[Premature termination--a multifactoral phenomenon]

Twelve drop out cases in psychodynamic short term therapies according to the focus of cyclic maladaptive pattern by Strupp and Binder (CMP 1984) are reviewed regarding initial diagnostics, tape-recorded therapy sessions, and supervision records. Predictors of premature termination of therapy such as initially rated patients' therapy motivation, narcissistic personality traits, but also characteristics of interpersonal behavior of both patient and therapist are examined and discussed. Particularly important are the therapeutic alliance and narcissistic patients' difficulties to relate personally to their therapists instead of enacting projective dynamics of idealization and devaluation. Therapists frequently tend to respond to them by subconscious display of hostile countertransference. Four patterns of dynamics of therapy drop outs are described.