Premature termination
Regarding the April article "Are your clients leaving too soon?", the notion of "premature termination" is a core conceptual flaw in mainstream clinical psychology. This idea disturbed me in graduate training, but in the 40 years since, I was fortunate to practice in a more open-minded counseling psychology setting, and then to move to a rural area where I felt free to apply my own client-centered approach. I have come to understand that, as I aim to offer something useful in each and every session, I never feel rejected or disappointed when a client chooses not to return. My narcissism has not been wounded because something has always been accomplished, and while I decide how effective my own work has been, I allow my clients to own the assessment of what the session has done for them. Using this perspective, they feel very safe with me, with the result that 95 percent return after the initial session and over 80 percent continue for more than a year, though not necessarily strictly once a week. Technically, while I believe that "premature termination," like "dropping out of psychotherapy" or "failure to complete treatment," is a meaningless concept, almost nothing of that kind occurs in my practice.
Clients consult us for a service which they will or will not find useful. Every time they leave a session, it is up to them whether or not it will serve them to return (unless, of course, the treatment is mandatory). In my opinion, understanding where the power lies in the therapeutic relationship is fundamental to effective, ethical professional practice. I can say that now without caring if my professors agree with me or not.
Sally E. McCollum, PhD
Ketchum, Idaho
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