The why, the how, and the what next: A qualitative investigation of premature termination from psychotherapy

This qualitative study investigated the complex phenomenon of premature termination from psychotherapy, exploring the reasons for patients' decisions to end therapy, their methods of communicating this decision, and the subsequent long-term impact on their willingness to engage in future mental health treatment. Data were collected through semi-structured interviews with 14 Israeli adults who had prematurely and unilaterally terminated individual, in-person psychotherapy. An iterative content analysis approach was used for data analysis. Key themes identified as precipitating termination included unmet expectations, difficulties in the therapeutic alliance, negative therapist behaviors, logistical and financial barriers, and experiences of emotional overwhelm. Patients communicated termination through disappearance, phone notification, or explicit discussion during a session. Immediate responses varied from therapist non-contact to insistence on continuation, with patients experiencing relief or negative affect. Long-term impacts highlighted a general reluctance to seek future therapy, though some reported corrective therapeutic experiences. These findings underscore the critical importance of addressing patient expectations, fostering robust therapeutic alliances, and navigating termination discussions with sensitivity and respect for patient autonomy to improve treatment engagement and outcomes.