Academic journal article International Journal of Psychology and Psychological Therapy

Understanding Prior Dropout in Psychotherapy

Academic journal article International Journal of Psychology and Psychological Therapy

Understanding Prior Dropout in Psychotherapy

Article excerpt

Understanding why people skip treatment is important: 30-40% of the patients fail to present themselves for medical appointments, thus imposing negative consequences upon themselves as well as the health system. In order to understand why, in general, patients abandon treatment and in order to prevent such abandoning, health psychology has extensively studied adherence to treatment. However, psychotherapy dropout literature is replete with conflicting findings, replication failures, and absence of a profile of the individuals who discontinue treatment (Di Matteo & DiNicola, 1982; Kazdin & Mazurick, 1994; Klein & Carroll, 1986; Koltun & Stone, 1986; Hays & DiMatteo, 1987; Sackett & Snow, 1979; Warzak et al., 1987; Wierzbicki & Pekarik, 1993).

The inconsistency of the findings has been attributed to divergent operational definitions of dropout. Dropouts often include individuals who fail to engage treatment at different points (e.g., while waiting for treatment, after a few treatment sessions, or later in treatment). It has been argued that the characteristics of the dropout person may vary as a function of the point in time at which she terminates; therefore, dropout research should test the existence of temporal subgroups for dropout, according to the moment of its occurrence over the course of treatment (Baekeland & Lundwall, 1975; Kazdin & Mazurick, 1994). According to this recommendation, variables associated with dropout at different points in treatment have been investigated. Still, there is a lack of studies that elucidate about the patients who apply for treatment but break off the clinical contact before the first treatment session. Some exploratory studies have tried to link failure to keep initial mental health appointments with variables such as gender, age, diagnosis, geographic area of residence, socioeconomic status, length of time on a waiting list, symptom duration (Carpenter et al., 1981; Errera et al., 1965; Lowman et al, 1984; Otero et al, 2001; Weighill et al, 1983). The range of studied variables restricts almost exclusively to sociodemographic variables or other non-complex variables, due to the difficulty of obtaining information about this subgroup of dropout population. There usually is no contact with, or information about, patients who simply do not come. The limited range of investigated variables and the divergence of results call for studies that carefully replicate and expand the factors associated to dropouts that occur prior to treatment. By the format of the intake procedures in our psychiatric service, we could obtain information about all patients who apply for therapy, including those who failed to engage. We could therefore replicate some results (concerning some demographic and clinical variables) and investigate more complex variables associated with prior dropout (pattern of relationship with mental health services).

Another reason attributed to the discrepancy of results among dropout studies concerns the sampling criteria. There is evidence that different variables are related to adult and child dropout. Most of the existing research does not distinguish between these two groups of age, which can obscure the specific effects that differently predict dropout within these two groups and can lead to divergent results (Kazdin & Mazurick, 1994; Pekarik & Stephenson, 1988; Wierzbicki & Pekarik, 1993). As a precaution, we explored data separately in order to ascertain whether the studied variables predicted prior dropout differently for the total sample and for the sub-samples of adults and children.

The terms "dropout", "early dropout", "premature dropout", and "premature terminator" have been indiscriminately used to designate patients who do not accomplish a certain number of therapy sessions (Frayn, 1992; Kazdin & Mazurick, 1994; Mohl et al., 1991; Shapiro, 1974) and to designate patients who fail to engage a new treatment, not honoring the first scheduled session (Hillis et al. …

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