Predicting termination type from client-therapist agreement on the severity of the presenting problem

Discrepancies between clients and therapists in their perceptions of the severity of the client's presenting problem were tested for their utility in predicting both premature and mutual termination. Eight problem types were examined, and analyses were conducted within a survival analysis framework. Across the majority of problem types, results indicated that greater discrepancies between clients and therapists lowered the odds of mutual termination; however, greater discrepancies did not in turn increase the odds of premature termination. Interaction tests of client-therapist discrepancy with a variable that changes over time, accruing number of sessions, offer some qualifications. In particular, in the case of two problem types--depression and family-of-origin--when large discrepancies occurred, the likelihood of premature termination maintained at an equal rate throughout treatment, whereas when discrepancies were moderate or absent, the likelihood of premature termination diminished. Implications for clinicians and researchers point to enhancement of the therapeutic alliance as a means of reducing the probability of premature termination and increasing the probability of mutual termination. (PsycINFO Database Record (c) 2010 APA, all rights reserved).