Premature Termination of Psychotherapy in Outpatient Clinic Settings: Structural effects of Patients’ Expectations, Treatment Tolerance, Therapists’ Competencies and Therapeutic Alliance

A great number of patients leave psychotherapy prior to the end of treatment. The present study predicts the premature termination of individual psychotherapy based on patients’ expectations and tolerance and therapists’ competencies with the mediating role of therapeutic alliance.

In this descriptive cross-sectional study, 317 patients referred to Mental Health Clinics, Pain Clinics and Substance Use Treatment Centers in Mashhad, Iran were selected by random sampling. The data were collected by Distress/Endorsement Validation Scale, Working Alliance Inventory-Short Revised, the Milwaukee Psychotherapy Expectations Questionnaire, and Outcome Questionnaire. The data were analyzed by SPSS-19 and structural equation modeling with LISREL-8.80 software.

The examined model indicated good fitness for the data observed (RMSEA=0.02, GFI=0.99, AGFI=0.99, NFI=1, CFI=1, IFI=1, RMR=0.00253, P value=0.90). Psychotherapy expectations (γ=-0.40) and therapists’ competencies (γ=-0.29) directly influenced the premature termination of individual psychotherapy. Treatment tolerance (γ=-0.17) directly affected the premature termination of individual psychotherapy. Therapeutic alliance (β=-0.13) had an impact on the premature termination of individual psychotherapy. Psychotherapy expectations (γ=0.42) and therapists’ competencies (γ=0.54) significantly influenced the therapeutic alliance, thereby affecting the premature termination of individual psychotherapy.

Psychotherapy expectations, treatment tolerance, therapists’ competencies and therapeutic alliance interactively effect in the premature termination of psychotherapy and therefore on the health outcomes of patients. This finding did develop insights into designing the tailored interventions to resolve premature termination and improve the outcomes of psychotherapeutic interventions. Furthermore, clinicians must be concerned with these factors in the clinics and healthcare centers to enhance the successful termination of psychotherapy.