17- Determining Therapeutic Process and Termination

Chapter 17: (pp. 369-394)

Key Answer: B. Including the child in planning for termination

Explanation: Child-centered play therapy emphasizes collaboration. Involving the child in decisions about how many sessions remain helps them prepare emotionally and fosters responsibility. Abrupt endings or focusing on the therapist’s needs can cause confusion or guilt.

Procedures for Ending the Relationship

Which of the following is the best practice when preparing a child for the end of play therapy?

A. Abruptly ending therapy to avoid difficult feelings
B. Including the child in planning for termination
C. Avoiding reminders about how many sessions remain
D. Emphasizing how much the therapist will miss the child

Key Answer: B. Because it may create feelings of guilt in the child

Explanation: The last session is the child’s time. If the therapist expresses personal feelings of missing the child, the child may feel guilty for not having the same thoughts or may take responsibility for the therapist’s emotions.

Emotional Reactions

Why should therapists avoid saying things like “I’m going to miss you” during the last session?

A. Because it shows the therapist is unprofessional
B. Because it may create feelings of guilt in the child
C. Because it reduces the significance of the relationship
D. Because children are too young to understand such statements

Key Answer: C. Expression of mixed feelings about ending the relationship

Explanation: Brad’s actions symbolized anger and resistance to termination, but also resolution when he carefully cleaned up. This reflected ambivalence—anger at separation but also readiness for closure.

Children’s Reactions

In the case of Brad, who dumped all the toys on the floor in the last session, what did his behavior most likely represent?

A. A desire to make the therapist angry
B. Regression due to immaturity
C. Expression of mixed feelings about ending the relationship
D. Testing whether limits would be enforced

Key Answer: B. The child may internalize the experience as punishment

Explanation: When parents stop sessions abruptly, children—especially if a difficult event occurred in the last session—may believe therapy ended because they did something wrong. This reinforces shame and confusion, making closure essential.

Premature Termination

What is the greatest risk if a child’s therapy ends suddenly without a termination session?

A. The child may lose interest in therapy forever
B. The child may internalize the experience as punishment
C. The child may forget the therapeutic gains made
D. The child may immediately seek another therapist

Key Answer: A. Reducing the frequency of sessions before ending

Explanation: Tapering (e.g., moving from weekly to bi-weekly sessions) or scheduling a follow-up session can help the child adjust gradually. Surprises or avoidance of discussion increases anxiety.

Termination Techniques

Which of the following is a recommended method for easing the transition out of therapy?

A. Reducing the frequency of sessions before ending
B. Extending sessions to make up for missed time
C. Giving the child gifts as rewards
D. Avoiding any mention of the end until the last day

Key Answer: B. Reflect the child’s actions and feelings symbolically

Explanation: Child-centered play therapy emphasizes reflection, not interpretation or correction. This allows the child to process their own meaning.

Symbolic Play

When a child uses toys to act out a situation (e.g., making a doll family move into a new house), the therapist’s main role is to:

A. Direct the child’s play toward healthy themes
B. Reflect the child’s actions and feelings symbolically
C. Ask the child to explain what the play means
D. Correct unrealistic parts of the play

Key Answer: C. Allow the play within safe boundaries

Explanation: Aggressive symbolic play is often a safe outlet for anger. The therapist permits expression unless it threatens actual harm. Stopping or redirecting too soon interferes with processing.

Handling Aggression Toward Toys

If a child “kills” a bop bag repeatedly during play and talks about cutting it up, the therapist should:

A. Stop the child immediately to prevent violent play
B. Interpret the behavior as trauma without waiting
C. Allow the play within safe boundaries
D. Redirect the child toward a calmer activity

Key Answer: C. Contact the parent to explain the importance of a termination session

Explanation: The therapist seeks to preserve closure by encouraging at least one final session. Avoiding action risks the child’s negative interpretation of the ending.

Premature Termination Response

If a parent suddenly discontinues therapy, the therapist’s first step should be:

A. Do nothing and wait for the parent to reach out
B. Immediately call the child to explain what happened
C. Contact the parent to explain the importance of a termination session
D. Mail a goodbye letter to the child

Key Answer: B. A celebration of the relationship and closure

Explanation: Children may express closure through symbolic celebrations, marking therapy’s end as a positive, memorable event.

