Premature Termination: When clients leave early

Just as I didn't blog for several months with no discussion or mention of my upcoming absence, many times clients will terminate therapy with no mention of their intentions. Research shows that the average number of therapy sessions varies from one to four sessions. One session! Meaning as a therapist, you have a short time period to make a sufficient impact.

Premature termination happens quite often with rates hovering around 47%. Meaning more than half of clients will terminate before they see significant progress. A harrowing statistic but one that emphasizes the importance of therapists actively engaging clients in an effort to increase treatment retention. One of the best articles I found on the subject was published in the 2005 Harvard Review of Psychiatry.

Premature termination is "a client's (patient’s) decision to end therapy, contrary to both the therapist’s current recommendation and the initial agreement between client (patient) and therapist." I would like to include a lack of significant progress by the time of termination in that definition. I typically think of significant progress as a significant drop in Beck Depression Inventory or Outcome questionnaire, etc. While "significant progress" may be included in the initial agreement between client and therapist, a client's definition of significant progress may be different than the initial plan.

Discussing premature termination is important because ultimately it hurts everyone involved in the therapeutic process. First of all, the client is impacted as they ultimately didn't experience successful treatment and may likely feel even more discouraged than when entering therapy. This is particularly true with clients experiencing disorders such as anxiety and PTSD in which avoidance is the essence of their presenting problem. When these clients prematurely terminate, they may experience a temporary reduction in symptoms because they are no longer discussing upsetting issues. However, their symptoms come back very quickly and often much worse than before.

Second, from my experience as a therapist, one of the most frustrating events is when clients terminate early. Although it takes much more effort and time for longer term clients, I always feel that clients just showing up to therapy speaks volumes about their engagement and sometimes my abilities as a therapist. When clients leave treatment early, it often makes the therapist question their skill and ability as a clinician. This is particularly true with new therapists. That lack of early career success may lead to a lack of confidence and impact a therapist's ability to successfully work with other clients.

What may be other impacts of premature termination? How can clients continue to engage in therapy despite the difficult nature of therapy? Next post will continue to discuss this topic and ways that therapists can help increase therapy retention.