PPRNet Clinical summary: Patients’ Experiences of Premature Termination from Psychotherapy

Premature termination from psychotherapy refers to a patient who unilaterally discontinues therapy, rather than doing so collaboratively with the therapist. Unilateral termination represents a substantial proportion of patients, ranging from 19.7% to 46.86% across different populations and treatment contexts. In most cases, premature termination indicates a failure of the treatment to help patients. While research has focused on various predictors of termination, few, if any, studies have asked patients about their experiences. In this study by Lipner and colleagues, the authors interviewed 14 patients who terminated therapy prematurely and unilaterally, and they conducted a qualitative analysis of the interviews. Four key themes emerged from patients’ termination experiences. First, patients discussed the factors that led to the premature termination of their treatment. This included (a) that the therapy failed to meet their expectations for progress, (b) difficulties in the therapeutic relationship, like unresolved therapeutic alliance ruptures and feeling misunderstood by the therapist, (c) problematic therapist behaviours including inappropriate self-disclosure or excessive passivity, (d) financial barriers, and (e) feeling emotionally overwhelmed by interventions like exposure-based therapies. The second theme concerned termination methods. Many patients simply disappeared from therapy, but a few had an explicit discussion with the therapist about termination. Having a discussion with a supportive therapist about termination was the most satisfying to patients. The third theme that emerged was the immediate response and impact. This included therapists’ responses to termination. Therapists who ghosted patients or who insisted that patients continue therapy caused the most distress and discomfort for patients who felt invalidated, whereas therapists who were supportive and understanding were most appreciated by patients. Patients described emotional responses to the termination, including relief, but also negative emotions related to doubt regarding the utility of any future therapy. The fourth theme was related to the long-term impacts of the termination. Primarily, this was related to patient reluctance to seek future therapy, especially if the experience of the termination was negative. A minority of participants described that a subsequent therapy provided them with a corrective experience.

Practice Implications 

Therapists should be attuned to negative therapeutic processes like therapeutic alliance ruptures to prevent premature termination. Negative emotions in patients may be heightened by therapists who pressure patients to continue therapy despite the patients’ explicit decision to leave. Therapists should carefully balance expressing genuine concern with demonstrating respect for the patient’s autonomy and validating their experiences of treatment dissatisfaction. This might involve creating a reflective space to explore the desire to terminate collaboratively.

Lipner,L.M., Katz, M., Tzor, K., Amar, A., & Yonatan-Leus, R. (2025): The why, the how, and the what next: A qualitative investigation of premature termination from psychotherapy, Psychotherapy Research, https://doi.org/10.1080/10503307.2025.2551067