Strategies for reducing patient-initiated premature termination of psychotherapy.
ABSTRACT 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.
- SourceAvailable from: Eugeni García-Grau01/2011;
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ABSTRACT: Treatment non-completion in personality disorder (PD) treatments is prevalent and non-completers show poorer treatment outcomes than completers. Identifying risk factors for non-completion, and particularly causal risk factors, is important to inform criteria for treatment selection, design treatments that are responsive to non-completion risk, and design interventions to minimise non-completion. Risk factors lie in a number of domains, including individual, treatment, and environmental characteristics. A model of Readiness to Engage in Treatment for Personality Disorders is presented to guide research and assessment. Pre-therapy preparation is one potentially valuable approach to improving treatment engagement and retention, and examples of interventions are described. Throughout this review, the relevance of research to forensic services is specifically highlighted.International Journal of Forensic Mental Health. 10/2012; 11(4):289-298.
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ABSTRACT: The goal of the study was to characterize older adults' experience with psychotherapy and examine its impact on engagement in psychotherapy. The study included 50 adults over age 60 who screened positive for depression and participated in the BRIGHTEN Program, an interdisciplinary geriatric mental health program. Qualitative analyses revealed five themes leading to treatment initiation: health concerns, family issues, the experience of depressive symptoms, beliefs about what participants could get from psychotherapy, and positive outcomes seen in others. Those without a history of mental health treatment were more likely to endorse health concerns as a treatment motivator and were more likely to terminate treatment early. Future research is warranted to determine how to effectively engage older adults seeking mental health treatment for the first time.Clinical Gerontologist 05/2013; 36(3):260-273. · 0.66 Impact Factor