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Ending the Therapeutic Relationship: Creative Termination Activities



Termination is a highly important part of every therapeutic relationship that should be addressed throughout each stage of the process.  While many adult clients have the ability to easily think back to their experience in therapy, for youth this is often more difficult.  Because of this I like to provide clients with some sort of physical representation of their time in therapy that will help them reflect on their experiences, highlight their strengths, remind them of what they learned and provide them with tools they can use to help prevent regression, and even continue their progress on their own.

These activities let you both reflect on their time in therapy and transition out of services in an engaging way. I’ve also found that using metaphors often helps young clients to better understand termination and makes after-care instructions more salient.  Below are some ideas for creative termination activities that are easily adaptable to fit your clients’ needs. I am not sure of the origins of all of them, so please let me know if there is someone that I should be citing.

Session Trackers


I recently spoke to an intern who was confused when a number of her clients seemed surprised when it came time to terminate, despite her verbal reminders.  It is sometimes helpful for young children to be able to have a visual representation of how many sessions are left, and it can help them better prepare for termination.  One way to do this is to create a session-tracking chart.  In the examples above clients color in one image, or choose a sticker, at the end of each session.  The activity is quick and also provides a good opportunity for therapists to check-in with clients and help process any feelings surrounding termination that come up throughout the process.

Ready to Set Sail: Termination Activity

sailing off

By Jodi Smith, LCSW, RPT-S at “Play is Powerful”

Supplies: Toy boat, paper boat, paper mache boat, box with a boat drawn on it, etc.


  • I’ve found that the use of metaphors increases the amount of information that clients retain and internalize so I use them frequently in termination.  Start by explaining to the client that because of the progress they have made they are ready to sail off on their own.
  • Reflect on what that feels like and process any anxiety, and transition into talking about all the things they will “take” with them to help with their journey.
  • Have the client answer each question and write their response on the back of the cards.  The boat will contain cards related to tools they will take with them (supports, coping skills, etc.), things that may get in their way and strengths (as identified by the client and therapist).  Along with my pre-made cards, I also give them blank ones.

Treasure Chest Termination Activity


Supplies: Treasure box (Michaels Crafts has wooden “treasure” boxes  that are cheap and easy to decorate.  A link to directions on how to make a paper one can be found here; Stick-on plastic jewels (found at crafts stores, oriental trading co., etc.); Small note cards (cut to fit the box); Pen.

Directions: First, have your client decorate a treasure chest.  Then stick a jewel to each card as your client writes down the “task” that is assigned to that specific color (see below).  On the back of the card they include a specific example of how what they identified has helped them in the past and/or how it will help them in the future.  Below are examples of possible color codes, but you should change them to meet your client’s specific age and needs.  In the end the chest will be full with a stack of jeweled cards.

  • Blue: Strengths (Identified by both the client and therapist)
  • Red: Coping skills
  • Green: Supportive people in their life
  • Orange: Resources from therapist (ex. hotline numbers, therapist referrals or directions for reenrolling in services.)
  • Purple: Self-care activities
  • Pink: Inspiration (future goals, motivational quotes, etc.)
  • Yellow: Things they have learned in therapy

 Suitcase Termination Activity


At termination, your client is finally ready to continue their journey on their own.  Even though they will be leaving you behind, they can pack up everything that they have learned during their time with you to take with them.  This metaphor is easy for most people to identify with and it is a fun activity.

Supplies: Plastic or cardboard suitcase; Blank sticker labels; Paper luggage tag; String; Cards; Travel stickers.

Goals: Process termination; Provide transitional object; Help prevent regression; Identify accomplishments, goals, coping tools, etc.


  • Have your client make and/or decorate their suitcase.
  • Then they write something they will “take with them” from their time in therapy on each card provided (I print cards with travel clip-art on the back).  This can be things they have learned, coping skills, supports, resources etc.
  • You can also integrate this with the after-care kit I posted.
  • On the labels they write or draw goals they have accomplished.  (Like the old suitcases in movies that are covered with stickers of past travels).  I also provide additional travel stickers.
  • On the luggage tag they write where they are going next.  This could be a new life stage (ex. my 8th graders usually write “high school”) or a goal they would like to accomplish that the contents of the box will help them achieve on their own.
  • Process feelings about termination throughout the activity.

