Date of Award

2026

Document Type

Dissertation

Degree Name

Doctor of Psychology (PsyD)

Department

Psychology

First Advisor

Lauren Lipner, Ph.D.

Second Advisor

Michael Katz, Ph.D.

Third Advisor

Marc Diener, Ph.D.

Abstract

Premature unilateral termination has been estimated to occur in approximately 20% of patients seeking psychotherapy. Research has identified a variety of factors including patient, therapist and treatment variables that may contribute to psychotherapy dropout. There is currently quite limited research on patients’ perspective of premature termination, with much of our understanding based on therapist’s perspective. Although therapist perspectives are an important source of information regarding premature termination, therapist judgments about patient progress are often inaccurate, and therapists consistently struggle with foreseeing unilateral termination. In addition, therapists have been found to attribute premature termination more to patient factors than their own shortcomings. This systematic review aims to collate the existing literature with the goal of creating a comprehensive, multi-level, organized catalog of patient-identified reasons for premature psychotherapy termination. Elucidating the various reasons for premature unilateral termination may have significant training implications for future clinicians with regard to preempting unilateral and premature discontinuation. This study yielded a myriad of different reasons for premature termination across 55 studies. Reasons were organized into 5 overarching categories and 21 subcategories, including structural barriers (k=44), dissatisfaction (k=40), attitudinal barriers (k=30), improvement (k=27), and social factors (k=8).

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