Predicting Clinician and Client Decisions in Forced Termination

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Termination, or the end of psychotherapy (Hill, 2009), represents a point in the therapeutic process at which clinicians and clients face important decisions. The way in which termination occurs varies depending upon characteristics of the client, clinician, and treatment context. Forced termination refers to the end of psychotherapy because the clinician is leaving, rather than because of client factors such as symptom reduction (Fair & Bressler, 1992; Zuckerman & Mitchell, 2004). This study focuses on outcomes of forced termination resulting when graduate student clinicians completed a yearlong psychotherapy externship. This type of forced termination is a common experience in training clinics (Zuckerman & Mitchell, 2004) that has been related to strong negative client reactions (Penn, 1990; Zahourek & Crawford, 1978). As a result, it is important to better understand the frequency with which student clinicians recommend that their adult clients terminate treatment versus transfer to a new therapist, the proportion of clients who make a successful versus an unsuccessful transfer, and factors that predict both of these decisions. The goal of this study is to provide psychology training clinics with valuable information for supervisors and student clinicians to consider when planning treatment goals and preparing for forced termination.

This research describes two decision points in the process of forced termination: the clinician’s decision to recommend that the client terminate versus transfer to a new clinician, and for those clients recommended for transfer, their decision to adhere to this recommendation by making a successful transfer. Data were collected via a systematic review of 327 medical records at a psychology training clinic. Participants are 136 adult psychotherapy clients seen by 73 student clinicians over an 8-year period. This study describes the proportion of clients who are recommended for transfer and termination following forced termination, and the prevalence of successful (i.e., meeting with the new clinician at least four times within the first three months of the transfer) and unsuccessful (i.e., meeting less often than that or not at all) transfers among those who were recommended for transfer. Lastly, this study examines client demographic characteristics, symptom reduction, and length of therapy as predictors of clinicians’ treatment recommendations for termination or transfer, and of successful or unsuccessful transfer, in the context of forced termination in a training clinic.