there is some degree of patient dependence on the therapist. Thus in response to the following" doorknob statements", the response must be handled in a way that the client does not feel rejected or abandoned.

Case #1 - "Don't worry about me, I won't be any problem anymore."

In response to this client, first, an appropriate response would be to assure the client that he has not been a problem. Next, the therapist should inquire if there is anything further that David would like to discuss. His statement may indicate emergency intervention, as it could indicate a cry for help, and potential suicide ideation. The ...

Solution Summary

This solution describes cases in which a client is reluctant to end a counseling session or ends it with a revelation, and discusses the appropriate way to terminate the counseling process. 1144 words with 4 references.