Symptom reduction and termination: client change and therapist identified reasons for saying goodbye

Abstract

Empirical efforts have focused on predicting whether or not clients prematurely terminate therapy, with nonattendance of last session equated to premature termination. However, this fails to explore the relationship between clients’ distress reduction and reasons for termination. With this study, we aimed to understand how clients’ distress change relates to premature termination and examine clients’ distress change in conjunction with therapists’ perceptions of termination reasons. We collected data from 797 clients who prematurely terminated or attended termination but completed therapy a minimum of three individual sessions provided by 38 therapists. Clients completed an assessment of psychological symptoms before each session. At the end of treatment, therapists identified the reasons they believed termination occurred for all clients in the sample. Results demonstrate that total sessions attended and missed predict premature termination, whereas distress change does not. Additionally, clients who were believed to accomplish goals do show greater change. However, therapists’ indicated that over half of clients did not reach goals at termination and they did not perceive nonattendance at last session to equate to drop out in all cases. Implications are discussed with respect to understanding why clients’ terminate, therapeutic goal conceptualization, and review of goals during termination in time-limited psychotherapy.

Keywords:

• Termination
• outcomes at termination
• reasons for termination
• termination in brief therapy
• treatment goals at termination

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Theodore T. Bartholomew is an assistant professor of Counseling Psychology in the Department of Educational Studies at Purdue University. Currently, he is also the secretary of the Society for Cross-Cultural Research. His research interests include psychotherapy processes and outcome (e.g., cultural factors, positive processes, and therapist effects), culturally diverse conceptualizations of mental illness and psychological healing, mental health in Namibia, refugee mental health, and the application of diverse methodologies in psychological research.

Allison J. Lockard is an assistant professor of Education at Bucknell University. Her research interests are focused on college student mental health and the impact of college mental health counseling on student functioning and academic outcomes.

Susan F. Folger is a staff member at Ohio University’s Counseling and Psychological Services. She enjoys working with college students to promote their well-being and growth. Her particular clinical interests include interpersonal violence, grief and loss, social justice, and identity development.

Blakely E. Low is a staff psychologist at Counseling and Psychological Services (CAPS) at the University of Arkansas, where she currently serves as the Group Therapy Coordinator. Her research interests include sport psychology (clinical and performance issues), mindfulness, and program evaluation related to clinical service delivery.

Andrea D. Poet is a staff psychologist at the Pennsylvania State University Counseling and Psychological Services. Clinically, Her interests include working with individuals struggling with eating disorders, sexual trauma, and cultural concerns. In addition, her research interests include issues around diversity, such as systems of oppression and discrimination, race, gender, and social class.

Brett E. Scofield is the associate director of the Center for Counseling and Psychological Services (CAPS) at The Pennsylvania State University. He is also a research team member of the Collegiate Mental Health (CCMH), a practice–research network of more than 400 college and university counseling centers. His research focus includes college student mental health.

Benjamin D. Locke is the senior director of the Center for Counseling and Psychological Services (CAPS) at The Pennsylvania State University. He is also the executive director of the Center for Collegiate Mental Health (CCMH), a practice–research network of more than 400 college and university counseling centers. His research focus is on college student mental health.

Acknowledgement

The authors would like to thank Andres Pérez-Rojas, Ph.D. and Jeffrey Hayes, Ph.D. for offering feedback on earlier drafts of this manuscript.