Introduction
Many studies have shown that psychotherapy is effective in the treatment of mental disorders. However, the prevalence of premature dropout from psychotherapy and counseling is very high. Clients and therapists are expected to agree on the time to end psychotherapy, but most of the clients leave the sessions without coordinating with the therapist. This action occurs for many reasons. Clients who leave sessions early receive fewer benefits compared to other clients. Therapists whose clients leave sessions early feel inadequate. The reasons for the presence or non-attendance of clients in sessions may vary from person to person and from moment to moment. Psychotherapy approaches vary, each with its own specific method and duration. Therefore, it is difficult to have a uniform definition of the premature dropout from psychotherapy and counseling. Our knowledge of the possible predictors of this phenomenon is incomplete, and the predictive patterns of this phenomenon, especially for the variables that are related to the patient, are poorly understood. The therapist is also a fundamental element in the treatment process. A study showed that the therapist’s impact on the results of psychotherapy for clients is higher than the impact of treatment methods. Most of the studies in the field of premature dropout from psychotherapy and counseling have been done using quantitative methods. This method of analysis results in the loss of unique information and data, focusing solely on a few limited variables for predicting premature dropout. Therefore, as recommended by Barrett et al. [7], it is better to use qualitative studies for a comprehensive investigation of the effective factors in premature dropout. Therefore, in the current research, we aim to investigate the reasons for Iranian clients’ premature dropout of psychotherapy and counseling from the therapists’ point of view.

Methods
This is a qualitative study based on Strauss and Corbin’s grounded theory. The main tool for data collection was semi-structured interviews. The interview questions were formulated by studying the theoretical and experimental background of the research or by consulting with active experts in the field of the phenomenon. The data collection was carried out from September 2023 to July 2024. On average, each interview lasted 60-80 minutes. The interview questions were aimed at investigating the effective factors in the premature dropout of psychotherapy and counseling by clients. The participants were male and female counselors and therapists active in the field of mental health in Bushehr city, south of Iran, who have the necessary experience and a comprehensive understanding of the phenomenon under investigation. They were selected using a purposive sampling method. The sampling continued until reaching theoretical data saturation, which was achieved after interviewing 25 participants. To further ensure the saturation of data, six more interviews were also conducted. Therefore, the final sample size was 31. The inclusion criteria were at least 25 years of age, at least a master’s degree in counseling or psychology, and at least ten years of active work experience in counseling and psychotherapy centers. The exit criteria were short answers to the questions, incomplete answers, and not reviewing the recorded interviews and the extracted data to confirm their accuracy and relevance. The coding process was carried out in an inductive way according to the problem and the research objectives. In the inductive content analysis method, the researcher avoids using pre-determined categories and tries to derive the categories and their names from within the research data. After extracting all the primary concepts, the data obtained from open coding were compared with each other, and similar codes were placed in a category. Finally, similar subcategories were merged into one category, and the main category was formed. Lincoln and Guba’s four criteria of credibility, transferability, dependability, and confirmability were used to assess the trustworthiness of the data. MAXQDA software, version 2020 was used to analyze the data. 

Results
Seventeen female therapists (54.84%) and 14 male therapists (45.16%) participated in the study. Their age range was 35-62 years. Their work experience in the field of psychotherapy and counseling ranged from 10 to 35 years. Nine main categories were obtained from the in-depth interviews with therapists. Table 1 reports the main category and subcategories extracted from 439 open codes.





Conclusion
In this study, we identified nine main categories as the reasons for clients’ premature dropout from psychotherapy and counseling from the therapists’ point of view, which included: 1) Lack of expertise and skill of the therapist in psychotherapy and counseling, 2) Cognitive, motivational, emotional, and behavioral actions of the client during the sessions, 3) Biographical factors of the client, 4) Environmental indicators, 5) Structural factors of psychotherapy and counseling sessions, 6) Client’s personality patterns, 7) Lifestyle, personality, and emotional characteristics of the therapist, 8) Biographical factors of the therapist, and 9) Psychiatric medications. Developing more effective interventions to reduce clients’ premature dropout from psychotherapy and counseling requires a proper understanding and perception of these factors by mental health professionals. 

Ethical Considerations
Compliance with ethical guidelines
This research was approved by the Ethics Committee of Bushehr University of Medical Sciences (Code: IR.BPUMS.REC.1403.087). All ethical principles, such as voluntary participation, informed consent, anonymity, and confidentiality, were observed.

Funding
This article was extracted from the dissertation of Somayeh Safarzade at the Faculty of Literature and Humanities, Persian Gulf University, Bushehr, Iran. This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Authors contributions
Conceptualization, Design, methodology, investigation, project administration, data curation, formal analysis, data interpretation, supervision, and writing: Somayeh Safarzade; conceptualization, design, methodology, investigation, data curation, formal analysis, data interpretation, and supervision: Mahnaz Joukar Kamalabadi; investigation, data interpretation, and supervision: Faridehsadat Hoseini; methodology, data interpretation and supervision: Seyed Mousa Golestaneh.

Conflicts of interest
The authors declare no conflict of interest.

Acknowledgments
The authors would like to thank the psychology and psychiatry clinics and the therapists for their cooperation in this study.

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