PPRNet Clinical summary: Termination of Psychotherapy

Regardless of length, modality, setting or orientation, termination of psychotherapy is potentially critical to every therapist, patient, and their work together. Terminations can be due to a mutual decision between therapist and patient, usually because the patient achieved their treatment goals, a unilateral decision by patients, which is similar to premature termination or drop-out caused by dissatisfaction, forced termination by the therapist leaving or changing their work, which sometimes leads to transfers to another therapist or facility. Despite its importance and inevitability (every therapy faces termination), there is relatively little research on the topic. In this systematic review of 67 studies on termination, Rabinowitz and colleagues focused on what is known from research. Reasons for psychotherapy termination varied widely between patients and therapists. Patients reported that external reasons (changes in life circumstances of the patient) accounted for 28% to 54.6% of terminations. However, therapists reported that only 11.5% to 40.2% of terminations occurred due to external factors of the patient. While 40% to 53% of patients stated that termination was due having successfully met their therapy goals, only 11.5% to 27% of therapists felt that termination was due to patients meeting their goals. Beyond eternal factors and goal achievement, 25% to 39% of patients indicated that they terminated therapy due to dissatisfaction with the treatment or therapist. High therapeutic alliance was associated with mutual and planned terminations, whereas ruptures in the therapeutic alliance were associated with unilateral terminations. Some research found that about 40% of treatments ended on time as planned, 37% ended earlier than planned, and 23% ended later than planned. Earlier and later than planned terminations were associated with greater patient dissatisfaction. Patients often had positive responses related to mutual and planned terminations, but they tended to have negative emotional responses to forced or premature terminations. Therapist-initiated terminations were associated with patients feeling hurt and angry. Therapists felt pride and accomplishment with patients’ success and mutual termination, but they also might feel sadness and anxiety, especially if the therapeutic relationship was strong. Forced, untimely terminations initiated by patients evoked anger, frustration, and guilt, especially in student therapists.

Practice Implications 

Successful terminations typically require therapists and patients actively talking about the process. This involves a collaborative agreement between the patient and therapist that the therapeutic relationship is a meaningful topic for discussion. Successful terminations require a good therapeutic alliance in which patients and therapists have a meaningful discussion about their successes in therapy, their regrets about therapy, and the meaning to them of losing the therapeutic relationship.

Rabinowitz, Y.L., Yim, B., & Muran, J.C. (2025). Termination of psychotherapy: A systematic review. Cogent Mental Health, 4(1), 1-25. https://doi.org/10.1080/28324765.2025.2535626