Therapeutic factors and premature termination in a university-based counseling training clinic
Walker, Rashada Nicole
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There is significant agreement that premature termination represents a major problem for individuals providing clinical services. There is some agreement that clients who drop out of psychotherapy do so before they are able to gain the full benefits of therapy including long-term symptom improvement. However, we are still unclear regarding how and why clients terminate from treatment prematurely. Despite years of research investigating factors that may predict premature termination, findings are variable. In psychotherapy, it is a recognized belief that there are factors common to all theories that contribute significantly to outcome. The current study explores the predictability of such factors, specifically the working alliance and expectations. A final predictive variable included was client symptom severity. Considering that most studies on premature termination were conducted in outpatient settings, the current study investigates this construct in a university-based counseling training clinic. Premature termination was defined as a participant failing to attend their last scheduled appointment. Instruments used were the Brief Symptom Inventory (BSI), Working Alliance Inventory- Long Version Form C (Client) and Form T (Therapist), and the Expectation for Counseling Success Questionnaire (ECS). Four research questions were addressed: (1) Does the strength of the working alliance as perceived by the therapist predict premature termination? (2) Does the strength of the working alliance as perceived by the client predict premature termination? (3) Does client expectation for success predict premature termination? And (4) Does client symptom severity predict premature termination? Data was collected at Intake, Session 3, and Session 10. Participants were 48 clients receiving individual counseling services at a university-based counseling training clinic. Master’s and doctoral level clinicians providing individual counseling services participated in this study as well. Binary logistic regression was used to analyze data. Results of the current investigation indicated that client’s perception of the working alliance was not predictive of premature termination. Aspects of client expectations for success were predictive of premature termination as well as two symptom dimensions of the BSI. Specifically, clients who expected their lives to improve with counseling were more likely to terminate treatment prematurely. Clients endorsing high hostility at Intake and clients endorsing low levels of somatic symptoms at Session 3 were more likely to terminate treatment prematurely.