Therapeutic Goodbye Cards


This is such a simple, yet powerful termination activity.  I got this idea from a client who gave me a very touching thank you note during our last session.  It is something I have kept and reflect back on, and i realized that it could potentially play a similar role for a client.

  • The focus of the content is on the journey through therapy and what has been accomplished.  I highlight strengths, review coping tools and lessons learned, and express my thoughts about termination. At the end I usually include instructions of what to do if they decide to enter therapy again.  You could also have the client write a letter to their future self that they can read when they are struggling.

Summer Bucket List


I put a therapeutic twist on this summer craft.  Most school therapists are unable to see clients throughout the summer but may pick up treatment again during the following school year, which is not ideal.  This activity can help encourage adherence to after-care recommendations.

Directions: Have your client design a bucket that will help them to continue your work together on their own and prevent regression.  On the back of the paper bucket they can write goals for the summer, self-care activities, etc.  For the 3D buckets these can go on cards placed inside the bucket.  On the shovel they write down “tools” that will help them to accomplish their goals (social supports, coping skills, resources, etc.)

You’ve Got Mail: Group Termination Activity


Directions: First, have your clients create their own paper mailbox.  Then, each person, including the therapist, writes a short note to every other member of the group.  You can instruct them to write something that they have gained by knowing that person, a strength they can identify in that person, a motivating message, etc.  The notes are then placed in the mailboxes for the group members to take home.



Certificates are very simple to create in programs like Word, Pages, etc. and are a good wrap-up for clients who have worked hard to meet their therapeutic goals.  In my example I left space to write specifics about progress, accomplishments, reflection, etc.  One the last group session we have a “graduation party” where we have fun, reflect on our time together/progress made and process termination.  They are then presented with their certificate.

The Creative Social Worker is a child and adolescent mental health therapist with special interests in trauma, play therapy and school social work. Her blog is dedicated to sharing interventions, resources, and activities with mental health professionals, as well as raising awareness about the social work field and assisting prospective MSW students with graduate school applications.

Beth Crane Palumbo says:

Terrific activities! Thanks for sharing!

After spending 7.5 years in therapy myself -initially catapulted by crisis, then choosing to remain for personal growth- our closure was great. So, in this respect, I was blessed.

Jamie Dvorak Jamie Dvorak says:

Lori Anne Lanski Chris Thompson Angie Mk

Travis Lloyd Travis Lloyd says:

Such a great practical tool!

Candace Sims Candace Sims says:

We talked about this in our clinical meeting brainstorming on ideas due to clients being discharged from court and not having a planned discharge

What a great resource!

Renee Fesser Renee Fesser says:

Good lessons the end is just as important as the beginning.

Really great piece by on creative ways of ending therapeutic relationships with children #socialwork


Rep. Bass Introduces Legislation To Ensure Former Foster Youth Can Keep Health Insurance In Other States



Recently, Rep, Karen Bass (D-Calif.), co-chair of the Congressional Caucus on Foster Youth, introduced the Health Insurance for Former Foster Youth Act, a bill that addresses a misinterpretation of the health care law by providing foster youth with the same health insurance benefits as their peers.

The current health insurance system is one of the many disproportionate challenges that our nation’s foster youth face. With the Affordable Care Act, foster youth who are in care by their 18th birthday and previously enrolled in Medicaid are able to receive healthcare until the age of 26, much like their peers who can remain on their parents’ insurance plans until that age. However, after several years of requested clarification, the Centers for Medicare and Medicaid Services misinterpreted the provision and restricted foster youth from receiving health insurance if they move out of their state.

Foster youth face incredible adversities throughout their lives, many of which begin after they turn 18 and grow out of the child welfare system,” Rep. Bass said. “I’m proud of this body’s resolve to address this issue and fix this incredibly harmful misinterpretation. Especially as we address the opioid epidemic, we must consider the importance of coverage for this vulnerable population.”

