Therapist Reported Reasons for Client Termination: A Content Analysis of Termination Reports

Bischoff, Thomas; Krenicki, Lydia; Tambling, Rachel B.

doi:10.1080/01926187.2019.1684216

Cited by 2 publications

(2 citation statements)

References 54 publications

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“…Such scenarios may be unexpected or difficult to anticipate, such as clinician death or disability, job loss, facility closure, or adverse utilization review. Circumstantial, situational, and/or unknown reasons are also commonly cited reasons for termination (e.g., Bischoff et al, 2020; Renk & Dinger, 2002; Todd et al, 2003). Studies on termination reasoning are challenging to interpret and generalize, as reason(s) for termination are not always clear, and, if reasons are given, clients and clinicians may not always agree (Hunsley et al, 1999).…”

Section: Who Decides To Terminate and Why?mentioning

confidence: 99%

Ethical considerations for complex termination.

Schwartz-Mette,

Rowan

2024

Practice Innovations

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Guidance exists for the mental health clinician approaching termination, the bulk of which pertains to mutually agreed upon, planned cessation of treatment that occurs as a collaborative process between client and clinician. Challenges arise, however, when facing a client's or clinician's unexpected decision to terminate, necessitating thoughtful analysis of ethical responsibilities, balanced with the acknowledgment that complex termination does not necessitate unreasonable extensions of clinicians' professional obligations. The ethics codes of the mental health professions each provide general guidance that may be used to flexibly respond in such contexts. This article first reviews this guidance as a foundation for exploring complex termination circumstances, followed by considerations for navigating ethical quandaries therein. General guidance is then provided for proactively preparing for termination, whether anticipated or not. Clinical Impact StatementThis article explores complex termination scenarios, balancing attention to clinicians' ethical responsibilities, expectations for client behavior, client and clinician autonomy and well-being, and context. Vignettes are used to illustrate ethical standards in action, as well as the challenges inherent in complex termination circumstances.

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Section: Who Decides To Terminate and Why?mentioning

confidence: 99%

Ethical considerations for complex termination.

Schwartz-Mette,

Rowan

2024

Practice Innovations

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“…While there are patient-related and contextual risk factors for treatment termination, such as having more severe problems, patients’ educational level, and clinical setting, several studies have identified an inadequate therapeutic alliance as a risk factor for premature termination (Anderson et al, 2019; Sharf et al, 2010). In a recent study by Bischoff et al (2020) that analyzed psychotherapists’ reports on premature treatment termination, perceived improvement was again the most common reason for terminating treatment, but it was also very common that patients terminated treatment for unknown reasons. It is likely that some of these patients were dissatisfied with the treatment or the psychotherapist but were hesitant to provide this information.…”

Section: Introductionmentioning

confidence: 99%

Psychotherapist variables that may lead to treatment failure or termination—A qualitative analysis of patients’ perspectives.

Alfonsson,

Fagernäs,

Sjöstrand

et al. 2023

Psychotherapy

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A substantial number of patients do not improve from psychotherapy, some even deteriorate, and some terminate treatment prematurely. Identifying therapist variables that may lead to treatment failures from patients’ perspectives can inform how psychotherapists can increase effectiveness. Using a semistructured protocol, we interviewed 24 patients who had experienced unsatisfying individual face-to-face psychotherapy within the last 2 years. The study procedures were guided by the consolidated criteria for reporting qualitative research. The manifest content analysis provided 13 subcategories grouped into four categories: (a) psychotherapists’ negative traits (inflexible, unengaged, unemphatic, insecure), (b) unprofessionalism (superficial, violating personal boundaries, breaking confidentiality, nontransparent), (c) incompetence (unstructured, poor assessment or understanding, poor knowledge, too passive), and (d) mismatch (therapist–patient mismatch). To reduce the risk of treatment failure, psychotherapists may need a multifaceted set of relational skills, theoretical and technical competence, ethical sensitivity, and engagement. Some of the identified subcategories were complex constructs (e.g., unengaged) that may need time and effort to develop for psychotherapists. Other identified subcategories were obvious inappropriate behaviors in professional psychotherapy (e.g., breaking confidentiality). However, the categories found in this study need further quantitative investigation to assess the validity, frequency, and relative impact on treatment outcomes.

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Therapist Reported Reasons for Client Termination: A Content Analysis of Termination Reports

Cited by 2 publications

References 54 publications

Ethical considerations for complex termination.

Ethical considerations for complex termination.

Psychotherapist variables that may lead to treatment failure or termination—A qualitative analysis of patients’ perspectives.

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