Emily Lazar

Date of Award

Summer 8-2017

Document Type


Degree Name

Doctor of Psychology (PsyD)



First Advisor

Derek Hatfield, Ph.D.

Second Advisor

Beverly Goodwin, Ph.D.

Third Advisor

Laurie Roehrich, Ph.D.


Client deterioration is a term that describes the worsening of a client’s condition during treatment. The most recent, comprehensive review on deterioration of adult clients in individual psychotherapy is over 20 years old (Mohr, 1995). Contemporary reviews exist but are narrower in scope or lack systematic methodology. The current study provides a broad, updated synthesis of the empirical literature on client deterioration. Data collection involved a systematic search of outcome studies published between 2011 and 2016 that focused on individual psychotherapy with adults. In addition to an online database keyword search, a manual search of 19 pre-selected clinical journals was conducted. Unpublished data were also sought. Results include the frequency with which researchers reported client deterioration rates in psychotherapy outcome studies, what definitions and measures of deterioration were used, and what proportion of client samples deteriorated. Rates of client deterioration are presented across several categories, including client diagnosis. Factors that may contribute to differential rates of deterioration are also explored. Results indicate that the majority of published outcome studies failed to distinguish clients who deteriorated from clients who showed no change, or failed to report on client deterioration altogether. The current review additionally provides recommendations for future research and practice. The impact of study findings on the conceptual understanding of client deterioration, and how it is detected and managed, is discussed. Results highlight the need for a unified definition of client deterioration, in addition to clearer standards to guide how deterioration is reported in publications.