The Health Insurance for Former Foster Youth Act is particularly important to ensure that foster youth maintain uninterrupted access to health insurance. According to the Congressional Research Service, between 35 and 60 percent of youth who enter foster care have at least one chronic or acute health condition such as asthma, cognitive differences, visual and auditory challenges, dental decay, and malnutrition that require long-term treatment, and 50 to 75 percent of foster youth exhibit behavioral or social competency issues that may require mental health treatment. In 2013, nearly 50,000 youth between the ages of 16-20 exited the foster care system.

The Health Insurance for Former Foster Youth Act is a bicameral bill that will provide health insurance to foster youth in any state until age 26, as is the law for their peers that did not grow up in the child welfare system.

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Turnkey: A Co-Housing Experience in an Italian Public Service for Addiction



Turnkey is a term used in the economic field, but it also fits well in a social rehab project. The idea comes from the need to give some answers to the problem of those patients that experienced a long term therapy in an addiction rehab center for 3 or 4 years.

In the Italian welfare system, the outpatient service team -work (doctor, psychologist, educator, nurse and social worker), operating in the addiction recovery can schedule long term treatment in the residential rehab centers. In some cases, this long time permanence is something obliged, because of the serious addiction and also for the lack of different life perspectives after the recovery.

These kinds of patients need more therapeutic help in order to return to civil society in order to find  meaningful social membership. Usually, these clients have no meaningful familiar connections, no job, and no significant friendship.

In the last years, our social services system has become more careful about the use of public money. They noticed social workers more equipped to provide therapeutic interventions using a holistic approach in order to spare economic resources. Social workers are more capable to assist patients in reaching a better life condition by using their abilities toward social integration.

The Project

Five years ago, the program’s director asked for the professional team to think about a solution for the rehabilitation of the” long term patients”.

I started wondering about the meaning of poverty which is not only economics but it also the satisfaction of primary needs. It’s the lack of healthy relational bonds which weakness a lot the patients coming out of the drug addiction recovery programs.

I also noticed that this relational deficiency is a modern human condition; in the weakest social situations the loneliness is something that “destroys the mind “.

So I got an idea: I proposed to my director to start thinking about a possible apartment for a temporary co-housing for at least two patients.

He liked the project and submitted the plan to the municipalities which have the competence in the social side of rehabilitation. The municipalities agreed to the project and financed it.

For the patients in long term recovery, the rent was paid through the financing with the municipalities (an average of 6.000 Euro a year for 4 years, renewable), whereas the utilities and the others cost of the house has been in charge to the occupants.

The management of activities like the admission of the patients, the guaranteed respect of the therapeutic contract, the check of daily life and the help in the money administration, are some of my specific competences as a social worker.

In my job role, I had a significant part into find fitting persons for the project who were able to live together. I also contributed to choosing the people eligible to live in that specific therapeutic situation.

I helped the patients to organize their new life and to establish minimum rules of mutual life in the apartment. The project is strictly tied to the learning of the skills required to come back to live a regular life.

For example:

– living together is an opportunity for the patients to learn mutual respect

-cleaning the home and paying the utilities is a way to come back to daily responsibility and autonomy.

– having a good neighborhood relationship is a way to learn again to have good relationships without drug addiction to interfered an apartment, next to the main social and sanitary services of the town.

The results

Since 2011, we housed 11 clients in the apartment with an average of one year placement. We should consider that one year in a residential rehab center cost 30.000 euro each person.

Eight of them returned was able to manage a regular social life, their addiction, a job, maintain social relationships which helped them to achieve a dignified lifestyle.

Two persons are still in the co-housing situation, one of them has a regular job, and he is searching for an own house. Only one person abandoned the treatment.

This intervention is a daily challenge for our team; it gave us good results in the recovery outcomes like independence, citizenship, struggle against the stigma and improvement of personal resources.

We also have spared a significant amount of public money while offering to our clients a higher quality of life.

The creativity and the professional skills mixed together with the help of other colleagues in the multidisciplinary teamwork made this project an effective strategy to help patients overcome their circumstances.

So, I can call myself a responsible social worker, because I help to improve the personal resources in my client’s life. I was mostly inspired from the basic professional principle “start from where the client is”.

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Teaching Inclusion in the Classroom



General education teachers are tasked with keeping many balls in the air, which is half the fun of working in a classroom—there are so many constantly moving and evolving pieces for which to account.

