Psychologists who terminate their practices need to be prepared for legal, ethical and even emotional challenges.

By Peter Freiberg

After 40 years as a private practitioner in Cleveland, Jack Wiggins, PhD, decided in June 1996 to retire within six weeks. He felt he had no choice: His wife, Alice, had just been diagnosed with pancreatic cancer.

?We had land in Phoenix,? says Wiggins, a past APA president. ?We knew my wife had limited time, so we decided to build our house, and that?s how we would use our time.?

Wiggins went through what he calls a ?crash course? in shutting down a practice. As a partner in a group practice, he didn?t have to worry about where to keep his records; they stayed in the same office. He found therapists inside and outside his practice to whom he could refer his patients. And he focused on the termination process.

?I told my patients precisely what was happening,? he says. ?Many were very sympathetic? and cooperative.? But some panicked. ?We dealt with each individual according to their own situation,? Wiggins says.

As for himself, Wiggins says the terminations were especially stressful because he was doing so many at once. Still, he?s glad he made his decision: He and his wife moved to Phoenix, where she lived to see their house completed. She died two days later, nine months after her diagnosis.

Most psychologists who close their practices aren?t faced with the excruciating time pressures Wiggins had to confront. Reasons for leaving practice are numerous, among them aging and ?just wanting to play,? as one therapist put it, frustration with managed care, sickness and disability.

But whatever the reason for closing practice, ?it?s essential to do advance planning? to make the closing down process go smoothly, says Billie Hinnefeld, PhD, JD, APA director for legal and regulatory affairs. That means thinking through the legal and ethical issues practitioners will need to address, as well as the emotions from their patients?and themselves?that they?ll encounter.

Legal and ethical issues

There are no hard-and-fast rules on how to close down a practice, but there are certain legal, ethical and practical para-meters. To start, psychologists should give ?adequate? notice of their retirement or decision to relocate geographically, says Hinnefeld. ?You just can?t come in one day and say, ?I?m closing,?? she explains. At the same time, she says, there is no rule of thumb on exactly how much notice to give. ?Every case is going to be different,? she says. A patient with serious, chronic disorders is likely to need a longer transition period than someone with less serious problems.

Closing a practice also includes helping patients who need continued care obtain another therapist. ?You can?t abandon someone,? says Hinnefeld. ?Negligent abandonment? is a legal cause of action that can be brought against a therapist if the termination process doesn?t follow the customary standard of care. Psychologists must also take steps to protect patient records and ensure that they remain confidential, according to APA?s Ethics Code. Some states have record-keeping laws, notes Hinnefeld; practitioners should check with their state psychological associations for details on those laws.

Psychologists can get more practical guidance on closing their practices from ?The Psychologist?s Legal Handbook,? published by the Council for the National Register of Health Service Providers in Psychology. The handbook advises that patients be given ?reasonable assistance? in finding a suitable successor therapist and that these efforts should be documented in writing to avoid legal claims.

APA?s Ethics Code also provides guidance on closing a practice, particularly in regards to protecting patient records and ensuring they remain confidential. If a psychologist is relocating or for other reasons will not retain the records personally, and the records are not transferred to a new therapist, it would be most appropriate to designate another psychologist to keep them, Hinnefeld says. Patients should also be informed of that so they will know how to get access to their records. ?The Psychologist?s Legal Handbook? cautions practitioners to remember that transfer of a patient?s records requires written informed consent by the patient.

With present patients, says Alan Entin, PhD, former president of Div. 42 (Independent Practice), the easiest way to obtain that written consent is simply to ask for it during sessions.

?The Legal Handbook? also reminds psychologists that it is essential to maintain liability insurance after retirement because patients can sue their therapists for malpractice long after treatment has terminated. Psychologist Bruce Bennett, PhD, executive director of APA?s Insurance Trust, says that if a practi-tioner holds what is called an ?occurrence policy,? he or she is covered for anything that happened while the policy was in force and the therapist was seeing the patient, regardless of when the claim is filed.

But if a psychologist holds a claims-made policy, retirement coverage is not automatic. In that case, Bennett recommends that an ?unlimited tail? be purchased to extend coverage for anything that happened before retirement. A psychologist who has held a ?claims-made? policy from the Insurance Trust for at least five years may receive the ?tail? free of charge. (A free ?tail? is also provided if the insured practi-tioner dies or is permanently disabled and can no longer practice; this protects the practitioner?s estate.)

Telling your patients

Getting your legal and ethical ducks in a row can be challenging, but most practitioners find that telling their patients about their decision to close shop is the most daunting part of the decision.

Donald Bruce, PhD, 63, a practitioner for more than two decades in Richmond, Va., closed his practice last year in response to the burdens of managed care. He was fed up ?with all the paperwork, having to justify everything I did, quarreling with case managers?[and] never getting referrals.?

Bruce told one severely disabled patient of his impending retirement almost a year in advance: It took that long to get her used to the idea, he says. But he waited until two months before retiring to tell most of his other patients. ?I believe in not crossing bridges before I come to them,? says Bruce.

Working through the terminations, Bruce says, was easier than he expected. He gave each patient at least two referral names and always offered to make the first contact. And he counseled his patients on the change.

?We talked a lot about their feelings of abandonment, about what they?d do after I referred them to someone else,? he says. ?Parting was very cordial.?

Some psychologists decide to retire in stages. Nina Fieldsteel, PhD, ended a primarily analytic practice in New York City five years ago. She continued her practice in New Jersey, where she lives, but took on new patients only for shorter-term therapy. Now 75, Fieldsteel plans to retire completely at the end of June. Fieldsteel says she gave her patients six months? notice about her retirement. Any longer, she felt, would interfere with the therapy, while any shorter would be unfair.

She has no regrets about retiring. ?I?ve watched too many of my colleagues practice long after they should have retired,? she says. ?It?s not difficult for me, because I?ve been wanting to do this and planning to do this for awhile.? She says she plans to continue to teach and write.

Your own emotions

Some psychologists report that the termination process was difficult for them as well as the patients. ?You have to go through a mourning process, the same as the patients do,? says Alma Bond, PhD, an analyst who retired seven years ago from New York City to Key West, Fla. ?You have to find what was unresolved in each patient. You have to come to terms with what you didn?t do that maybe somebody else could have done better. You have to accept the limitations of both the field and yourself.? Bond decided to retire after a taxi ran into her while she was jogging in Central Park. ?I almost died,? she says, recalling her seven broken bones, concussion and muscle problems. The accident got Bond to focus on the future. ?I thought, ? I?ve had a wonderful life, I have children, grandchildren. The one thing I have not done is write full time.??

In retirement, she has written six fiction and nonfiction books, including, ?Is There Life After Analysis?? She decided to take as long to close her practice as necessary; it ended up taking two years. ?I went ahead with each patient until I felt satisfied they could get along without me,? she says.

Peter Freiberg is a writer in Miami Beach, Fla.