Termination, Appointment Use, and Outcome Patterns Associated With Intake Therapist Discontinuity Stevan Lars Nielsen, John Okiishi, and Dianne L. Nielsen Brigham Young University Eric J. Hawkins Veterans Affairs Puget Sound Health Care System S. Cory Harmon New York–Presbyterian Hospital Tyler Pedersen, Vaughn E. Worthen, Richard L. Isakson, Michael J. Lambert, and Jane Lawson Brigham Young University Jason L. Whipple Bassett Army Community Hospital Robert L. Gleave Brigham Young University Nathan B. Hansen Yale University M. Kirk Dougher, David W. Smart, Maureen L. Rice, Ronald K. Chapman, and Aaron P. Jackson Brigham Young University Psychotherapy clients often experience intake therapist discontinuity: meeting first with an intake therapist, then entering therapy with a different treating therapist. The authors compared such disconti- nuity clients at a university’s counseling center (55.6% of 15,137 clients) with continuity clients, who continued therapy with their intake therapists. Discontinuity clients were twice as likely as continuity clients to terminate by missing the appointment after intake. Improvement among discontinuity clients lagged behind improvement among continuity clients at Sessions 2 and 3. Though more likely to terminate by missing Session 2, discontinuity clients attended 2 sessions more than continuity clients, on average, making treatment of discontinuity clients 19% more expensive than treatment of continuity clients in terms of sessions attended. The extra sessions attended by discontinuity clients did not yield overall better outcomes. Intake therapist discontinuity appeared to disrupt the beginning of psychother- apy, dissuading some clients from returning after intake, slowing early improvement among those who did return, and unproductively lengthening their treatment. Keywords: intake, continuity of care, outpatient psychotherapy Clients at our counseling center have sometimes complained about meeting with an intake therapist, then being assigned to psychotherapy with a different treating therapist—a pattern we call intake therapist discontinuity. Concerned by their complaints, we searched psychotherapy and related literatures for research exam- ining this common way of beginning psychotherapy. For several decades clinical research has examined the ef- fects of continuity of care (e.g., Haggerty et al., 2003), the effects of matching clients with therapists or with specific therapies (e.g., Beutler et al., 2004; Clarkin & Levy, 2004; Zane, Hall, Sue, Young, & Nunez, 2004), and the effects of particular session use patterns (e.g., Orlinsky, Rønnestad, & Willutzki, 2004), but we could find only two studies that examined entering psychotherapy with different intake and treating therapists. The first study, conducted by Wise and Rinn (1983), found that clients seeking therapy at a Huntsville, Alabama, community mental health center who experienced intake therapist discontinuity were three times more likely to terminate prematurely; they defined premature termination as termination before a fourth session. Gottheil, Sterling, Wein- stein, and Kurtz (1994) later found no relationship between intake therapist discontinuity and premature termination among clients seeking psychotherapy for cocaine dependence at an inner-city treatment facility in Philadelphia, Pennsylvania; they defined premature termination as termination before a third session. Thus, the two studies that have examined intake ther- apist discontinuity found contradictory relationships between discontinuity and premature termination based on different cri- teria for prematurity; neither study examined appointment use or outcome. These two studies were inadequate to guide our practice, but continuity of care research seemed quite relevant to our con- cerns. Haggerty et al. (2003) reviewed continuity of care re- search across several health care disciplines and identified three Professional Psychology: Research and Practice © 2009 American Psychological Association 2009, Vol. 40, No. 3, 272–278 0735-7028/09/$12.00 DOI: 10.1037/a0013286 272 This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.