Therapist and relationship factors influencing dropout from individual psychotherapy: A literature review

Abstract

Among potential predictors of dropout, client variables are most thoroughly examined. This qualitative literature review examines the current state of knowledge about therapist, relationship and process factors influencing dropout. Databases searches identified 44 relevant studies published January 2000-June 2011. Dropout rates varied widely with a weighted rate of 35%. Fewer than half of the studies directly addressed questions of dropout rates in relation to therapist, relationship or process factors. Therapists' experience, training and skills, together with providing concrete support and being emotionally supportive, had an impact on dropout rates. Furthermore, the quality of therapeutic alliance, client dissatisfaction and pre-therapy preparation influenced dropout. To reduce dropout rates, therapists need enhanced skills in building and repairing the therapeutic relationship.

Neural Predictors of Successful Brief Psychodynamic Psychotherapy for Persistent Depression

“…For these individuals, who have already invested time and resources in treatment, it becomes especially important to rapidly identify a treatment that is more likely to work. As in other studies of psychodynamic psychotherapy [3,4], the rate of premature termination was substantial; clearly, this form of treatment does not benefit all patients equally. Herein, the first clinical indicators of treatment success, i.e.…”

“…Meta-analyses of both long- and short-term psychodynamic therapies indicate their overall effectiveness for depression and related psychiatric disorders [1,2]. However, as with other treatments for depression, discontinuation rates for psychodynamic psychotherapy are high, and reasons for early termination are difficult to predict [3,4]. …”

Colaboração terapêutica: Estudo comparativo de um caso finalizado e de um caso de desistência

“…Esta interpretação é consistente com os resultados de outros estudos sobre a colaboração terapêutica em casos de desistência, nos quais as respostas de invalidação a intervenções de desafio, especialmente por risco intolerável, aumentavam progressivamente ao longo dos processos e em especial antes da interrupção da terapia (Pinto, Ribeiro, Sousa, Pinheiro, & Freitas, submetido). O desencontro entre as propostas do terapeuta e as respostas da cliente poderá estar associado ao desacordo ao nível dos objetivos e/ou tarefas da terapia, fragilizando a qualidade da aliança terapêutica, o que, em linha com os resultados dos estudos sobre a relação da aliança com a desistência da psicoterapia (e.g., Roos & Werbart, 2013) também nos ajuda a perceber a desistência da terapia neste caso.…”

“…Uma pobre qualidade da aliança terapêutica, especialmente na fase inicial da terapia, está associada a uma maior probabilidade de desistência, por parte dos clientes, dos seus processos terapêuticos (e.g., Roos & Werbart, 2013;Sharf, Primavera, & Diener, 2010). Embora a definição de desistência em psicoterapia não seja consensual, resultando em discrepâncias significativas nomeadamente no que diz respeito à avaliação da prevalência do fenómeno (e.g., Benetti & Cunha, 2008;Jung, Serralta, Nunes, & Eizirik, 2013), a maioria das definições adotadas parece centrar-se no não comparecimento do cliente à última sessão agendada, e daí em diante, sem o conhecimento e/ou o acordo do terapeuta (e.g., Jung et al, 2013).…”

Do mental health patients learn what their cognitive-behaviour therapists think they do? A short report on qualitative interviews comparing perspectives

“…As alliance is supposed to reflect the mutual engagement of patients and therapists, its important moderate association with treatment outcome has been replicated repeatedly, it is of relevance for reducing drop-out and pivotal in CBT as in other forms of psychotherapy (Flückiger, Del Re, Wampold, Symonds, & Horvath, 2012; Roos & Werbart, 2013). On the other hand, therapists’ experiences of their work may also predict divergent patient and therapist views of alliance (Hartmann, Joos, Orlinsky, & Zeeck, 2015).…”