BackgroundFormal help-seeking behaviour and premature termination of therapy is influenced by several factors, including access to mental health services, cultural beliefs about mental health and illness, gender, and socioeconomic status. Current local and regional studies have focused on formal help-seeking attitudes of university students or on utilisation of psychiatric services. This study sheds light on actual formal help-seeking behaviours of adults attending a non-profit counselling centre in Palestine by use of both client and therapist reports. MethodsThe sample consisted of 1068 clinical records belonging to clients aged 18 years and older, who approached the Palestinian Counseling Center for individual therapy between 2008 and 2018 in three different locations in the West Bank. The Birzeit University Ethical Committee approved the study and granted a waiver for obtaining consent owing to the use of an anonymous secondary dataset. 12 quantitative variables describing clients’ demographic information and data on therapy and dropout were analysed using binary logistic regression. One qualitative variable describing patients’ subjective reports about their symptoms was analysed using thematic analysis with an inter-rater reliability of 65%. Findings70·3% of clients (750 of 1067) were women, 44·1% (471) were married, and 42·2% (450) had never married. The mean age was 30·4 years (SD 9·7). 42·3% of clients (280 of 661) had a BA degree or higher and 60·5% (633 of 1045) reported their economic status to be above average. 45·2% (457 of 1011) were working, 25·4% (257) were housewives, and the rest (297) were students or unemployed. 56·7% of clients (587 of 1036) were from cities and 38·6% (400) from rural areas. A large proportion of clients approached the Palestinian Counseling Center on their own (39·9%, 411 of 1030), and others were referred by friends (19·2%, 198) and doctors (19·0%, 196). The qualitative data show that the most common complaints reported by clients were relational problems (51·6%, 297 of 575) and anxiety (33·6%, 193). The most frequent diagnoses made by clinicians were anxiety disorders (20·9%, 196 of 939), personality disorders (20·7%, 194), depressive disorders (19·2%, 180), and other conditions with a clinical focus (18·2%, 171). The average number of sessions was 23·1 (SD 20·9), and the rate of premature discontinuation was 39·4% (392 of 994). Clients with very low education (illiterate or primary education level) were 4·1 times (95% CI 1·09–15·48) as likely as clients with a BA degree or higher to discontinue therapy prematurely (p=0·036). Clients that approached the centre on their own were 56·6% (95% CI 0·24–0·8) less likely to discontinue prematurely than those referred by institutions or professionals (p=0·008). InterpretationThe predominance of women and clients with higher education and economic status is consistent with previous findings. These groups tend to have better access or more positive attitudes, or both, to therapy use. Furthermore, previous studies reported a similar dropout rate and a link between lower education and premature discontinuation. The percentage of clients diagnosed with personality disorders and the percentage of married clients was higher than predicted. The main limitation of the study is the location of the Palestinian Counselling Center clinics in cities, and the fee that clients pay (calculated based on their financial ability), affect access to therapy, utilisation, and discontinuation. Analysing the clinical records of other Palestinian centres and institutions is necessary to understand whether the patterns reported by this study are generalisable to the Palestinian population. FundingNone.