Therapy discontinuation in a primary care psychological service: why patients drop out

Abstract

The present study aimed to explore patients’ experience with an Improving Access to Psychological Therapies (IAPT) service, and to investigate the reasons for discontinuing their treatment. A qualitative approach was adopted using thematic analysis of semi-structured interviews carried out with 818 patients attending for treatment in Talking Change from November 2015 to January 2019, retrospectively. The five main themes that emerged from the study were: ‘Felt better’, ‘Issues with group settings’, ‘Therapeutic alliance breakdown’, ‘Miscommunication’ and ‘Impracticalities’. The qualitative study uncovered a wide range of reasons for people who had dropped out from their treatment. The findings mainly emphasised general dissatisfaction and inconvenient appointments. However, improvement in symptoms of depression and anxiety was also identified as a key factor among patients who discontinued their treatment. This recovery is known as ‘progress withdrawal’ in which patients withdraw from treatment early due to good therapeutic progress. We present clinical and procedural implications arising from these themes. Key learning aims (1) To explore what can cause discontinuation of therapy. (2) To obtain the experience of people who have received treatment and dropped out from Talking Change Psychological Therapy services. (3) To explore whether people recovered as part of the treatment withdrawal and what may have helped towards that recovery.

Implementation of a psychological treatment outcomes evaluation system for young people at Uruguay's National Health System: Using CORE‐OM

“…According to the therapists, the principal reason for termination was dropout. The dropout rate (47.8%) was consistent with other studies-the reported dropout rate in psychotherapy ranges from 30% to 60% (Ghaemian et al, 2020;Wang, 2007;Wierzbicki & Pekarik, 1993).…”

“…Studies have found that dropout should not always be associated with poorer outcomes (O'Keeffe et al, 2019), and some studies have highlighted the fact that patients may feel better in spite of dropping out of treatment (Ghaemian et al, 2020).…”

Development and validation of the Readiness for Therapy Questionnaire (RTQ)

“…Patient feedback was transcribed at the point of collection. The transcriptions obtained from January 2016 to January 2017 were collated, and a thematic analysis was conducted (see Ghaemian et al, 2020).…”

“…Data transparency. Three of the current authors of this manuscript have published a qualitative paper (Ghaemian et al, 2020), where the data have been extracted from the same sample as this manuscript, albeit with a different focus. The current manuscript is looking at the validity of RTQ and whether or not RTQ can predict outcome and drop-out, whereas the qualitative paper is focusing on patients' subjective experience of therapy and reasons for discontinuation from therapy.…”

Development and initial evaluation of a treatment integrity measure for low-intensity group psychoeducational interventions

“…Delgadillo et al (2016) found significant outcome variability between large didactic psychoeducational groups despite the intervention being manualized (White and Keenan, 1990), and so called for more research evaluating the effectiveness of group LI interventions that concurrently measured the competency and fidelity of practitioners to LI treatment protocols. Ghaemian et al (2020) noted that these large psychoeducational groups can be difficult to manage, with practitioners also needing good teaching skills to deliver the psychoeducational content in an easy-to-understand manner.…”