Given the high prevalence of client unilateral termination from psychotherapeutic services, elucidating client reasons for ending therapy is an important activity for researchers. Three studies were designed to shed light on reasons for both premature and appropriate termination from the perspective of adult clients and therapists: 1) In Study 1, I examined data from the Canadian Community Health Survey, Cycle 1.2, to establish base rates of client reasons for psychotherapy termination in Canada, along with their demographic and clinical correlates, 2) In Study 2, I used training clinic data to examine client and therapist perspectives of reasons for termination, working alliance, and barriers to treatment participation in mutual versus unilateral terminators, and 3) In Study 3, I collected data from Canadian clinical psychologists to examine their perspectives of client reasons for early versus later termination, and their use of engagement strategies to reduce client-initiated unilateral termination. In Study 1, 43.1 percent of respondents reported terminating therapy for reasons other than feeling better or completing treatment. In general, individuals with low income and diagnosable mental disorders had significantly increased odds of premature termination. Study 2 revealed that when clients made unilateral decisions to end therapy, therapists were only partially aware of either the extent of clients’ perceptions of their success in therapy or with their dissatisfaction with therapy. Although working alliance and barriers to treatment participation were rated as lower in the context of unilateral termination by both clients and therapists than in the context of mutual decisions to terminate therapy, all clients, in general, rated the early alliance and barriers to treatment as higher than did their therapists. In Study 3 psychologists assigned differential importance to reasons for termination depending on whether termination was before versus after the third session. Theoretical orientation (CBT versus other) did not influence views of reasons for termination, but influenced use of some engagement strategies. Results are discussed in terms of research and clinical implications.

Given the high prevalence of client unilateral termination from psychotherapeutic services, elucidating client reasons for ending therapy is an important activity for researchers. Three studies were designed to shed light on reasons for both premature and appropriate termination from the perspective of adult clients and therapists: 1) In Study 1, I examined data from the Canadian Community Health Survey, Cycle 1.2, to establish base rates of client reasons for psychotherapy termination in Canada, along with their demographic and clinical correlates, 2) In Study 2, I used training clinic data to examine client and therapist perspectives of reasons for termination, working alliance, and barriers to treatment participation in mutual versus unilateral terminators, and 3) In Study 3, I collected data from Canadian clinical psychologists to examine their perspectives of client reasons for early versus later termination, and their use of engagement strategies to reduce client-initiated unilateral termination. In Study 1, 43.1 percent of respondents reported terminating therapy for reasons other than feeling better or completing treatment. In general, individuals with low income and diagnosable mental disorders had significantly increased odds of premature termination. Study 2 revealed that when clients made unilateral decisions to end therapy, therapists were only partially aware of either the extent of clients’ perceptions of their success in therapy or with their dissatisfaction with therapy. Although working alliance and barriers to treatment participation were rated as lower in the context of unilateral termination by both clients and therapists than in the context of mutual decisions to terminate therapy, all clients, in general, rated the early alliance and barriers to treatment as higher than did their therapists. In Study 3 psychologists assigned differential importance to reasons for termination depending on whether termination was before versus after the third session. Theoretical orientation (CBT versus other) did not influence views of reasons for termination, but influenced use of some engagement strategies. Results are discussed in terms of research and clinical implications.

Given the high prevalence of client unilateral termination from psychotherapeutic services, elucidating client reasons for ending therapy is an important activity for researchers. Three studies were designed to shed light on reasons for both premature and appropriate termination from the perspective of adult clients and therapists: 1) In Study 1, I examined data from the Canadian Community Health Survey, Cycle 1.2, to establish base rates of client reasons for psychotherapy termination in Canada, along with their demographic and clinical correlates, 2) In Study 2, I used training clinic data to examine client and therapist perspectives of reasons for termination, working alliance, and barriers to treatment participation in mutual versus unilateral terminators, and 3) In Study 3, I collected data from Canadian clinical psychologists to examine their perspectives of client reasons for early versus later termination, and their use of engagement strategies to reduce client-initiated unilateral termination. In Study 1, 43.1 percent of respondents reported terminating therapy for reasons other than feeling better or completing treatment. In general, individuals with low income and diagnosable mental disorders had significantly increased odds of premature termination. Study 2 revealed that when clients made unilateral decisions to end therapy, therapists were only partially aware of either the extent of clients’ perceptions of their success in therapy or with their dissatisfaction with therapy. Although working alliance and barriers to treatment participation were rated as lower in the context of unilateral termination by both clients and therapists than in the context of mutual decisions to terminate therapy, all clients, in general, rated the early alliance and barriers to treatment as higher than did their therapists. In Study 3 psychologists assigned differential importance to reasons for termination depending on whether termination was before versus after the third session. Theoretical orientation (CBT versus other) did not influence views of reasons for termination, but influenced use of some engagement strategies. Results are discussed in terms of research and clinical implications.

