When Therapy Ends: A Qualitative Study on Termination Processes in Youth with a History of Residential Care

Abstract

Introduction: Young people raised in residential care often face attachment challenges that impact their psychotherapy experiences. While research has examined their therapeutic needs, little is known about their experiences of therapy termination—a process potentially reactivating earlier separation experiences. This study explores how clients from residential care backgrounds and their therapists experience the psychotherapy termination process. Methods: Using a qualitative phenomenological approach, we conducted semi-structured interviews with five young adults (aged 21-27) who had spent 3-10 years in residential care and completed psychotherapy and six therapists who had worked with this population. Data were analyzed using reflexive thematic analysis. Results: Six themes emerged: (1) Attachment-Influenced Motivations and Goals; (2) Therapeutic Process as Corrective Attachment Experience; (3) Outcomes Reflecting Attachment Development; (4) Barriers to Therapeutic Engagement; (5) Client Resilience as a Resource; and (6) Termination as a Crucible for Attachment Dynamics. Conclusion: Therapy termination often activated earlier attachment patterns, with clients displaying preemptive withdrawal, feelings of unworthiness, or occasionally achieving healthy closure. For young people with residential care backgrounds, therapy termination is influenced by early attachment experiences and institutional histories. Therapists should approach termination with sensitivity, emphasise the therapeutic relationship, provide longer-term services when possible, and implement carefully planned endings. These findings contribute to developing more effective termination strategies for this vulnerable population. © 2025 Elsevier B.V., All rights reserved