While the comparison of client and therapist reasons for termination might shed light on their respective views of outcome and process, only one published study has examined directly the reasons given by therapist-client pairs. One barrier to such research is the absence of a systematic conceptualization of reasons for termination that incorporates both therapist and client perspectives. This article describes a comprehensive conceptualization, drawn from the existing literature, and applies a coding system based on that conceptualization to naturalistic clinical data from 123 therapist-client pairs in a psychology training clinic. Coders were able to categorize reliably open-ended client data into reasons for termination. For therapist and client data, the relationships between coding categories and participants' outcome ratings, generally were consistent with expectations, providing limited validation. Some support was found for concordance between therapist and client reasons, especially for those related to therapist or client departures, which were prominent in this setting. As expected, however, therapists were more likely than clients to endorse success as a reason for termination. Negative client feelings about therapy, including dissatisfaction, were reported infrequently as reasons for termination, and with little agreement between clients and therapists, but this may be due to methodological limitations.

Comprehensive exposure-based approaches to treating posttraumatic stress disorder (PTSD) are effective, but they are time intensive and not widely used because of factors such as client noncompliance and fears of iatrogenic effects. Exposure by writing disclosure (WD), modeled after Pennebaker's brief stress-reduction procedure, may circumvent these obstacles. WD treatment reduces PTSD symptoms in trauma victims but has rarely been tested in diagnosed PTSD participants and never in substance use disorder (SUD) populations-despite high comorbidity rates. The authors applied a standard Pennebaker WD treatment for 45 SUD inpatients screened for full or subsyndromal PTSD in an uncontrolled study. Results suggested potential strong cost-effectiveness: Posttreatment outcome measures showed significant symptom reductions, which remained stable at 3-month follow-up. With converging evidence from future controlled studies, WD strategies may emerge as effective and easily implemented treatment options for PTSD in SUD treatment settings.

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