One of these essential pieces to ensure equitable learning for every student is inclusion. Of course, this term is nothing new to educators—we work to create an inclusive environment on a daily basis. What might be new, however, are the many ways in which we teachers can look at inclusive practices. Since every child is different, we must continue our exploration of strategies and practices that best suit the needs of all students.

One best practice that supports inclusion is to vary the output of information. By this, we mean that teachers should relay content and instruction in different ways. Some students, especially those with auditory processing difficulties, find that verbal instruction is hard to grasp. To ensure inclusion for these students’ special needs, teachers should try to present information in visual or tactile ways, in addition to the verbal instruction.

Depending on the class or lesson, this might take the form of a demonstration, video, or hands-on activity. Some skills or lesson objectives may even lend themselves to a more kinesthetic or tactile approach. Even students without an auditory processing deficiency would find it confusing to listen to a verbal explanation of cursive letter formation. A demonstrated approach to writing using clay, beads, shaving cream, etc., makes more sense.

Similarly, when teachers are introducing concepts like grammatical conventions or figurative language devices, an audio or visual approach might work better than a written explanation of how a properly formatted sentence should sound. Teachers should also practice inclusion by encouraging students to demonstrate their learning in various ways.

This means that not only is the presentation of information different for each child, but the means by which a student exhibits mastery should be individualized, as well. Some students might prefer to write a formal, organized research paper to convey their knowledge of a subject, while others might feel most comfortable presenting a visual demonstration of their topic. The key is to provide multiple opportunities for students to display their knowledge so that everyone’s learning styles are being incorporated.

Another way to look at inclusion is to utilize multiple means of engagement. For students with attention issues, memory difficulties, or other learning disabilities, engagement in the classroom can make all the difference. Engagement might mean listening to music to identify metaphors, similes, or narrative voice. A film study might help students understand a new culture or part of the world. An analysis of a slow motion field goal might help students understand kinetic energy, velocity, or other properties of physics.

The point is, when students are engaged, learning not only flourishes but behaviors and attentiveness increase, as well. Engagement also assists with moving information from short-term memory into long-term memory. Inclusion, with regard to engagement, means that teachers are not only teaching with methods for each type of learner but also appealing to each learner, so that memory of the information or skill can solidify. In order to provide engagement, there must be a level of interest on the student’s end. As different as each student’s learning style may be, so maybe their interests.

This is where building relationships with students become essential for inclusion. Cultural inclusiveness provides students with a platform to express themselves on a more personal level. This also promotes a positive classroom environment, one in which students feel heard, understood, and accepted. Cultural inclusion allows students to see beyond themselves, as well, which fosters perspective-taking.

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Networking – The Best Way to Keep Learning on the Job



Like most comms professionals, I have a curiosity about learning. Be it about the latest craze on social media, or the newest news platform that I could try and get my organisation into.

I have been fairly diligent about keeping my skills set up-to-date. Regularly attending industry training courses, as well as embarking on a post-grad a few years back while juggling the demands of a busy role.

What’s struck me, however, is that the most profound learning comes from something far less slick than formal qualifications and training sessions, and that’s networking with our peers.

I’ve been fortunate enough to have worked across a number of sectors having moved from the arts, to education, to health, back to education, and then back to health – you get the theme – and now into the children’s sector now into the children’s sector where I work as Communications Manager at CELCIS (the Centre for Excellence for Looked After Children in Scotland).

With each move, I’ve managed to make connections with my counterparts at other organisations. By regularly keeping in touch with them, occasionally meeting up for a coffee, you can gain so much knowledge from each other by comparing notes, woes, and inspirations all in a oner. It really is cathartic. I would urge anyone to get to know their equivalent elsewhere, you never know when you might need them.

In the earlier stages of my career, I established a useful working relationship with a colleague at another institution. Given the supposed ‘rivalry’ between the institutions we worked for (I’m not naming names!) we had to use judgment and discretion when it came to information sharing. There was a real value to us being able to use each other as a sounding board for managing difficult media requests. On one funny occasion, we both spoke to each other mobile to mobile from our respective toilets!

