Understanding Psychotherapy Discontinuation Among Ethnically Minoritised Adults: A Systematic Review and Qualitative Synthesis.

Psychotherapy discontinuation remains a persistent challenge for mental health services, with approximately half of clients ending therapy prematurely. Individuals from ethnically minoritised backgrounds are disproportionately affected by early discontinuation; however, less is known about how these populations understand and experience this process. This review aimed to explore the lived experiences and perceived reasons for psychotherapy discontinuation among adults from ethnically minoritised backgrounds. A systematic review and qualitative synthesis were conducted. Six electronic databases were searched from 1983 to February 2026. Eligible studies included qualitative and mixed-methods designs where qualitative findings could be extracted. After screening, 13 studies involving 286 participants were included. Study quality was assessed using the Critical Appraisal Skills Programme qualitative checklist. Data were synthesised using narrative synthesis. Six interconnected themes were identified: (1) perspectives and expectations of therapy; (2) cultural and societal influences; (3) practical and accessibility-related barriers; (4) the therapeutic relationship; (5) systemic and service-level barriers; and (6) autonomy and control in treatment engagement. Across studies, psychotherapy discontinuation was characterised as a multidimensional process shaped by interacting individual, cultural, relational, and structural factors. Discontinuation was not solely attributable to lack of motivation but was strongly influenced by structural inequalities, cultural incongruence in care, ruptures in the therapeutic relationship, and limited patient autonomy. Findings suggest that improving engagement and reducing psychotherapy discontinuation among ethnically minoritised populations requires interventions that extend beyond service provision alone. Culturally responsive practice, stronger therapeutic alliances, shared decision-making, and flexible models of care delivery may help address the complex barriers to sustained engagement in psychotherapy.