The present study examined predictors of couple therapy dropout in the VA medical centers using six different dropout criteria. The most accurate dropout definitions included using a statistical modeling procedure to determine whether the client's rate of change at the final session was greater than average of change for all clients; clients who were still demonstrating gains greater than the average rate of change at the final session were considered to have terminated prematurely. A total of 177 couples (354 individuals) who sought therapy in the VA medical centers in Charleston, SC and San Diego, CA were examined. With a few exceptions, demographic variables generally did not predict dropout. A couple's relationship adjustment and response to conflict were significant predictors of dropout. The content of therapy sessions predicted dropout only when dropout was defined, at least in part, by client's rate of change at the final session, suggesting that such methods of defining premature termination are the most sensitive to the therapy process. Therapists' characteristics, including gender and level of experience, did not predict dropout across all six definitions of dropout.

Given the high prevalence of client unilateral termination from psychotherapeutic services, elucidating client reasons for ending therapy is an important activity for researchers. Three studies were designed to shed light on reasons for both premature and appropriate termination from the perspective of adult clients and therapists: 1) In Study 1, I examined data from the Canadian Community Health Survey, Cycle 1.2, to establish base rates of client reasons for psychotherapy termination in Canada, along with their demographic and clinical correlates, 2) In Study 2, I used training clinic data to examine client and therapist perspectives of reasons for termination, working alliance, and barriers to treatment participation in mutual versus unilateral terminators, and 3) In Study 3, I collected data from Canadian clinical psychologists to examine their perspectives of client reasons for early versus later termination, and their use of engagement strategies to reduce client-initiated unilateral termination. In Study 1, 43.1 percent of respondents reported terminating therapy for reasons other than feeling better or completing treatment. In general, individuals with low income and diagnosable mental disorders had significantly increased odds of premature termination. Study 2 revealed that when clients made unilateral decisions to end therapy, therapists were only partially aware of either the extent of clients’ perceptions of their success in therapy or with their dissatisfaction with therapy. Although working alliance and barriers to treatment participation were rated as lower in the context of unilateral termination by both clients and therapists than in the context of mutual decisions to terminate therapy, all clients, in general, rated the early alliance and barriers to treatment as higher than did their therapists. In Study 3 psychologists assigned differential importance to reasons for termination depending on whether termination was before versus after the third session. Theoretical orientation (CBT versus other) did not influence views of reasons for termination, but influenced use of some engagement strategies. Results are discussed in terms of research and clinical implications.

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Given the high rates of premature termination in training clinics, research aimed at understanding client attrition is urgently needed. Recent investigations in this area have implicated expectations of psychotherapy as a strong predictor of premature termination; however, this phenomenon has only been studied from the perspective of client expectations to date. There is reason to believe clinician expectations for the duration and effectiveness of psychotherapy may further impact the likelihood of their clients terminating prematurely. This study sought to address this gap in the literature by examining the association of clinicians' expectations to clients' psychotherapy outcomes and termination status in a training clinic setting. Clinicians were found to hold significantly higher expectations for client improvement than would be expected, and these high expectations were found to be positively correlated with clinically significant change in clients. Implications for improving client retention and treatment outcome in training clinics are discussed.

