Premature termination from psychotherapy by adolescents

Every clinician has treated the adolescent who precipitously decides to terminate therapy before satisfactory resolution or diminution of the presenting symptoms. Most clinicians feel awkward, if not therapeutically impotent, when faced with an adolescent who is proclaiming a desire to stop treatment prematurely. A conceptual framework is presented in which the therapist takes an inclusive view of the adolescent and his/her world and tries to understand the meaning of premature termination at several levels: (1) the intrapsychic economy, (2) the dyadic relationship with the therapist, (3) the treatment approach, (4) the family system, and (5)’ other practical influences. Once the meaning is elucidated in a particular case, the therapist can then take steps to intervene at the most appropriate level in an empathic yet direct manner. Descriptions of these five levels along with illustrative case vignettes are provided.