whether it’s something they are doing or
not doing. This is a difficult profession.
There is an art to this, as well as a science.
The fit isn’t always as good as it could be.
To be able to take a step back at times
and to look at what you are doing and
who you are is an important element in
all of this. Elicit feedback from clients on
a regular basis about how you are doing
and whether there is something getting
in the way of where we want to go. One
of the hallmarks of a successful therapist
is to handle the ruptures in the therapy.
The smoother you can be, the better
outcomes you’ll get.
Swift: Therapists can learn from their
own mistakes. Also, if they have open
communication with clients, the client
will feel comfortable saying, ‘Hey, this
upset me,’ or ‘I was feeling like dropping
out.’ If you don’t get too demoralized or
defensive from a rupture or a dropout,
you can instead learn from it and grow
as a therapist.
Are certain types of therapy more
prone to dropouts?
Greenberg: One thing we found is that
Where is more research on
all of the brands of therapy seem to be
similar in terms of dropout. Psychologists
sometimes assume that one brand is
superior to another, but research on
outcomes shows that most brands have
very similar success rates. It parallels that
they have similar dropout rates.
Swift: It has become standard practice
to report dropout rates, but often there’s
nothing else reported with it. Such as:
What were the differences between
dropouts and completers in treatment A
and treatment B? We also need to gain a
deeper understanding of why clients are
deciding to drop out. Some of the good
qualitative studies that have followed
up with clients who have dropped
out are dated. Most of it often breaks
down to dissatisfaction, but we need a
way to break that down and get more
detail. What exactly did the therapist do
that was dissatisfying? What could the
therapist have done differently? We need
to give more depth to those questions,
and we need more research to develop
and test out these strategies. n
Slides, discussion questions, role-play
activities and other teaching materials are
available for each chapter of “Premature
Termination of Psychotherapy” at
• Barrett, M. S., Chua, W. J., Crits-Christoph, P., Gibbons, M. B., & Thomspon,
D. (2008). Early withdrawal from mental health treatment: Implications for
psychotherapy practice. Psychotherapy: Theory, Research, Practice, Training, 45,
• Swift, J. K., & Greenberg, R. P. (2012). Premature discontinuation in adult
psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology, 80,
• Swift, J. K., Greenberg, R. P., Whipple, J. L., & Kominiak, N. (2012). Practice
recommendations for reducing premature termination in therapy. Professional
Psychology: Research and Practice, 43, 379–387.
Dr. Joshua K. Swift Dr. Roger Greenberg