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Article Excerpt
Premature termination from counseling is a significant problem for the field of counseling. In contrast to previous research on counseling dropout, in this study, the authors examined the impact of family participation and constellation as possible mediators. Archival data were collected from 113 client files at a non-profit community mental health agency in North Texas and chi square analyses were conducted. Results indicated that family participation was an important factor in counseling continuation. Implications for clinical practice, research, training, and public policy are discussed.
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A consistent problem that affects both clients and mental health professionals at all levels of experience and training is premature termination. Numerous studies have demonstrated a large dropout rate from counseling with an average premature termination rate of about 50% (Wierzbicki & Pekarik, 1993). Although ending counseling in and of itself does not suggest therapeutic failure, concluding counseling prior to counselor recommendations and without achieving agreed upon goals is not commonly considered a success. This leads investigators to question why attrition rates are so high.
AWARENESS OF SERVICE DELIVERY PROBLEMS
Client Dropout
Premature terminators or "dropouts" from counseling are connected to numerous difficulties for the mental health system. Of these challenges, the sense of dejection and dissatisfaction that may occur for both clients and counselors is especially salient. Moreover, economic losses resulting from the forfeiture of payments from absent clients, along with the subsequent expenditures connected to processing and following up on discontinuers, can be substantial (Wiezerbicki & Pekarik, 1993). Premature termination may also lead to declines in perceptions of effectiveness among service providers and to frustration, self-doubt (Sledge, Moras, Hartley & Levine, 1990; Wiezerbicki & Pekarik), and ultimately attrition of counselors themselves from the field (Pekarik, 1985). Early counseling discontinuance clearly is a pervasive problem for mental health service providers.
Defining Premature Termination
One of the primary problems in investigations of counseling discontinuation to date has been the lack of a cohesive way of defining the problem (Dew & Bickman, 2005). Some investigators emphasized the number of sessions attended (Epperson, Bushway, & Warman, 1983; Nock & Kazdin, 2001) or defined arbitrary categories for assessing dropout as a function of differing lengths of counseling (Beck, et al., 1987; Shuman & Shapiro, 2002). Other studies included those who miss their first scheduled session as premature terminators (Richmond, 1992) while still others rejected them (Kokotovic & Tracey, 1987). Perhaps the most efficient way of defining dropout is through an investigation of a combination of factors. Thus, Bergin and Garfield (1994) defined a premature terminator in individual treatment as "one who has been accepted for psychotherapy, who actually has at least one session of therapy, and who discontinues treatment on his or her own initiative by failing to come for any future arranged visits with the therapist" (p. 195). Because of the comprehensiveness of this definition, it will be used in the current investigation.
THE PHENOMENON OF ATTRITION
Historically, researchers examining attrition have scrutinized such factors as characteristics of the counselor (Chung, Pardeck, & Murphy, 1995), pathology-based factors (McKay, Gonzalez, Quintana, Kim, & Abdul-Adil, 1999; Sheppard, Smith & Rosenbaum, 1988), client demographics (Watkins & Terrell, 1988), and racial/cultural match between counselor and client (Sue, McKinney, Allen & Hall, 1974; Sue, McKinney & Allen, 1976). However, in focusing on...
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