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.

Download full-text


Available from: Anthony Joyce, Jan 05, 2015
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Jan 2016 · Psychological Assessment
  • Source
    • "Psychoeducation interventions usually consist of information about the development and maintenance of a particular mental disorder, the principles behind the treatment of that disorder, and suggestions for coping strategies. In accordance with the arguments that therapist support is a critical component in ICBT treatments (Johansson and Andersson, 2012), psychoeducation is thought to be a common factor that may enhance the patient's experience of accountability to the therapy and the therapist (Newman et al., 2003), stimulating the development of the therapeutic alliance (Horvath and Luborsky, 1993), and facilitate the process of entering a change promoting role (Ogrodniczuk et al., 2005). All together, these factors are thought to increase satisfaction, use, and treatment outcome among patients seeking help for anxiety disorders (Taylor et al., 2012). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Guided Internet-delivered cognitive behavioural therapy (ICBT) is an effective treatment of social anxiety disorder (SAD). However, the treatment is not effective for all. The amount and type of therapist contact have been highlighted as a possible moderator of treatment outcome. Objective: The aim of this study was to examine whether treatment effects of ICBT are enhanced with an initial 90. min face-to-face psychoeducation (PE) session for university students with SAD. Method: University students with SAD (N=37) were randomized into one out of two conditions: 1) an initial therapist-led face-to-face PE session followed by guided ICBT, 2) guided ICBT without an initial PE session. Data was analysed with an intent-to-treat approach. Results: Eight participants (21.6%) dropped out of treatment. A statistically significant reduction in symptoms was found for all outcome measures for both groups. There were no significant additional effects of adding the initial face-to-face PE. Moderate to large within-group effect sizes on self-rated social anxiety symptoms were found at post-treatment (d=0.70-0.95) and at a six month follow-up (d=0.70-1.00). Nearly half of the participants were classified as recovered. Conclusions: Notwithstanding limitations due to the small sample size, the findings indicate that guided ICBT is an effective treatment for students with SAD. Adding an initial face-to-face PE session to the guided ICBT did not lead to enhanced outcomes in the present study.
    Full-text · Article · Oct 2015 · Internet Interventions
  • Source
    • "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). "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Apr 2014 · Journal of Psychiatric Intensive Care
Show more