Date of Completion


Embargo Period



attachment, termination, dropout, alliance, psychotherapy, relational, premature

Major Advisor

Inge-Marie Eigsti

Associate Advisor

Marianne Barton

Associate Advisor

Preston Britner

Field of Study



Doctor of Philosophy

Open Access

Open Access


Premature termination in psychotherapy is associated with negative consequences for clients, therapists, and the institutions that employ them, in the form of poorer mental health, diminished confidence, and lost revenue, respectively. Missed appointments in the form of late cancellations and no-shows exert similarly negative effects on client outcomes and treatment providers (Berrigan & Garfield 1981; Edlund et al., 2002; LaGanga & Lawrence, 2007; Oldham, Kellett, Miles, & Sheeran, 2012). Approximately one out of every five patient/clients in treatment will drop out of therapy before goals are met, regardless of treatment settings or intervention (Swift & Greenberg, 2012). The current study sought to explore relational variables – the therapeutic alliance and adult attachment style – as they relate to premature termination and missed appointments. A total of 110 case files, collected at a university training clinic over a period of 38 months, were consulted to determine rates of premature termination and missed appointments, as well as the relationships of these dispositions with alliance and attachment. The effects of attachment and alliance on premature termination could not be adequately tested due to missing data; missed appointment rate was analyzed instead. The results of regression analyses indicated that individuals who missed more sessions were more likely to prematurely terminate. Client-reported adult attachment style did not predict missed appointment rate; effects of client-reported alliance were confounded with a low sample size and positively skewed distribution and as such results were not conclusive. Implications and recommendations are suggested for future research.