"Endings in Clinical Practice is very interesting, well-conceptualized, and well-written. Its focus on theoretical perspectives on endings is particularly valuable because students often get caught up in the techniques of practice and lose sight of the importance of theory. The author's points are clearly developed and well illustrated with case examples from a variety of practice settings.”

- Irene Gutheil, Fordham University

"Joseph Walsh has produced a concise but thorough text which brings the topic of termination into full view… This text is useful to the beginning as well as the more seasoned practitioner."

-Marta Lundy, Loyola University Chicago

ENDINGS IN CLINICAL PRACTICE
Effective Closure in Diverse Settings

Second Edition

Joseph Walsh, Virginia Commonwealth University

Effective endings ensure that intervention gains continue after the therapeutic relationship ends. Joseph Walsh relates this critical topic to all practitioners through his use of diverse settings, detailed coverage of clinical endings, and extensive case illustrations that make the content concrete, practical, and accessible. Walsh takes a multi-setting and multi-theoretical approach to the often-overlooked topic of endings in clinical practice.

Endings in Clinical Practice is organized into three parts. The first part covers types of endings in clinical practice, both planned and unplanned; the importance of closure; and common endings tasks across fields of practice. Part Two outlines theoretical perspectives on endings especially pertinent to advanced practitioners. The final section considers a variety of specific clinical ending situations and the ways in which clients and practitioners may react to them.

 New to the Second Edition

• 10 new case studies
• Revised and expanded chapter on endings with families
• An exploration of client suicide
• Discussion on how children and adolescents experience clinical endings
• More material on the role of agency administrators in maximizing chances to experience positive endings with clients