Peer-to-peer learning comes in many forms and guises. An occasional and irregular meeting to talk shop, can lead to bigger plans for shared learning.

From Networking to Communities of Practice

I moved into a job promoting a brand new museum and gallery in central London some years back. Having attended a meeting on Southbank of arts PRs, I was vocal about the need to develop something a little more formal for us to keep abreast of what was happening in our tiny sector of comms professionals. What emerged from this was a working group of budding volunteers, and the establishment of a national conference where like-minded colleagues from throughout the country got together to learn from each other, and hear insights from those at the top of our industry.

What we didn’t realise at the time of its formation was that we really were a Community of Practice in the making (NB ‘Community of Practice’ is the slightly more academic/formal term for networking with peers.

New Year’s Resolution

One of my new year’s resolutions for 2018 is to help keep a network of comms professionals going in the children’s sector in Scotland. We are a varied bunch – from third sector organisations and campaign groups, to academic centres, NGOs and colleagues working in government – but we have much in common: our values as organisations; keeping our comms relevant to our intended audiences; and the need to embrace new and emerging technology.

Anyone wanting to know more, do be in touch.

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Changing the Lens on Poverty Research



Using an innovative technique to measure poverty, a Georgia Institute of Technology economics professor has found that more older Americans live in deprivation than official statistics suggest.

Shatakshee Dhongde, associate professor at Georgia Institute of Technology, found that 12.27 percent of senior citizens were deprived in two or more crucial areas, including multiple disabilities, low income, a lack of education, and severe housing burden.

Dhongde said the research illustrates a shortcoming in the official measure of poverty in the United States, which focuses solely on income. The federal government reported that 9.5 percent of older Americans were living in poverty in 2013. That is below the 12.3 percent rate found in Dhondge’s multidimensional poverty index.

Research Reveals Deprivation beyond Official Poverty Count

According to Dhongde’s research, nearly four in ten older U.S. residents reported being deprived in at least one of the four categories: multiple disabilities, low income, a lack of education, and severe housing burden.

Moreover, many of those living with multiple deprivations were not income poor. For instance, 3.6 percent of seniors experienced both multiple disabilities and severe housing burden, but would not appear in official poverty statistics because their income was above poverty line threshold.

Race plays a role, as well. Dhongde found that white senior citizens were less likely to be deprived, while Asian, African-American, and Hispanic seniors were more likely to be deprived. In fact, Dhongde found that 30 percent of Hispanic seniors were deprived in two or more dimensions.

Study Relies on Census Data

The study draws on the 2013 edition of the U.S. Census Bureau’s American Community Survey, which includes detailed data on economic, housing, educational, and healthcare circumstances of people living in the United States.

Dhongde, a faculty member in the School of Economics within the Ivan Allen College of Liberal Arts, is in the vanguard of economic researchers examining multidimensional deprivation in the United States. Thinking of deprivation in a multidimensional manner is a way of looking beyond income while measuring poverty.

“The main idea is that you change the lens and look at overlapping deprivations,” she said. “So I’m not separately looking at what percent of the elderly population was deprived in X and what percent was deprived in Y and so on. Instead, I choose one individual and then analyze how many deprivations he or she is facing simultaneously.”

By examining multiple areas that can affect a person’s quality of life, Dhongde says the multidimensional poverty index can provide better insight into the population’s broader economic condition. It can also give policymakers tools to gauge where best to focus limited resources.

Multidimensional Analysis Gains Traction

The research follows up on a groundbreaking 2017 paper that Dhongde co-authored with Robert Havemen of the Institute of Research on Poverty at the University of Wisconsin-Madison. In that paper, Dhongde and Haveman showed that during the “Great Recession” which gripped the United States economy from 2008 to 2013, nearly 15 percent of working-age U.S. residents were deprived in at least two of the measures.

Most of those in the study who were multidimensionally deprived were low-income earners whose incomes exceeded the poverty line.

That paper was the first in the United States to take a comprehensive look at multidimensional poverty at a national level, but similar techniques are taking hold internationally.

The United Nations has used a similar approach in measuring poverty since 2010. The European Union has also adopted a multidimensional approach. The United States government, however, still assessed poverty largely using income data alone.

