Factors Influencing Psychotherapy Continuation and Premature Termination Based on Clients’ Lived Experiences: A Phenomenological Study

Nastaran Sadat  Ghasemi; Shahram Vaziri; Farah Lotfi Kashani; Saeed Imani

Authors

Nastaran Sadat Ghasemi Department of Psychology, UAE.C., Islamic Azad University, Dubai, United Arab Emirates. Author https://orcid.org/0009-0004-2945-9146
Shahram Vaziri Department of Psychology, Ro.C., Islamic Azad University, Roudehen, Iran. Corresponding Author https://orcid.org/0000-0001-5035-6054
Farah Lotfi Kashani Department of Psychology, Ro.C., Islamic Azad University, Roudehen, Iran Author https://orcid.org/0000-0003-3383-6931
Saeed Imani Department of Counseling, Faculty of Education and Psychology, Shahid Beheshti University, Tehran, Iran. Author https://orcid.org/0000-0001-5290-2995

Keywords:

Psychotherapy Retention, Psychotherapy Dropout, Premature Termination, Therapeutic Alliance, Client Experience, Phenomenology

Abstract

Objective: This study aimed to formulate the factors influencing psychotherapy continuation and premature termination based on the lived experiences of clients who had participated in individual psychotherapy.

Methods and Materials: This qualitative study employed a descriptive–interpretive phenomenological approach. Participants were 18 clients with experience of individual psychotherapy who were selected through criterion-based purposive sampling until data saturation was achieved. Data were collected through in-depth semi-structured interviews and analyzed using inductive thematic analysis in MAXQDA. The analysis focused on identifying recurrent experiential patterns associated with remaining in psychotherapy, disengaging from treatment, and strategies perceived by clients as facilitating sustained therapeutic participation.

Findings: Inductive analysis yielded five overarching themes, 12 organizing themes, and 36 basic themes. The overarching themes were: dynamics of client agency in maintaining psychotherapy continuation; quality of the therapeutic alliance as a mechanism of treatment retention; erosion of the therapeutic relationship and development of the premature termination process; contextual and environmental constraints affecting treatment continuation or dropout; and strategies for reconstructing and strengthening psychotherapy continuation. The findings indicated that sustained engagement in psychotherapy emerged from the interaction of individual, relational, organizational, and social factors. Premature termination was associated with the convergence of disruptions in the therapeutic alliance, diminished hope for meaningful change, and environmental or contextual barriers. Participants also identified goal readjustment, explicit discussion of the therapeutic relationship, continuous feedback, and flexibility in service delivery as important mechanisms for strengthening treatment retention.

Conclusion: Psychotherapy continuation and premature termination appear to be multidimensional processes shaped by the dynamic interaction of client agency, therapeutic relationship quality, contextual constraints, and service characteristics.