Strategies for Reducing Patient-Initiated Premature Termination of Psychotherapy

Department of Psychiatry, University of British Columbia, Vancouver, BC V6T 1W6, Canada.
Harvard Review of Psychiatry (Impact Factor: 1.73). 03/2005; 13(2):57-70. DOI: 10.1080/10673220590956429
Source: PubMed


Rates of patient-initiated premature termination in different forms of psychotherapy are consistently high. Patient-initiated premature termination is recognized as a significant obstacle to the effective and efficient use of psychotherapy. The literature describes many strategies for preventing premature termination, but lacks integration. This review attempts to provide a concise and comprehensive summary of the strategies that research or clinical experience have suggested may be useful for minimizing patient-initiated premature termination. A search was conducted on the MEDLINE, PsycINFO, and EMBASE databases for literature published between January 1970 and March 2004. Retrieved articles were published in English in peer-reviewed journals and focused on psychotherapy for adults. Thirty-nine publications that discussed strategies for preventing or reducing patient-initiated premature termination of psychotherapy were identified. Surprisingly, only 15 of these were research studies. Most of the retrieved literature consisted of clinical descriptions. The strategies can be assigned to nine categories: pretherapy preparation, patient selection, time-limited or short-term contracts, treatment negotiation, case management, appointment reminders, motivation enhancement, facilitation of a therapeutic alliance, and facilitation of affect expression. Research supports some of the strategies for reducing premature termination. However, methodologically sound studies of prevention strategies remain few in number.

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Available from: Anthony Joyce, Jan 05, 2015
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    • "Negotiation has emerged as a topic of interest in recent years (Ogrodniczuk et al., 2005; Reiner & Campbell, 2001; Reiss & Brown, 1999), with a burgeoning literature on the related process of alliance ruptures and their repair in psychotherapy (Horvath & Luborsky, 1993; Norcross & Wampold, 2011; Safran & Muran, 2000, 2006). Given the observed relationships between ruptures, their repair, and treatment outcome (Muran, Safran, Gorman, Wallner-Samstag, Eubanks-Carter, & Winston, 2009; Safran et al., 2011; Stiles, Glick, Osatuke, Hardy, Shapiro, Agnew-Davies et al., 2004; Strauss et al., 2006), understanding the mechanisms that underlie or facilitate these processes is of paramount importance for clinicians and researchers alike. "
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    ABSTRACT: This study investigates the utility and psychometric properties of a new measure of psychotherapy process, the Alliance Negotiation Scale (ANS; Doran, Safran, Waizmann, Bolger, & Muran, 2012). The ANS was designed to operationalize the theoretical construct of negotiation (Safran & Muran, 2000), and to extend our current understanding of the working alliance concept (Bordin, 1979). The ANS was also intended to improve upon existing measures such as the Working Alliance Inventory (WAI; Horvath & Greenberg, 1986, 1989) and its short form (WAI-S; Tracey & Kokotovic, 1989) by expanding the emphasis on negative therapy process. The present study investigates the psychometric validity of the ANS test scores and interpretation – including confirming its original factor structure and evaluating its internal consistency and construct validity. Construct validity was examined through the ANS’ convergence and divergence with several existing scales that measure theoretically related constructs. The results bolster and extend previous findings about the psychometric integrity of the ANS, and begin to illuminate the relationship between negotiation and other important variables in psychotherapy research.
    Psychological Assessment 01/2016; 26. · 2.99 Impact Factor
    • "Adequately preparing people for treatment however, has the potential to improve engagement. Ogrodniczuk et al. (2005) listed a variety of strategies to prepare patients while Banerjee et al. (2006) developed psychoeducational interventions to develop skills and attitude to help patients make the best use of therapy. The development of psychoeducation programmes for male in patients with personality disorder has been well received (D'Silva & Duggan, 2002). "
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    ABSTRACT: A group psychoeducation programme for women in medium security was piloted. The programme aimed to increase participants’ knowledge about emotionally unstable personality disorder, decrease feelings of stigma, increase hope and motivate engagement in treatment. Treatment completers showed significant improvements on selected measures while non-completers did not. The implications of the findings are discussed along with suggestions for further research.
    Journal of Psychiatric Intensive Care 04/2014; 11(01):1-9. DOI:10.1017/S1742646413000344
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    • "Reducing the likelihood of dropouts is crucial to avoid a situation in which psychologically vulnerable patients hearing voices experience a sense of treatment failure, which may have deleterious consequences for other therapies that they might be offered in the future. Several strategies could be incorporated into clinical practice to prevent the risk for dropouts (see Ogrodniczuk et al., 2005). However, with patients hearing voices, it is important to consider how they experience their AVHs, how they manage them, and the nature of the frame of reference (e.g., medical, relationships, spiritual) that they use to account for the voices (Romme and Escher, 1998). "
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    ABSTRACT: The current study investigated the effectiveness of a group cognitive behavioral therapy for auditory verbal hallucinations (AVHs), the Voices Group. This consists of seven specific sessions. Forty-one participants with schizophrenic or schizoaffective disorders completed a battery of questionnaires. The severity of psychiatric symptoms, beliefs about voices, quality of life, self-esteem, clinical global impression, and functioning were assessed at baseline, before and after intervention, and at the 6-month follow-up. After intervention, there was a statistically significant reduction in the severity of AVHs. This result remained stable at follow-up. The dropout rate was high. Some differences were found in subjective experience of AVHs between the patients who completed the intervention and those who dropped out. Altogether, these findings suggest that a brief intervention has some positive benefits in patients struggling with voices, which remain stable over time.
    The Journal of nervous and mental disease 02/2014; 202(2):144-53. DOI:10.1097/NMD.0000000000000084 · 1.69 Impact Factor
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