Factors Associated with Premature Termination of Psychotherapy by Children

Article excerpt

Identifying children who fail to complete psychotherapy is critical for two reasons: Those who drop out do not receive needed clinical services; and clinics have invested a great deal of costly staff time in the treatment. If factors which lead to premature termination can be identified, practitioners can take appropriate preventive actions.

Limited research has been conducted on the reasons children prematurely drop out of treatment; however, a number of factors have been identified with adult populations. These include the importance of client input into the treatment plan (Heine & Trosman, 1960), client satisfaction with his or her therapist (Garfield, 1963), practical problems that confront the client (e.g., transportation) (Becham, 1992), and social class (Garfield, 1986).

The few notable studies that have explored why children drop out of psychotherapy prematurely include one by Gould, Shaffer, and Kaplan (1985) who report that demographic, personality, and psychopathology measures offer little explanation. However, Lasky and Salmone (1977) found that the client's age and gender may be factors that influence continuation of treatment. Viale-Val, Rosenthal, Curtiss, and Marohn (1984) report that adolescents as a specific age group often do not complete treatment. They also found that race and social class were possible predictors of early termination. Further, they report that if a child had an initial positive reaction to treatment, early termination was unlikely.

Given the fact that past research has identified only a limited number of variables associated with premature termination of treatment by children, the present research explores factors that have been found to be associated with older populations who experience this serious clinical problem. Specifically, the purpose of this study was to explore the influence of satisfaction with the treatment plan, the therapist, and related treatment variables on early termination. Other practical concerns related to the client's family, including financial matters, were also explored.

METHOD

The sample included 72 children who had dropped out of psychotherapy prematurely over a one-year period. Of these, 45 participated in the research. The average age of the participants was 13.5 years with an age range from 6 to 18 years. There were 22 males and 23 females.

The 45 children in the survey were receiving inpatient services from a midwestern psychiatric hospital prior to premature termination. The psychiatric services included a children's unit (ages 4 to 12), a preadolescent unit (ages 10 to 14), and an adolescent unit (ages 12 to 18). The following list identifies the psychological problems treated in each unit:

Children's unit: ineffective coping techniques; aggression/harm to self or others; impulsive, active mood/unable to stay on task in groups; depressed mood, sad affect/tearfulness; out of parental/school control; lack of boundaries; encopresis; and enuresis.

Preadolescent unit: depressive symptoms; suicidal behavior; aggressive behavior; history of running away; and history of sexual abuse.

Adolescent Unit: self-destructive behavior; aggressive behavior; elopement risk; depression; alteration in social norms; sexual abuse; anxiety; defiance of authority; substance abuse; family conflicts; and manipulative behaviors.

The research instrument which explored the phenomenon of early treatment termination was composed of 12 items and a comment section. The survey was conducted by telephone, and the adult caretaker was interviewed for all children under 18 years of age (98% of the cases). A one-group chi-square was the primary statistical test used in the data analysis.

FINDINGS AND CONCLUSIONS

As noted in Table 1, several of the survey items indicated statistically significant results. One important finding is that the child's family was generally supportive of early treatment termination; however, the results were not statistically significant when the role of financial considerations in the termination process was analyzed. …

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