First Advisor

Maria Talbott

Date of Publication

Fall 11-21-2019

Document Type


Degree Name

Doctor of Philosophy (Ph.D.) in Social Work and Social Research


Social Science




Psychotherapy -- Failure, Psychotherapy patients -- Attitudes, Psychotherapy -- Termination, Psychotherapist and patient, Psychotherapists -- Evaluation



Physical Description

1 online resource (vii, 171 pages)


Attrition in psychotherapy, also known as dropout, is a problem that affects clients who terminate, their families, therapists, mental health systems, and the overall community. Research on attrition is vast. However, the majority of this research has been done post hoc, relied on quantitative methods, and looked primarily at client demographic variables as the predictors of attrition. This has resulted in inconsistent findings, offers little to no useful information about attrition, and appears to blame clients for failed therapy. There has been little research on attrition from the perspective of clients who terminate. This study was designed to answer the question, why do clients choose to terminate therapy prematurely? Qualitative methods were used. Twelve participants engaged in in-depth one-on-one interviews. The interviews were transcribed and analyzed using Constructivist Grounded Theory methodology. In-session and out-of-session behaviors by therapists were found to be the key reasons participants chose to end therapy. Experiencing invalidation (rejection of a person's experiences, emotions, thoughts, and perceptions), invalidation of identity (rejections based on a person's sexual identity), invalidation of culture (rejections based on a person's culture), problems not being solved, and not feeling valued by the therapist were key factors in participants' decisions to terminate therapy. Immediate and long-term consequences of these experiences, including questioning sanity, feeling anger, feeling like a burden, increased pain and despair, prolonging of suffering, and experiencing the loss of an important opportunity are also addressed. Implications and recommendations for theory, research, education, practice, and social work are discussed.


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