From therapy to mentoring: Study provides useful recommendations for reducing premature terminations

Swift, Joshua K.; Greenberg, Roger P.; Whipple, Jason L.; Kominiak, Nina (2012). Practice recommendations for reducing premature termination in therapy. Professional Psychology: Research and Practice, Vol 43(4),  379-387.

Abstract (from article)

• “Premature termination from therapy is a significant problem frequently encountered by practicing clinicians of all types.
• In fact, a recent meta-analytic review (J. K. Swift & R. P. Greenberg, 2012, Premature discontinuation in adult psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology. doi:10.1037/a0028226) of 669 studies found that approximately 20% of all clients drop out of treatment prematurely, with higher rates among some types of clients and in some settings.
• Although this dropout rate is lower than previously estimated, a significant number of clients are still prematurely terminating, and thus further research toward a solution is warranted.
• Here we present a conceptualization of premature termination based on perceived and anticipated costs and benefits and review 6 practice strategies for reducing premature termination in therapy.
• These strategies include providing education about duration and patterns of change, providing role induction, incorporating client preferences, strengthening early hope, fostering the therapeutic alliance, and assessing and discussing treatment progress.”

The six practice recommendations for reducing premature termination in therapy:

Provide Education About Duration and Patterns of Change

Make sure that you and your client are on the “same page” when it comes to expectations about treatment. While it is important to establish positive goals and illuminate the client’s awareness of their potential transformation, it is critical that the client is prepared and knows that there are many “waves” in the upcoming sea of change.

Provide Role Induction

Give the clients education about appropriate therapy behaviors before they begin their immersion into the process. Provide the client with the full spectrum of topics, code of conduct and exercises that the client can practice in stressful situations.

Incorporate Client Preferences

No two fingerprints are alike, just as your clients differ in their range of life experiences and origin of environment, as each case is a discovery in and of itself. Remember to ask the questions about what your clients prefer and keep a keen awareness of subtle cues your client is giving you.

Strengthen Early Hope

Early on in the relationship with your client, it is critical to establish a benchmark and goal to work towards, which is reasonable and possible within the context of their environment. By providing your client with clear examples of their future possibilities, it will assist them on becoming established within their treatment program.

Foster the Therapeutic Alliance

While there is not a universally agreed upon definition of the therapeutic alliance, it is essential to formulate trust with your clients. Establishing bonds through empathy and fostering the client’s hope for the possibility of change will reduce premature withdrawal from the treatment process. Provide a safe, predictable environment of refuge for your client and this action will assist you in opening the channels of communication.

Assess and Discuss Treatment Progress

Hold up the mirror of progress to your client frequently, which reflects the positive changes that your client accomplishes while in treatment. Often your client resides in a warped perception of their progress, not able to see even the minor accomplishments that are made. It is just as important to shed light on even the smallest amount of progress, as it is to reveal inappropriate behaviors or concepts.