What the Research Tells Us About Saying Goodbye Well
Ending therapy is rarely just an administrative event — it’s a clinical moment in its own right. Yet for many Australian clients and clinicians working under a Mental Health Treatment Plan (MHTP), that ending arrives on a schedule set not by readiness, but by Medicare rules. Under the Medicare Better Access initiative, a client is eligible for an initial course of up to six individual sessions, followed by a GP review, and then a further course of up to four sessions — a structure often described as the “6+4” model — capped at 10 individual sessions per calendar year. This is a genuinely distinctive therapeutic frame, and it’s worth pausing to ask: what does the evidence say about ending well, and how do we translate that into a model where the ending is, in some sense, built into the paperwork from day one?
The Evidence Base on Termination
A 2025 systematic review of adult individual psychotherapy termination — synthesising 67 empirical studies — offers some of the clearest guidance available on this under-researched phase of treatment. Several findings stand out as directly relevant to brief, structured models like the MHTP.
First, planned and mutually agreed terminations are consistently associated with better outcomes and higher satisfaction than abrupt or unilateral endings. Second, a strong therapeutic alliance is reliably linked to mutual, planned endings — clients who feel securely connected to their therapist are more able to engage constructively with the ending rather than avoid or sabotage it. Third, termination discussed early and revisited throughout treatment — rather than sprung on the client in the final session — produces better engagement and closure. Fourth, in cognitive behavioural approaches specifically, therapists routinely name the time-limited frame from the outset, helping clients set goals, track progress, and understand that skill-building — not indefinite dependency — is the point.
The American Psychological Association’s summary of this literature reinforces the stakes: appropriately terminating psychotherapy preserves client wellbeing and supports continued growth after the relationship ends, whereas abandonment or poorly handled endings can worsen symptoms and erode trust. Importantly, successful termination isn’t simply the absence of a bad ending — it correlates with better overall treatment outcomes from both the client’s and therapist’s perspective.
Why the 6+4 Model Is a Genuinely Different Beast
Most termination research was built on open-ended or longer-term therapy, where ending is a clinical decision made collaboratively as goals are met. The MHTP inverts this. The ending point — 10 sessions per calendar year — is fixed by policy, not by the natural rhythm of the work. The GP review after the first six sessions is a built-in checkpoint, a moment to assess progress and decide whether further sessions are clinically warranted, but it does not reset the clock: the total remains capped at 10 across the calendar year, and the plan itself does not expire, so clients can draw on remaining sessions later in the year or from January the next.
This creates a paradox worth naming honestly with clients: the therapeutic relationship may need to end (for MBS-rebate purposes) well before the clinical work feels finished. This is not the same as treatment failure, and it is not abandonment — provided it is planned for.
Applying the Evidence Within 6+4
Given what the research shows about planned, alliance-rich, early-discussed endings, a few practical translations for the 6+4 context stand out:
- Name the frame in session one. Just as CBT practitioners flag the time-limited nature of treatment from the start, clinicians working within an MHTP can openly discuss the 6+4 structure early, so clients aren’t blindsided by a “final” session.
- Use the GP review as a genuine collaborative checkpoint, not a formality — a chance to jointly assess gains, name what’s been achieved, and realistically discuss what four more sessions can and can’t address.
- Treat the last scheduled session (whether at session 6 or session 10) as an actual termination-phase session, not a regular session that happens to be last. Evidence suggests even a small proportion of total treatment time — roughly 8–17% in some studies — deliberately spent reviewing progress and processing the ending materially improves how clients experience closure.
- Consolidate gains explicitly. Reviewing what’s changed, naming skills the client can now use independently, and normalising that progress is rarely linear all help clients carry the work forward without the therapist in the room.
- Address feelings on both sides. Clients may feel pride, relief, grief, or anxiety about the ending simultaneously — and therapists are not immune to this either. The research is clear that acknowledging these reactions, rather than glossing over them, is part of what makes an ending “successful.”
So What Happens After the 10 Sessions?
This is the question clients ask, and it deserves an encouraging, practical answer rather than a shrug. A few realities are worth holding onto.
In practical terms, once a client has used their 10 sessions in a calendar year, they can return to their GP at any point to discuss the possibility of a new Mental Health Treatment Plan. They can also explore the option of other subsidized services with their GP, such as a Chronic Condition Management plan, depending on the presenting issue.
From a short-term therapeutic perspective, a well-conducted 6+4 termination is not the end of a client’s growth — it’s often the handover point from therapist-led work to client-led maintenance. This mirrors exactly what the CBT termination literature describes: therapy tapering toward independence, with the client increasingly acting as “their own therapist,” equipped with concrete skills rather than an open-ended reliance on sessions. Framed this way, the Medicare cap — while frustrating from a resourcing standpoint — can be leveraged clinically as a forcing function for consolidation, self-efficacy, and realistic goal-setting from the very first session.
For clinicians, this reframes the 6+4 model not as an obstacle to good therapy but as an invitation to practise termination with more intention than many longer-form models ever require.
Given how strongly the evidence favours planned, alliance-based, collaboratively processed endings, brief models like this may actually offer more opportunities to do termination well — precisely because it can’t be avoided or indefinitely postponed.
If you’re navigating this rhythm with your own clients, the encouraging takeaway is this:
A good ending, built early & honestly into the frame, is one of the most protective & empowering things you can offer — regardless of how many sessions the calendar allows!
Article is written with the assistance of Perplexity AI.