Chapter 1:	Types of Endings The Importance of Closure Types of Endings Unplanned Endings Initiated by the Client Case Study: The Face That Will Never Look Old Case Study: The Jazz Pianist Unplanned Endings Initiated by the Practitioner Case Study: Out with a Bang Case Study: She Wouldn’t Pay Her Bill Planned Endings Case Study: The Priest Case Study: The Pushy Psychologist The Roles of Administrators in Clinical Endings Case Study: The Layoffs Summary
Chapter 2:	The Importance of Closure Understanding Closure The Power of Closure: Eight Illustrations Case Study: Bad Beginning, Better Ending Case Study: The Photo Collage Case Study: The Pregnant Therapist Case Study: From the Laundromat to the Park Case Study: A Spiritual Celebration Case Study: A Second Chance for Closure Case Study: The Lonely Hobo Case Study: The Grievance Summary
Chapter 3:	Tasks for Ending Deciding When to Actively Implement the Ending Phase Case Study: Pen Pals Timing the Announcement of One’s Leaving Case Study: What’s the Point of Continuing? Anticipating the Client’s and One’s Own Reaction Case Study: The Quiet Child Appropriately Spacing the Remaining Sessions Case Study: Jeremy’s Last Four Visits Shifting the Intervention Focus from “Inside” to “Outside” Reviewing Intervention Gains Generalizing Intervention Gains Planning for Goal Maintenance and Relapse Prevention Addressing the Client’s Remaining Needs Linking the Client with Social Supports Resolving the Clinical Relationship Formally Evaluating the Intervention (Process and Outcomes) Setting Conditions and Limits on Future Contact Case Study: The Client Who Wouldn’t Go Away Summary
Part 2 Theoretical Perspectives on Endings
Chapter 4:	Reflective Theories The Relationship of Theory to Practice Reflective (Psychodynamic) Theories Ego Psychology Transference and Countertransference Common Countertransferences Endings in Ego Psychology Object Relations Theory Endings in Object Relations Theory Case Study: The Distressed Wife Case Study: The Champagne Toast Existential Theory Endings in Existential Theory Case Study: A Midlife Crisis Summary
Chapter 5:	Cognitive-Behavior Theory Cognitive Theory Major Concepts Nature of Problems and Change Intervention Principles Preparing the Client for Ending Ending Activities Case Study: The Mama’s Girl Behavior Theory The Nature of Problems and Change Intervention Principles Endings in Behavior Theory Cognitive-Behavior Theory Case Study: The Boy with the Feeding Tube Case Study: The Aggressive Adolescent Summary
Chapter 6:	The Solution-Focused and Narrative Theories Social Constructivism Solution-Focused Therapy Major Concepts and the Nature of Change Assessment and Intervention Principles Endings in Solution-Focused Therapy Case Study: The Journalist Narrative Theory Major Concepts and the Nature of Chang Assessment and Intervention Principles Endings in Narrative Therapy Case Study: The Mountain Climber Case Study: Going to Disney World Summary
Chapter 7:	Family Theory Family (Emotional) Systems Theory Major Concepts Intervention Approaches Ending Family Systems Interventions Case Study: The Family Genograms Case Study: From Tension to Tranquility Case Study: The Empty Nesters Case Study: The Zeller Siblings Case Study: Kathy’s Three Parents Structural Family Theory Major Concepts Problem Development Intervention Approaches Ending Structural Family Interventions Case Study: Crowded House Case Study: Crowded House, Part II Case Study: Crowded House, Part III Case Study: Crowded House, Finale Case Study: The Family Drawings Case Study: A Mobile Home near the Woods Summary
Chapter 8:	Group Interventions Types of Treatment Groups Group Leadership across Stages The Ending Stage Label the Onset of the Ending Stage Help Members to Grieve Case Study: The Runaway Shelter Address Separation—Individuation Themes Case Study: The Wilderness Group Process One Member’s Departure Case Study: “I’m Outta Here!” Process One Practitioner’s Departure Resolve Unfinished Business Prior to the Final Meeting Case Study: The Family Education and Support Group Structure the Final Session Case Study: The Art Therapy Group Celebrate the Group’s Significance Case Study: The Multiple-Family Weekend Retreat Summary
Part 3 Endings across Service Settings
Chapter 9:	Client Reactions to Endings Positive Reactions Pride in Accomplishments and Increased Sense of Competence Increased “Real-World”Activity A New Capacity for Other Attachments Sadness Relief Case Study: No Time for Sadness Problematic Reactions Avoidance of the Topic Case Study: Where’s Jeannette? Denial of the Topic’s Significance Case Study: The Man in the Basement An Extreme Sense of Loss Case Study: The Anxious New Mother A Recurrence of Old Problems—an Introduction of New Problems A Request for Additional Help Case Study: The Practitioner as Consultant A Request for a Dual Relationship Missing Sessions or Abruptly Dropping Out Expressions of Anger Case Study: Battling Barbara Aggressive Acting Out Case Study: The Relief Counselor Testing the New Worker Factors Influencing Client Reactions Degree of Success or Satisfaction with the Intervention Case Study: Keeping the Customer Satisfied Context of Brief versus Long-Term Intervention Case Study: The Hot Chocolate Man Previous Experiences with Loss Case Study: The Business Cards Current Life Situation Case Study: The End-of-the-School-Year Blues Case Study: Miss Jeffers Meaning of the Clinical Relationship Case Study: The Life That Might Have Been Case Study: The Drone of Apathy Cultural Traditions Case Study: The Chef Case Study: The Apache Tear Usual Coping Style Case Study: Structured Worker, Avoidant Client Summary
Chapter 10:	Practitioner Reactions to Endings Positive Reactions An Enhanced Sense of Competence Pride in the Client’s Achievements Case Study: Ambivalence in the Relationship Sadness Case Study: The Hospice Family Problematic Reactions A Diminished Sense of Competence Guilt The Agency’s Role in Dealing with Client Suicides Case Study: The Suicide Avoidance or Delay Case Study: Death at the Nursing Home Offering Additional Contact Inappropriately Factors Affecting Practitioner Reactions The Practitioner’s Theory Base Case Study: A Couple in Conflict Ability to Plan for the End Case Study: An Annual Dilemma The Practitioner’s Attachment Needs Case Study: Fried Chicken and Warts How the Practitioner Manages Loss Case Study: The Funeral The Quality of the Client’s Life Case Study: The Diabetic Adolescent The Quality of the Practitioner’s Personal Life The Practitioner’s Job Satisfaction Confidence in Clinical Judgment Case Study: The Violent Wife Case Study: The Little Princess Summary
Chapter 11:	Additional Ending Activities Rituals Formal Service Evaluations Case Study: Can We Talk? Expressive Tasks Case Study: The Museum Status Elevation Ceremonies Case Study: Going Home Additional Ending Activities for Individuals Story Time A Walk in the Park Black Coffee The Invisible Gift The Tea Party Silk Cat in a Sewer: A Letter about a Premature Ending Additional Ending Activities for Families The Wake-Up Call Symbolic Objects Organizing Setbacks Sculpting Progress and Change The Family Consultation Letters to Families That Leave Intervention Prematurely Additional Ending Activities for Groups The Compliment Box The Review Sheet End of the Semester

About the Author
Joseph Walsh, (PhD, LCSW, Ohio State University) is professor of social work at Virginia Commonwealth University. He has been a direct services practitioner in the field of mental health since 1974, first in a psychiatric hospital and later in community mental health center settings. He continues to provide direct services to clients at the university counseling center and also at area shelters, clubhouses, and group homes. Professor Walsh was the 1998 recipient of the National Mental Health Association’s George Goodman Brudney and Ruth P. Brudney Social Work Award, given annually to recognize significant contributions to the care and treatment of persons with mental illness.

2007, Paper, 264 Pages, ISBN 978-1-933478-00-5, Price $32.95