When couples unexpectedly terminate therapy before goals have been achieved, the practitioner is often left wondering “What did I do wrong?”.
We know that individual clients who prematurely discontinue are more likely to experience poor outcomes, be dissatisfied with treatment, and relapse in the long term. Significant attention has been paid to factors which predict early termination in individual therapy with Swift and Greenberg’s (2015) meta-analysis identifying three common categories: external factors, financial issues, difficulty scheduling, and accessibility being the most common, followed by dissatisfaction with the treatment or therapist, and thirdly client improvement. Less attention has been paid to couples, with a systemic review of 43 studies measuring premature discontinuation in couple therapy estimating the average prevalence rate to be about 36%.In exploring the reasons the focus has been on demographic characteristics or other therapist-reported reasons rather than client’s own explanation.
Asking Couples Directly
A study by Codecà et al (2025) addressed this discrepancy through the administration of a questionnaire to explore the reasons for couples discontinuing, the strongest motivation when more than one reason was cited, who made the decision, and why they chose not to discuss their decision with the therapist. Of the 160 participants each was able to identify a number of reasons for discontinuing.
What Did They Say?
The most frequently endorsed was discomfort due to sessions making homelife more uncomfortable, followed by external factors including availability and financial concerns and dissatisfaction with their partner and the therapeutic process. Sufficient improvement was the least likely response. Only a little over half made the decision jointly with their partner and chose not to speak directly to the practitioner to avoid a difficult conversation or payment for another session.
While practitioners often assume dissatisfaction relates to them, analysis of the dissatisfaction category revealed that displeasure with one’s partner was the most common while dissatisfaction with the therapist was the least cited reason within this category. Contrary to most practitioners’ fears ‘51% reported being somewhat or extremely satisfied with therapy, and 51% of participants indicated that they left therapy prematurely because they felt improvement.’ In addition, 23% endorsed the statement “Therapy gave us the tools we needed to figure it out on our own.”
What are the Implications for Practitioners?
This study is important in directing a practitioner’s attention to key factors which underpin a decision to discontinue couples therapy rather than assuming full responsibility for ‘not being good enough.’ However, it does alert us to the need to be attentive to the impact of a session on home life and directly enquire about this. It is important to directly address how challenging conversations can and should be managed after the session to maximise the possibility of positive outcomes and that this is directly followed up in subsequent consultations. Enquiring about each person’s engagement in the process and their partner’s perception of this is also indicated. Finally, each session should conclude with feedback from both parties to ascertain their experience, assessment of progress and future needs and practical constraints that may make continuing difficult. While none of this removes the necessity to interrogate one’s own role in premature discontinuing it may not always be as central as we fear.
Codecà, L., Anderson, S., Christensen, J., Jackson J., D’Aniello‐Heyda, C. (2025) Client Perspectives of Premature Discontinuation in Couple Therapy Journal of Marital and Family Therapy, 51:e70061 1 of 12 https://doi.org/10.1111/jmft.70061
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