Exploring relationships among termination status, therapy outcome and client satisfaction

Frederick P. Gager (2003)

Premature termination (dropout) from psychotherapy is a common event in both public and private outpatient settings, resulting in considerable costs to both psychotherapy clients and treatment providers. Although the use of therapist judgement to classify termination status (completer versus dropout) has high face validity, this method of defining dropout ignores the perspective of the client. This study examined differences in therapist and client perspectives of psychotherapy termination through the analysis of data collected from community mental health, private practice and family service/child guidance settings. Clients and therapists disagreed about the status of psychotherapy termination in 17% of the study cases. Clients disagreed with therapists in 14% of the cases defined by the therapist as incomplete and in 23% of the cases defined by the therapist as complete. Clients who agreed with therapists that treatment was complete displayed lower final symptom ratings and greater levels of treatment satisfaction than did clients from pairings who agreed that therapy ended in dropout. Completion agreement clients attended more sessions and had lower final Brief Symptom Inventory scores than dropout agreement cases. Client/therapist dyads that disagreed about termination status tended to have symptom, satisfaction and treatment duration ratings between the extremes found within the completion agreement and dropout agreement groups. These results are consistent with previous research findings that reported outcome differences between treatment completers and dropouts and provide support for the assumption that not all therapy clients are fully served by treatment. Completion agreement versus dropout agreement group membership was predicted by education, initial pathology and age with older, more educated and less pathological clients associated with the completion agreement group. These results replicate previous findings that connected socioeconomic factors to termination status. Study results suggest that the clearest definition of treatment dropout may be obtained by considering both therapist and client termination perspectives.