Practicum Monday: Premature Termination in Counseling

Today in Practicum class we discuss matters around ending treatment or counseling relationships with our counselees. The one that causes interns most consternation is the premature termination by clients after only one session. The trainee is left to wonder why. “Did I fail to connect? Did I say something to offend them? What did I do wrong? Did they figure out I don’t know what I’m doing?” Usually, they report feeling like a failure. Here’s a secret: even experienced therapists feel this at times as well.

Well, let’s start with the murky data. Brogan, Prochaska & Prochaska (v. 36 (1999) of Psychotherapy: Theory, Research, Practice & Training, 105-113) report that various studies reveal a premature termination after just one session stands somewhere between 20 and 57%. Some 30-60% drop out before the counselor thinks they should. And a meta-analytic study (of 125 studies) reports a premature dropout rate of 47%. Even though our research in this area is still weak (we don’t really know what factors to use to report premature dropout), the numbers are pretty high.

So, why do people stop counseling before they should? Why do our clients not return? We really don’t know as much as we would like. We do know that individuals in certain demographics are more likely (lower SES, lower education, minority status) to drop out. But even here, we don’t really know why. Is it client-counselor mismatch? Lack of understanding of the process of counseling? Lack of hope?

We do know that several factors do NOT seem to relate to premature termination (therapy mode, setting, and ages of clients).

While our research is still cloudy, it makes sense to consider the combination of client factors (motivation for personal growth, ability to have insight), environmental factors (financial status, family support or detraction, cultural support), and counselor factors (capacity to empathize and connect with the client’s perceptions, diagnostic and listening skills).

Trainees can ask these questions in their postmortems:

1. Did we share an understanding of the type and severity of the problems?
2. Did I give evidence that I understand their experience (beyond saying so)?
3. Did I give some evidence of the path forward and hope for the future without overselling it?
4. Did I acknowledge potential pit-falls, hopelessness, fear?
5. Was my client the “customer” or was someone else demanding it (e.g. parent)?   


Filed under counseling, counseling science, Psychology, teaching counseling

5 responses to “Practicum Monday: Premature Termination in Counseling

  1. I was taught in grad school that “there is no such thing as a resistant client… only a resistant therapist”. Buying into that argument meant I struggled for years feeling every client who dropped out of therapy early WAS my personal failure. I no longer believe it.

    Now I ask myself: what was the client a customer for? Sometimes the failure IS mine: I wasn’t able to connect in a way that allowed me to understand what the client was searching for. Sometimes the client wasn’t a customer for change; or not a customer at my prices (time or finances); or only interesting in “buying” enough sessions to appease a spouse, parent, or significant other.

  2. Cantika Marlangen

    May I use this as one of my sources for my papers? Thanks 🙂

  3. Samay Ahadi

    I had a question about practicum, how would you recommend devout religious students who want to gain a masters in clinical psychology/counselling deal with cases of adultery, homosexual acts, and abortion? I’m currently in my bachelors program but this is dissuading me from going into clinical therapy simply to avoid such situations where I’d have to promote or help a patient facilitate his way through a sin. I don’t mind allowing a homosexual accept him/herself without promoting the act in of itself, my problem arises in patients who want assurance that what they are doing is right or they shouldn’t feel guilty in the act.

    • Dear Samay, thank you for your question. It is a good one. Let me ask your question in a different way. If someone came to you and was seeking to become a clergy member of a denomination or faith that wasn’t your own…would you feel you could help him or her work through feelings and decisions? How would this feel different to you than the question you posed. Your last sentence is the one that I will respond to: I don’t think it is your job to give assurance or to remove guilt in any problem as a therapist. I want to explore guilt, I want to explore anxieties. I want to help people come to terms with their choices and their experiences. I’m not responsible for their choices, whether I agree or disagree with them.

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