Situation: A nurse at a community mental health clinic begins weekly one-to-one sessions with a 45-year-old man who is in recovery from alcohol use disorder. In the first session they agreed to meet for 10 sessions of 45 minutes each. At the eighth of the 10 sessions he says, "I might skip the last two sessions. There is not much point now." He has met most of his goals, has stayed sober, and reports no crisis. What should the nurse do?

Clients may withdraw early near termination to avoid feelings of loss or abandonment; this is a reaction to separation, not a sign that the work is finished. The nurse explores feelings about ending and uses the remaining planned sessions to review progress and arrange aftercare, keeping the agreed end date.

The client’s statement in the eighth session is best understood as a reaction to the approaching end of the therapeutic relationship, not as a rational judgment that the work is complete. In structured, time-limited therapy, the termination phase itself carries therapeutic weight. Clients who have benefited from a relationship may preemptively withdraw to avoid the sadness, loss, or sense of abandonment that ending can evoke. The nurse’s role is not to accept the withdrawal at face value, nor to extend the contract, but to bring the feelings about ending into the conversation.

Why early withdrawal happens near termination

In time-limited work, the final sessions are not simply a wind-down; they are a distinct phase with specific tasks. A systematic review of psychotherapy termination identifies the initiation of termination and the emotional reactions surrounding it as central themes in the literature ^[1]. Clients may initiate termination earlier than planned for many reasons, and among these, avoidance of separation-related affect is well recognized. The client here has met most goals, maintained sobriety, and reports no crisis. On the surface, this makes ending seem logical. However, the timing of the statement—at the eighth of ten agreed sessions—is clinically significant. Announcing an intention to skip the remaining sessions is a subtle move to take control of the ending, which can protect against the vulnerability of saying goodbye within the planned frame.

Premature withdrawal near the end is often a defense against the feelings of loss and abandonment that termination activates. The client may be testing whether the nurse will let him leave easily, or whether the relationship matters enough for the nurse to notice and explore the pull away. In psychoanalytic and psychodynamic frameworks, termination is understood as a re-experiencing of earlier separations, and supervision of termination emphasizes helping the clinician attend to these dynamics rather than colluding with avoidance ^[2].

What the nurse should actually do

The correct response is to explore the client’s feelings about the sessions coming to an end. This does not mean pressuring him to stay, but rather opening a reflective space: what has changed, what the ending means to him, and what he anticipates losing or gaining. The agreed end date remains intact; the nurse uses the remaining sessions to review progress and arrange aftercare. This preserves the therapeutic frame while making the emotional experience of ending a legitimate topic for the work.

The nurse keeps the agreed end date and uses the remaining sessions to process the meaning of ending, review gains, and plan aftercare. This approach is consistent with the finding that termination is a complex and challenging phase requiring planning and active intervention, not passive acceptance of the client’s stated preference . In group therapy for substance use disorders, termination interventions include structured review of progress and explicit attention to the feelings that arise when the group ends . The same principle applies in individual work: the ending is part of the treatment, not an administrative afterthought.

Why the other options are less appropriate

Agreeing to end now (option 1) colludes with the avoidance. It treats the client’s statement as a purely practical matter and misses the opportunity to work through the separation. It also abandons the planned termination tasks that support consolidation of gains. Adding two more sessions (option 3) changes the contract in response to the client’s ambivalence, which can blur boundaries and may reinforce the idea that endings are too difficult to face as agreed. Referring to a peer support group in place of the sessions (option 4) may be a useful component of aftercare, but it should not replace the remaining therapeutic work. It also risks communicating that the nurse is willing to hand the client off rather than stay with the discomfort of ending.

Key point! A request to end early near the planned termination date is a clinical event to be explored, not a logistical decision to be managed. The nurse’s task is to name and examine the feelings about ending while holding the original frame.

Termination as a therapeutic task

The termination phase has identifiable functions: reviewing what was accomplished, consolidating coping strategies, anticipating future challenges, and processing the emotional meaning of the relationship’s end. A qualitative meta-synthesis on dropout highlights that premature termination often involves unaddressed relational processes between client and therapist . When a client moves to leave early, the nurse should consider what has not yet been said or felt. In this case, the client’s sobriety and goal attainment make the remaining sessions an ideal time to reflect on how he will sustain these gains without the weekly contact. That reflection is precisely what avoidance of the last two sessions would foreclose.

The final sessions are not optional; they are where the client consolidates gains and prepares for life after the therapeutic relationship ends. The nurse’s gentle but direct exploration of the wish to skip them honors the client’s autonomy while keeping the therapeutic work honest. The agreed end date remains the anchor; the feelings about that date become the material for the remaining sessions.