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Premature Termination: What therapists can and should do

With premature termination resulting in serious consequences for both clients and therapists,  it is persistently important for therapists to be actively involved in subverting early termination. There are several strategies suggested for therapists to utilize in decreasing the chances of premature termination.

Pretherapy Preparation: Pretherapy preparation is any process that prepares the client for therapy engagement. Therapy is such a difficult process that takes alot of emotional and mental energy. Even clients that have been in therapy before can find therapy very draining. Therefore, explaining the nature, rationale, and expectations for therapy allows clients to prepare themselves mentally and emotionally for the difficult process in which they are about to engage. Examples include

-Role induction: Explicit discussion of the roles for both therapist and client
-Vicarious therapy pretraining: providing clients with examples of therapy
-Experiential pretraining: Although this one seems pretty silly, it involves engaging in simulations of therapy.

Patient Selection: This strategy also seems somewhat pretentious. Sounds more like a research study than a therapy approach. How about using therapy selection instead? If you are a multiframework or integrative therapist, assess your clients needs for various therapeutic frameworks and utilize the most appropriate one.

Multidisciplinary teams: The recommendation of case management is well founded, especially with clients facing severe axis IV issues (environmental/situational barriers). Because a therapist already has enough to do in the therapeutic context, case management can be overwhelming. Therefore, utilize all available community resources such as social workers and case managers to help connect clients to appropriate resources.

Motivational Enhancement: Also known as Motivational Interviewing, ala William Miller. MI allows clients to engage in a discussion of their ambivalence about engaging in the change process while reducing defensiveness.

Facilitation of a Therapeutic Alliance: Warmth, Empathy, Genuineness. These principles were wonderful when Carl Rogers introduced them and are still wonderful now. Even in the age of Evidence Based therapies, the therapeutic alliance can never be underestimated. This alliance is the one true lifeline to your clients and can be what keeps them in therapy even when times get tough.


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