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Guidance from APA’s Ethics Code about how to ensure a safe transition for your patients — and yourself.

Closing your practice — whether because of retirement, moving or any other reason — is a big deal for you. It’s also a big deal for your patients, says Christine Courtois, PhD, who closed her Washington, D.C., practice in 2016 when she retired.

For some patients, the closure prompted memories of childhood abandonment. Others worried they had done something to make Courtois quit. Some simply refused to believe she was leaving despite repeated reminders.

Before you shut down your practice, review APA’s Ethics Code and this advice from other experts:

  • Notify current and would-be patients. Courtois gave her patients six months’ notice of her retirement. If you’re still taking on new patients after you’ve decided to close, be transparent, adds private practitioner Denise Davis, PhD, of Nashville, who has given workshops based on her book "Terminating Therapy: A Professional Guide to Ending on a Positive Note." If they need more help than you can provide during that timeframe, she says, “you can still help people by directing them to alternate resources.”
  • Give patients enough time to process the change. Standard 10.10 (c) of the APA Ethics Code (PDF, 273KB) states: “Except where precluded by the actions of clients/patients or third-party payors, prior to termination psychologists provide pretermination counseling…” “That means taking into consideration their reaction and what their needs for continuation might be and making a judgment about how much time is going to be needed to process that,” says Davis, who’s also an associate professor of the practice of psychology at Vanderbilt and director of professional affairs at the Tennessee Psychological Association. While this kind of wrapping up discussion will be straightforward and brief for many patients, she says, others may need more time make sense of the upcoming changes.
  • Offer referrals. Standard 10.10 (c) also requires that psychologists: “…suggest alternative service providers as appropriate.” It is generally good practice for practitioners to offer patients some appropriate alternatives when they stop practicing. This helps patients maintain continued access to care and also provides you an opportunity to potentially help more junior psychologists grow their businesses, says Davis. And even though Courtois’s practice is closed, her website offers resources that can help would-be clients find practitioners to suit their needs.
  • Maintain good self-care practices. Self-care is one of practitioners’ ethical responsibilities, says Davis, noting that mistakes in practice are more likely to happen when psychologists don’t take care of themselves. As you wind down your practice, she suggests, reflect on your work, take stock of what you’ve accomplished and plan for your future. You might want to keep your license in case you pursue volunteer work that requires it, for example.
  • Decide how you’ll handle future contact. At the last sessions, Courtois gave patients cards with notes “memorializing the work we had done together.” She also allows some continued contact with previous patients while making it clear she is no longer acting in a therapeutic capacity. Former clients now write to ask questions or report successes. 

This article is the fourth in a series of columns focusing on closing a practice. Subsequent articles will focus on financial, legal and other issues.

Date created: July 2019