Case of Lori

Lori decorated the therapist’s office with streamers and balloons on the last day of therapy. This likely symbolized:

A. Her desire to distract from sadness
B. A celebration of the relationship and closure
C. Avoidance of real feelings about termination
D. The therapist’s suggestion for a party

Key Answer: B. They give the child external structure and a sense of safety

Explanation: Limits provide security and predictability, allowing the child to explore freely within safe boundaries.

Rules and Limits

Why are rules (like session time limits or safety boundaries) important in play therapy?

A. They help the therapist stay in control
B. They give the child external structure and a sense of safety
C. They reduce the child’s freedom of expression
D. They keep sessions short so more clients can be seen

Key Answer: B. The child is showing both anger and resolution about termination

Explanation: Acting out and then restoring order is a common way for children to symbolically process ambivalence about ending therapy.

Scenario: Mixed Feelings

A child in the final session throws toys around the room but then carefully puts them away before leaving. What is the most likely explanation?

A. The child is testing whether the therapist will enforce rules
B. The child is showing both anger and resolution about termination
C. The child is trying to avoid future consequences
D. The child does not know how to behave in therapy

Key Answer: B. Internalization of therapy termination as punishment

Explanation: Abrupt endings can leave children believing therapy stopped because of their behavior. This highlights why planned closure is essential.

Scenario: Missed Sessions

A parent cancels several sessions without warning and then stops bringing the child altogether. Later, the child tells a teacher, “I think I was too bad, so I don’t get to see Dr. L anymore.” This illustrates:

A. Healthy independence
B. Internalization of therapy termination as punishment
C. Lack of interest in therapy
D. Miscommunication by the teacher

Key Answer: C. To help the child manage separation by knowing the relationship is not permanently closed

Explanation: Telling the child they can return communicates that the relationship is not lost forever and reduces anxiety about separation. It supports the child’s coping without avoiding the reality of ending.

Leaving the Door Open

Which of the following best reflects the purpose of the therapist telling a child, “You can come back if you need to in the future” during termination?

A. To reduce the therapist’s own anxiety about ending
B. To give the child permission to avoid feelings of loss
C. To help the child manage separation by knowing the relationship is not permanently closed
D. To delay the termination process indefinitely

Key Answer: C. To provide a supportive bridge for the child’s adjustment after ending

Explanation: A follow-up session is based on the child’s needs and provides support during the adjustment period after termination, not to satisfy the therapist’s curiosity or to restart therapy unnecessarily.

Follow-up Sessions

Why might a therapist schedule a follow-up session a month after the last regular play therapy session?

A. To check whether the child still remembers the therapist
B. To meet the therapist’s need for reassurance about progress
C. To provide a supportive bridge for the child’s adjustment after ending
D. To restart the therapy process if the child regresses

Key Answer: B. Range widely, from indifference to anger or clinging

Explanation: Children’s responses vary greatly—some may seem matter-of-fact, others angry, clingy, or openly expressive. The therapist should not assume or predict one fixed pattern.

Variability in Reactions

A therapist should recognize that children’s reactions to the last session:

A. Can be predicted accurately with careful observation
B. Range widely, from indifference to anger or clinging
C. Are always marked by sadness or crying
D. Depend primarily on the therapist’s behavior in the session

Key Answer: B. Because such comments may shift focus to the therapist’s needs rather than the child’s

Explanation: The final session belongs to the child. Comments that center on the therapist’s feelings may create guilt or confusion, shifting focus away from the child’s needs and emotions.

Last Session as the Child’s Time

Why should the therapist avoid comments like “I’ll miss you” in the final session?

A. Because it makes the therapist look unprofessional
B. Because such comments may shift focus to the therapist’s needs rather than the child’s
C. Because children do not understand emotional goodbyes
D. Because it prevents the child from expressing anger

Key Answer: C. It provides the child with a model for handling endings and loss in life

Explanation: A sensitive and structured termination process models healthy closure, teaching children how to cope with loss and separation experiences in other parts of their lives.

Termination as a Model for Healthy Endings

What is one therapeutic value of a well-managed termination process in play therapy?

A. It ensures the child never experiences sadness
B. It guarantees the child will not regress in the future
C. It provides the child with a model for handling endings and loss in life
D. It eliminates the possibility of premature termination