Ways to prevent premature termination of counselling

Research shows that 20 percent of clients end therapy prematurely. In their book “Premature Termination in Psychotherapy,” Joshua K. Swift, PhD, and Roger Greenberg, PhD, list eight practical strategies with strong empirical support for reducing the likelihood of early dropout.

Eight strategies to reduce dropout rates

The strategies are simple, but many are not emphasized in training and often aren’t practiced by seasoned clinicians, say the authors.

  1. Provide role induction: how therapy works?: 

Clients who are confused about how therapy works may be more likely to drop out. Educate them about appropriate therapy behavior — what you expect from the client and what the client can expect from you.

  1. Incorporate client preferences into the treatment decision-making process: “how do you prefer to work?”. Help clients feel more invested in therapy by talking with them about treatment options. Balance their preferences with the best treatment options.
  1. Help plan for appropriate termination: How / when to end?. 

Give your clients information on how long treatment typically lasts and discuss a possible timeline for their therapy. Discussing an endpoint promotes a client’s commitment to treatment and can help him or her feel comfortable speaking up if they have thoughts of ending therapy early.

  1. Provide education about patterns of change: How and what will change?: Forewarn clients that they might feel tempted to end therapy prematurely when they experience a setback or experience “surface-level” improvements and feel the work is done.
  2. Strengthen early hope: What to expect and hope for? When clients have hope that therapy will produce change, they are more committed and more likely to work past the type of setbacks that can lead to dropout.
  1. Enhance motivation for treatment:  How confident are you that we meet your goals for sessions? How committed are you? 

Directly address clients’ motivation from session to session and use motivational interviewing and other strategies to help them continue coming back even when they experience setbacks.

  1. Foster the therapeutic alliance: “Do you feel i am getting you and what you need?” Be warm, empathic and accepting and pay close attention to how a client’s needs and expectations may shift. Repair ruptures in the therapeutic bond as soon as they occur.
  1. Discuss treatment progress with your clients: Are we on the right path? Making a progress? Studies show that therapists aren’t always the best predictors of patient progress. That’s why clinicians should also have a system of client feedback in place, either through in-session discussion or objective self-reports, to gauge progress and identify problems before they result in dropout.

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