Clinical outcomes of psychotherapy dropouts: does dropping out of psychotherapy necessarily mean failure?

Abstract

Objective: A large proportion of psychotherapy patients remain untreated, mostly because they drop out. This study compares the short-and long-term outcomes of patients who dropped out of psychotherapy to those of therapy completers. Methods: The sample included 63 patients (23 dropouts and 40 completers) from a controlled clinical trial, which compared narrative therapy vs. cognitive-behavioral therapy for major depressive disorder. Patients were assessed at the eighth session, post-treatment, and at 31-month follow-up. Results: Dropouts improved less than completers by the last session attended, but continued to improve significantly more than completers during the follow-up period. Some dropout patients improved with a small dose of therapy (17% achieved a clinically significant change before abandoning treatment), while others only achieved clinically significant change after a longer period (62% at 31-month follow-up). Conclusion: These results emphasize the importance of dealing effectively with patients at risk of dropping out of therapy.Patients who dropped out also reported improvement of depressive symptoms without therapy, but took much longer to improve than did patients who completed therapy. This might be attributable to natural remission of depression. Further research should use a larger patient database, ideally gathered by meta-analysis.

Risk for psychotherapy drop-out in survival analysis: The influence of general change mechanisms and symptom severity.

“…Third, as no follow-up data were available for the patients in this study, we cannot draw any conclusions whether drop-out was actually detrimental to the patient and/or therapist. Although there is evidence that dropping-out might result in less or a delayed improvement (Cahill et al, 2003; Lopes, Gonçalves, Sinai, & Machado, 2017), there is also counterevidence that long-term treatment outcomes are at least mixed for patients who dropped out during treatment (Knox et al, 2011). Fourth, we used the GSI of the SCL-90R or SCL-14 as a global measure to calculate symptom severity change.…”

Scheitern in der Psychotherapie – der aktuelle Wissensstand

“…Der Therapieabbruch bzw. die vorzeitige Beendigung von Therapie stellt in der Psychotherapieforschung ein besonderes Thema dar, da ein Abbruch vielerlei Bedeutung haben kann (Lopes et al 2017…”

Dropout in brief psychotherapy for major depressive disorder: Randomized clinical trial

“…Treatment with short‐term models of psychodynamic psychotherapy and cognitive‐behavioural psychotherapy has proven to be effective in remitting symptoms and improving overall functioning in MDD (Barth et al, 2013; Cuijpers et al, 2013; Lambert, 2013; Leichsenring et al, 2016; Linde et al, 2015; Lopes et al, 2018; Zieve et al, 2019).…”