Therapist (Dis)Continuity, Therapeutic Relationship, and (Premature) Termination in a University-Based Psychology Training Clinic

When an individual is interested in seeking therapeutic services, he/she might follow an ideal chain of events that looks something like this: searching for therapy providers, calling to schedule an intake appointment, filling out pre-session paperwork before seeing the therapist, participating in an intake - including assessment that informs a treatment plan, obtaining the therapeutic services he/she sought -which includes completing assessments throughout, and terminating services after meeting therapeutic goals. At the University of North Texas (UNT) Psychology Clinic, a university-based student-training clinic, the experiences of an individual seeking therapeutic services differ only slightly from this prototype.



In most cases, an individual seeking services at UNT calls or walks into the clinic, provides brief information regarding their problem, and is scheduled an intake with a student therapist. The client then comes back to the clinic to fill out more in-depth background information, the Psychiatric Diagnostic Screening Questionnaire (PDSQ; Zimmerman & Mattia, 2001a) and completes his or her intake interview. Once the initial intake report is complete, the clinic director assigns the case to a permanent therapist. The permanent therapist then calls to schedule the initial therapy appointment, and the client attends therapy to obtain the therapeutic services he or she sought. Clients fill out the Outcome Questionnaire-45 (OQ45.2; Lambert et al., 2004), prior to every session, and every 3 weeks clients fill out the Working Alliance Inventory - Short Revised (WAI-SR; Horvath & Greenberg, 1986; Tracey & Kokotovic, 1989; Hatcher & Gillaspy, 2006) and the Assessment for Signal Clients (ASC; Lambert et al., 2007),and the OQ45.2. Finally, once goals of therapy are met, the therapist and client terminate. Alternatively, in some cases, the client is immediately assigned to his/her permanent therapist who completes the intake report. The clinic director assigns the case after reading the brief information the client provided regarding his/her problem during the initial call or walk-in. These courses of treatment are consistent with those followed by many clients receiving services at training clinics...