Book Review—Premature Termination in Psychotherapy: Strategies for Engaging Clients and Improving Outcomes

by Joshua K. Swift and Roger P. Greenberg


Premature Termination in Psychotherapy is an accessible resource for novice and experienced counselors alike who are interested in learning potential causes for and strategies to prevent premature client termination. This text does a wonderful job creating a foundation supported by research, while providing examples and vignettes to bring that research out of the theoretical and into practical application. The book is structured in three sections that build on each other to offer the reader a sequence that is easily understood. The first section focuses on understanding premature termination in psychotherapy, the second section includes strategies for reducing premature termination, and the final section suggests areas for further study.

Part one includes the first two chapters of the book and clearly outlines the challenges for clients, clinicians and organizations that result from premature termination. The first chapter describes the problematic effects of having multiple operational definitions for client dropout and presents evidence on which definitions are empirically reliable. In the same section, Swift and Greenberg list the pros and cons for each operationalization, and with research present their recommendation for the most reliable operational definition. The authors take an extensive look at the definitions used to describe dropout through an examination of multiple studies, ensuring that the reader grasps the discrepancies in the field and has a frame of reference for the remainder of the book. Once the definitions are flushed out, this section addresses the most common reasons for dropout as supported by research.

The second chapter includes the bulk of the empirical justification for the text. This chapter might be daunting for clinicians or students who are not familiar with complex statistical models. Swift and Greenberg explain the previous studies associated with dropout, and stress the importance of an operationalized definition for continuity of research. The authors completed their own meta-analysis in 2012 on premature client termination, examining which clients were terminating most frequently, what type of clinician they were seeing, and what setting termination was occurring in. The chapter allows the reader to make an informed decision on the most relevant strategies for his or her clientele. The incorporation of a large-scale meta-analysis conducted by the authors increases the strength of the recommendations provided later in the text.

Part two includes chapters 3 through 10 and examines strategies for reducing premature termination. The chapters are consistently well structured and make the material accessible, especially given the multifaceted subject matter. Each chapter begins with a definition and description of the terms; then Swift and Greenberg present the empirical research supporting the strategy they are introducing, and next they describe how to put the strategy into practice. Each chapter ends with two clinical examples in the form of vignettes. The chapters include strategies for instilling hope, building the therapeutic relationship and incorporating client preferences into treatment, among others. These strategies are useful for novice and experienced clinicians alike and are all well grounded in research. The consistency in the text’s structure makes it easy for the reader to navigate and reference specific aspects of a chapter if necessary.

The final section of the book includes the conclusion and recommendations for future research. In this chapter the authors reiterate the important information presented in each of the previous chapters, including a short synopsis of each of the eight strategies presented. I found it especially useful to be able to see the strategies listed together; this arrangement allows the reader to focus on the part of the book that is directly applicable to clinical practice. Swift and Greenberg end with recommendations for further research, which support the notion that there is still more to be done.

Premature client termination is a problem for both beginning and experienced clinicians. The objective of this book is to offer an understanding of why it happens and when it happens most frequently, as well as provide strategies supported by empirical data that meaningfully reduce the incidence of premature termination. This objective is certainly attained in a clear, concise and empirically supported style that is for the most part accessible to any level of counselor.

Swift, J. K., & Greenberg, R. P. (2014). Premature termination in psychotherapy: Strategies for engaging clients and improving outcomes. Washington, DC: American Psychological Association.

Reviewed by: Charmayne R. Adams, graduate student, Wake Forest University, Winston-Salem, NC.

The Professional Counselor