A meta-analysis was conducted of 125 studies on psychotherapy dropout. Mean dropout rate was 46.86%. Dropout rate was unrelated to most of the variables that were examined but differed significantly as a function of definition of dropout. Lower dropout rates occurred when dropout was defined by termination because of failure to attend a scheduled session than by either therapist judgment or number of sessions attended. Significant effect sizes were observed for 3 client demographic variables: racial status, education, and income. Dropout rates increased for African-American (and other minority), less-educated, and lower income groups. Recommendations for future psychotherapy dropout research are presented.

The deleterious clinical and administrative effects of the high dropout rate among psychotherapy outpatients are described. After selectively reviewing the dropout literature, it urns concluded that discrepant expectations of clients and therapists regarding the duration and goals oj treatment could account for much of the dropout rate and associated problems.Two approaches for coping with the dropout problem were presented: (a) procedures designed to increase the duration of treatment and (b) use of treatments designed for short duration, that is, for crisis therapy. OverviewThe extremely high proportion of outpatients who drop out of treatment presents one of the greatest single obstacles to the effective delivery of mental health services, creating fiscal, administrative, clinical, and personnel problems. In spite of this, relatively little is done to address the dropout problem at most clinics. This article describes the scope, analyzes the causes, and suggests some solutions to the dropout problem. Scope of the Problem PREVALENCEOutpatient services are the backbone of the public and private mental health service system. The National Institute of Mental Health (NIMH, 1978) reported that about 59% of all community mental health center (CMHC) admissions are for outpatient care, and an additional 28% are for emergency services, a variant of outpatient care.Reviews of the relevant literature have found that 30%-60% of outpatient psychotherapy clients in all settings terminate by dropping out of treatment (Baekeland & Lundwall, 1975); moreover, there is evidence that the majority of CMHC outpatients are dropouts (Fiester, Mahrer, Giambra, & Ormiston, 1974;Pekarik, 1983a). The extent of the dropout problem is dramatized by length of treatment data: Although the prescribed duration of short-term treatment is 20-40 visits (Strupp, 1978), and even brief psychotherapy is expected to require 10-20 visits, mental health centers have reported that over 40% of their clients attend only one or two outpatient visits (Ciarlo, 1979;Fiester & Rudestam, 1975;Pekarik, 1983a). Reports suggest that less than one fourth of outpatients attend even brief psychotherapy's minimum criterion of 10 visits for effective treatment (Ciarlo, 1979).High dropout rates exact several clinical, fiscal, and personnel costs. First, the dropouts may be adversely affected by their premature termination. This is the prevailing belief among psychotherapists (Garfield, 1978). Research has found that clients who dropped out of treatment early (after only one or two visits) had one of the poorest outcomes documented in the psychotherapy literature (Gottschalk, Mayerson, & Gottlieb, 1967;Pekarik, 1983a).Second, there are financial costs to the mental health clinic: (a) Most dropouts

No abstract

No abstract

Addressed the dropout problem by (a) directly asking clients their reasons for dropping out; and (b) assessing pretherapy to follow‐up symptom change in clients grouped by dropout reason. Forty‐six dropouts who had been administered the Brief Symptom Inventory at intake were contacted 3 months later. At follow‐up they were asked their reasons for dropping out and read‐ministered the Brief Symptom Inventory. It was found that 39% quit due to “no need for services,” 35% due to “environmental constraints,” and 26% due to “dislike of services.” The “no need for services” and “environmental constraints” groups had significant decreases in intake to follow‐up Brief Symptom Inventory scores. Dropouts were found to be a heterogeneous group whose follow‐up adjustment was related to termination reason. This contradicts prevailing notions that consider all dropouts as treatment failures.