Dhongde said that her latest research suggests avenues for policymakers to approach quality-of-life issues and health care costs among the nation’s growing elderly population.

For instance, her research shows that people with little education are more likely to have health issues. This suggests that policy makers could address literacy as a way to help people make better health choices — and hold down the spiraling cost of health care.

New Areas of Study to include Transportation

Dhongde is now working to extend the research model to other fields that could benefit from such analysis.

She is currently working with Laurie Garrow, a professor of transportation systems engineering in Georgia Tech’s School of Civil and Environmental Engineering. Garrow is interested in developing a transportation deprivation index to help guide transit decisions — particularly in rural areas.

“As transportation engineers, we have regulatory requirements to ensure we are designing public transportation systems in ways that are fair and equitable for all individuals,” Garrow said.” By better understanding how transit dependency characteristics, such as income, employment, disabilities, etc., are related and how these characteristics are spatially distributed, we can design public transit services to better meet individuals’ needs.”

Dhongde said such a tool might use data sets to produce a comprehensive evaluation of transportation factors such as access to private cars, availability of mass transit, and even how often public transportation is available, and how far people have to travel to get groceries or go to school.

Dhongde’s new research appears in the book, Measuring Multidimensional Poverty and Deprivation: Incidence and Determinants in Developed Countries.

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Assessments Often Miss Mental Health Issues for Youth on Probation



An assessment tool used by many jurisdictions within the juvenile justice system that is intended to help recognize the effects of adversity and trauma in children’s lives is not the best means of evaluating mental health problems faced by at-risk youth, according to new study by a University at Buffalo social work researcher.

The groundbreaking research, which lead author Patricia Logan-Greene believes is among the first studies to connect the adverse childhood experience (ACE) assessment for juveniles on probation to mental health problems, could help improve the justice system’s responses to court-involved youth, especially those who have experienced maltreatment and trauma.

“The United States continues to have a massive juvenile justice system that does not, generally speaking, serve youth well,” says Logan-Greene, an assistant professor in UB’s School of Social Work. “We suspect that the way mental health is often assessed in the juvenile justice system is missing many mental health problems – in particular with disadvantaged youth.”

The number of youth on probation is a far larger group than those who are incarcerated or in treatment facilities. Yet most of the research literature is on that smaller population.

“We may have identified a gap,” says Logan-Greene. “The court assessment asks whether youth have ever been diagnosed with a mental illness.  That question makes a lot of big assumptions like equal access to health care and equal desire to access mental health care, which has a lot to do with stigma.

“A better assessment tool would address symptomology,” she says.

The problems faced by youth on probation are widespread, according to Logan-Greene. The vast majority have histories of child abuse, family dysfunction and social disadvantage.

“Only 25 percent have no history of abuse,” she says. “One of my elevator speeches argues against punitive responses for youth with histories of trauma.”

Although most jurisdictions do assess mental health, these are not necessarily good assessments – and some jurisdictions aren’t assessing for this at all. A single question to capture all aspects of mental health simply isn’t sufficient.

“While the adverse childhood experience tool has done wonderful things to help us recognize the importance of adversity and trauma in children’s lives, there is still room for improvement,” she says. “For instance, there is nothing in the ACE tool about childhood poverty, and we know from previous research that childhood poverty is deeply damaging.”

In the current study, Logan-Greene and her co-authors Robert L. Tennyson and Paula S. Nurius, both from the University of Washington, and Sharon Borja, University of Houston, divided their assessment of childhood adversity into childhood maltreatment, family dysfunction including substance abuse, family history of mental illness, physical health problems with the family, and social disadvantage, using a diverse sample of more than 5,300 youth on probation.

The findings suggest a clear connection between childhood maltreatment and mental health problems.  Although there did not appear to be a relationship between social disadvantage and mental health problems, there was a connection between mental health and the symptoms of social disadvantage such as coping problems, social isolation and what the authors call aspirations or the measure of hope for the future.

“Because social disadvantage did have a negative effect on those indicators we suspect the court assessments are not picking up what are probably undiagnosed and untreated mental health problems among disadvantaged youth,” Logan-Greene says.

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