Reasons for Terminating Psychotherapy: Client and Therapist Perspectives
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.016 | 0.035 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.005 | 0.002 |
| Scholarly communication | 0.006 | 0.002 |
| Open science | 0.002 | 0.004 |
| Research integrity | 0.002 | 0.004 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".