Department

Counseling and Human Services

Degree Name

Doctor of Philosophy (PhD)

Date of Award

Fall 2025

Format

pdf

Degree Level

Ph.D.

LCSH subject

Psychotherapy -- Termination; Mental health surveys; Patient satisfaction

Medium

Manuscript

Proquest Document ID

32118533

Identifier

1599111937 (OCLC)

School/University

St. Mary's University (San Antonio, Tex.)

Size or duration

119 pages

Document Type

Dissertation

First Advisor

Montilla, Romulo Esteban

Second Advisor

Reyna-Vasquez, Priscilla

Third Advisor

Spurgeon, Shawn

Abstract

Unilateral termination is a pervasive issue that has persisted since the inception of mental health services. The act of terminating needed services impacts not only on the client but also the provider, community, family, and stakeholders. The therapeutic alliance established during the counseling process is a well-established predictor of outcome in mental health services. The purpose of this study was to examine the relationship between unilateral termination reasons, satisfaction, and working alliance. A total of 390 participants responded to the online survey resulting in the descriptive results of Working Alliance Inventory-12 (M = 3.93, SD = .83), Client Satisfaction Questionnaire-4 (M = 2.7, SD = .830), and Unilateral Termination Reason Scale (M = 2.80, SD = .83). Logistic regression analysis found influence of sociodemographic variables on therapy outcomes, controlling for the working alliance strength was not significant (F (3, 380) = 1.807, p = ns; r = .058, p = ns), which indicated age (𝛃 = -.01,Β  p = ns), sex (𝛃 = .015,Β  p = ns), and race/ethnicity (𝛃 = .117, p = ns) were not found to be predictors. Multiple regression analysis on the predictive power of WAI-12 scores on CSQ-4 was not predictive (F (1, 382) = 1.270, p = ns), with a positive slope (𝛃 = .058, p = ns), but was found to be predictive on UTRS (F(1, 382) = 5.86, p = < .05) with an inverse slope (𝛃 = -1.23, p < .05). Pearson correlation analysis found the relationship between WAI-12 scores and CSQ-4 scores was not significant (r = .058, p = ns). The relationship between WAI-12 scores and UTRS scores was significant (r = -.123, p < .05), and the relationship between UTRS and CSQ-4 was found to be significant (r = .144, p < .01). ANOVA analysis found there to be a significant relationship between WAI-12 mean and the primary reason for unilateral termination reason (Fβ‚„, ₃₇₉ = 26.405, p < .001). ANOVA analysis did not find a significant relationship between CSQ-4 mean and primary reasons or unilateral termination reasons (Fβ‚„, ₃₇₉ = 1.295, p = ns).Β  The study’s findings aim to contribute to the existing literature, enhance therapeutic practices, and potentially benefit future clients by improving therapeutic outcomes.

Keywords: dropout, therapeutic alliance, working alliance, unilateral termination, ruptures, Working Alliance Inventory-12 (WAI-12), Unilateral Termination Reasons Scale (UTRS), client satisfaction. Client Satisfaction Questionnaire-4 (CSQ-4), therapist variability, therapeutic outcome, self-reported measure, psychometric properties, self-reported measures.

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