Dropout and early termination in therapy is a concern for many practicing psychologists or therapists. Research indicates that 20 percent of clients will terminate therapy prematurely (Chamberlin, 2015). Furthermore, Swift and Greenberg (2012) found that one in five clients will dropout before completing therapy. So the question becomes, what are the common reasons for early termination and what can the practitioner do to influence this trend? Briefly, according to Dr. Greenberg (as cited in Chamberlin, 2015) some of these common factors could be easily addressed. For example, clients may have unrealistic assumptions about therapy or they may not fully understand the roles of client or therapist. They also may not understand the timeline or commitment needed. Additionally, some clients may have more practical problems, such as childcare or transportation difficulties. Finally, clients may experience anxiety about discussing feelings and/or traumatic, emotional experiences.
In their book, Premature Termination in Psychotherapy, Swift and Greenberg offer eight empirically supported strategies (listed below) to help clients stay on track.
- Provide role induction. Here the clients are offered education on the process of therapy, as well as, clarify client and therapist expectations.
- Incorporate client preferences into the treatment decision-making process. This will help balance treatment options and will foster a client’s investment in therapy.
- Help plan for appropriate termination. Provide an estimated timeline for treatment; also allow open discussion about termination and endpoints that indicate the end of therapy.
- Provide education about patterns of change. Preparing clients for emotional setbacks is necessary, as well as discussing the initial improvements and thinking therapy is done.
- Strengthen early hope. Hope fosters commitment, and as a result, clients are more likely to continue and work past setbacks.
- Enhance motivation for treatment. Address motivation from session to session; utilizing techniques of motivational interviewing may also help clients remain in therapy.
- Foster the therapeutic alliance. Foster and develop basic therapeutic skills, as well as monitor and repair ruptures in the alliance.
- Discuss treatment progress with your clients. Providing feedback through discussion or objective self-report may help gauge progress and identify problems before clients dropout.
Overall, the strategies listed above provide simple interventions that have shown to mitigate dropout rates. Often these strategies are not emphasized in training, but have shown to be effective in helping clients remain in treatment.
Chamberlin, J. (2015). Are your clients leaving too soon? Monitor on Psychology, 46(4), 60-63.
Swift, J. K., & Greenberg, R. P. (2012). Premature discontinuation in adult psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology, 80, 547-559.
Swift, J. K., & Greenberg, R. P. (2014). Premature termination in psychotherapy: Strategies for engaging clients and improving outcomes. Washington DC: American Psychological Association.
Dannie S. Harris, M.A., M.A., M.A.Ed., Ed.S.
WKPIC Practicum Trainee