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The Relationship Between Therapeutic Alliance and Client Progress in Predicting Premature Termination in Counseling
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The purpose of the current study was to explore how client perceptions of the therapeutic alliance and client functioning develop over the course of therapy as they relate to premature termination. Adolescents and adults ranging in age from 13 to 73 years old completed the Outcome Rating Scale (ORS) and Session Rating Scale (SRS) during each therapy session. At the end of treatment, therapists indicated whether or not clients made sufficient progress and who initiated the termination. Clients making unilateral decisions to terminate without making sufficient progress were designated as terminating prematurely. For both therapeutic alliance and client functioning, a quadratic growth curve best captured change over time. Clients reporting a stronger therapeutic alliance at the end of the first therapy session and clients entering therapy without a clinical diagnosis were less likely to terminate prematurely; however, there was a significant interactive effect such that a stronger therapeutic alliance mitigated the increased risk associated with entering therapy with a clinical diagnosis. Over the course of the first ten sessions, the therapeutic alliance at intake was the strongest predictor of premature termination with clients who reported a stronger alliance being at decreased risk for premature termination. In terms of client functioning over the first ten session, the fourth session was the strongest predictor of premature termination with clients who reported poorer overall functioning being at increased risk for premature termination. The overall model for client functioning, age, and diagnostic status was not statistically significant. When considering both the main effects and potential interactive effects of therapeutic alliance and client functioning, main effects for client functioning and therapeutic alliance at intake demonstrated the anticipated negative relationship with premature termination such that increases in functioning or a stronger alliance at intake were associated with a lower probability of premature termination; however, their interaction term was positive. When both client functioning and therapeutic alliance increased at intake, the risk for premature termination also increased. Overall, results demonstrate the importance of monitoring both therapeutic alliance and client functioning starting with the very first therapy session in order to inform therapists when clients are at greater risk of premature termination.
Smith, Ashley Michelle (2019). The Relationship Between Therapeutic Alliance and Client Progress in Predicting Premature Termination in Counseling. Doctoral dissertation, Texas A&M University. Available electronically from