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: 2.49). 03/2005; 13(2):57-70. DOI: 10.1080/10673220590956429
Source: PubMed

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.

Download full-text


Available from: Anthony Joyce, Jan 05, 2015
  • Source
    • "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). "
    [Show abstract] [Hide abstract]
    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 · 1.81 Impact Factor
  • Source
    • "Furthermore, the research topic of preparation for psychotherapy needs more attention. Too many patients terminate psychotherapy prematurely, or submit to psychotherapy reluctantly , only to leave it dissatisfied (Ogrodniczuk et al., 2005). Methods for preparation for psychotherapy based on SDT and MI, currently used in connection with cognitive– behavioral therapy (Westra et al., 2011), should be applied also in connection with other psychotherapeutic methods, such as psychodynamic and experiential psychotherapy. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The present study aimed to examine whether patients' pretherapy motivation was related to other patient characteristics and whether it predicted retention in psychotherapy. Data were collected within a naturalistic outcome study of various forms of psychotherapy for patients (N = 172) with substance use disorders (SUD). Therapy motivation was measured using the Client Motivation for Therapy Scale (CMOTS), including the variables autonomous motivation, controlled motivation, and amotivation. Female patients had higher levels of autonomous motivation (d = .53), lower levels of controlled motivation (d = -.32), and lower levels of amotivation (d = -.62). Level of symptoms and impairment was significantly positively correlated with controlled motivation (r = .31). Autonomous motivation was positively correlated with four expectation subscales associated with constructive therapeutic work, whereas amotivation was negatively correlated with three of these subscales. Controlled motivation was positively correlated with the subscales external orientation, defensiveness, and support. In a logistic regression, amotivation stood out as a negative predictor of retention, in terms of starting in psychotherapy after assessment or not. Quite surprisingly, autonomous motivation was not a significant predictor of retention. The present study indicates that amotivation is a risk factor for early dropout among SUD patients. More efforts should be directed at preparing patients for psychotherapy through strengthening motivation. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Psychotherapy Theory Research Practice Training 09/2013; 51(4). DOI:10.1037/a0033360 · 3.01 Impact Factor
  • Source
    • "A further seven studies used samples that had a variety of diagnoses, and it was usually impossible to disaggregate the proportion of the sample with different disorders. The fact that diagnosis was a significant moderator of intervention effectiveness highlights two issues: (a) where patients present with comorbid psychological problems (i.e., various diagnoses), this is likely to indicate a level of complexity that attendance interventions fail to match, and (b) future trials of attendance strategies should reliably record the patient groups on which interventions are being tested (Ogrodniczuk et al., 2005). Specific diagnoses permit inferences about well-evidenced deficits and problems (i.e., inertia/rumination in depression and avoidance/ escape in anxiety) and prompt the development and testing of theoretically driven interventions that target the disorder-specific mechanisms creating TR and PT in reliably identified patient groups. "
Show more