Premature termination from child and adolescent psychotherapy is a prevalent problem for clients, their families, and mental health services. Rates of premature termination have been estimated at a range of 16-72%. Many variables have been examined as potential predictors of premature termination, yielding inconsistent conclusions. Researchers propose that part of this variability in rates and predictors is due to the inconsistent application of definitions of premature termination. The past literature identifies two main categories of definitions in this line of research: therapist judgment and number of sessions. This study aims to incorporate a relatively new definition, clinically significant change, in the evaluation of premature termination rates and predictor variables in a sample of adolescents receiving treatment in three community mental health clinics. Results showed that 65.7% of the participants were classified as premature terminators under the definition of clinically significant change. Premature termination was significantly correlated with parenting skills and ratings of the therapeutic alliance by both the parent and adolescent. However, the only variable that predicted PT was the therapeutic alliance as rated by the adolescent. It appears that, rather than having a small range of rates and universal predictors of premature termination, it may depend on the definition that is chosen.

Premature termination is a common clinical phenomenon in university counseling setting, often very disruptive to the therapeutic process, can be dangerous for clients at risk, evokes considerable reactions and among therapists, and often causes treatment to be not as beneficial to them. The existing literature reflects both clinical conceptualizations and empirical investigations into the nature and effects on premature termination in psychotherapy, both on clients and therapists. However, there are only few studies that examined, from an objective personality assessment standpoint, profiles of clients who tend to drop-out of therapy prematurely. The current study investigated if clients at a university counseling center, who were classified to two groups (prematurely terminated and non-prematurely terminated), significantly differ on their Personality Assessment Inventory (PAI; Morey, 2003) scales. A canonical discriminant function analysis was conducted to determine whether the PAI scales could predict premature termination within a sample of university counseling center clients. The results indicated that the overall predictors differentiated between the two groups. The within-groups correlations between the predictors, two scales demonstrated significant relations with the discriminant function—SCZ and ANT-A. These results suggest that clients with antisocial behaviors (ANT-A) tend to prematurely terminate, whereas clients with schizophrenic tendencies (SCZ) tend to remain in treatment. In order to receive more accurate results and better range of those scales descriptive statistics were utilized, checking the percentage of students from the ANT-A group that received moderate results on the scale (T=>60) as well as those from the SCZ group who also receive moderate results on the scale (T=>60) . Results suggested that 83% of the prematurely terminating group had moderate elevation of ANT-A symptomatology (T=>60T), and 66% of the non-premature terminating group had moderate elevation of SCZ symptomatology (T=>60T). An integrative discussion of the results, via the lens of Motivational Interviewing perspective, allows for explanation and possible implications for clinical work.

Treatment dropout is a pervasive phenomenon that can preclude clients from benefiting fully from psychotherapy. Research efforts to understand the phenomenon in the preceding decades yielded few consistent results. The investigation of intrinsic client and therapist factors gave way to the more recent exploration of dynamic therapeutic process factors potentially influencing the dropout process. The availability of periodic treatment outcome measurement instruments has helped client-focused research explore the effects of treatment response as a process factor on aspects of psychotherapy. As an added benefit, real-time treatment response measures, such as the Outcome Questionnaire, offer the possibility of timely adjustment in clinical intervention to meet evolving client needs and enhance therapeutic treatment. This present study primarily sought to explore the relationship between psychotherapy dropout and treatment response patterns in terms of clients' psychosocial well-being as measured by the Outcome Questionnaire. The results suggest that treatment response patterns alone may not effectively predict dropout probabilities. Even so, the measure's sub-component assessing the client's subjective experience of symptom distress is shown to be more accurate in predicting dropout than the composite Outcome Questionnaire measure or any other component scale. This finding conceivably highlights the relative importance of symptom distress in the dropout process for the sampled clients. Those clients reporting higher levels of symptom distress appeared to be associated with greater probabilities of dropout termination. Additionally, prior research has recognized a likely mediated relationship between higher client educational attainment and lower dropout probabilities - a trend also observed in this study's sampled population. As one of its expressed intents, this study examined educational attainment's moderating effect on the relationship between aspects of client treatment response and dropout probabilities. While showing educational attainment to be a relevant factor in assessing dropout risks, the analysis results indicate that this client characteristic variable's interactional effect on the evaluated treatment response pattern feature is weak and statistically nonsignificant. The present study contributes to the research literature through providing some clarification to the importance of treatment response in the prediction of psychotherapy client dropout.