A Case of Premature Termination in a Treatment for Generalized Anxiety Disorder

Abstract

In this paper we present a case of failure in an integrative treatment for generalized anxiety disorder (GAD) combining cognitive-behavioral therapy, an empirically supported treatment for GAD, and interpersonal-emotional processing therapy. The client of focus dropped out of treatment after the eighth session. Based on our analysis of this case, we discuss the participant, technical and relationship factors that were likely implicated in this case of premature termination in both of the cognitive-behavioral and interpersonal-emotional processing segments that comprised the treatment. Implications for practice, training and future research are also discussed.

Psychotherapy: Process, mechanisms, and science–practice integration.

“…The use of CBT interventions per se was not problematic; rather, it was the increased use of CBT interventions on the part of historically nondirective therapists who were facilitating relatively nondirective treatments, potentially illustrating the negative effects of breaking an established treatment frame. This has important implications for psychotherapy integration (Boswell, Llera, Newman, & Castonguay, 2011; Boswell & Goldfried, 2010). Although technical flexibility is an important element of being responsive (see Owen & Hilsenroth, 2014), there are also dangers to haphazard integration.…”

The Difficult Task of Assessing and Interpreting Treatment Deterioration: An Evidence-Based Case Study

“…Recent work on treatment failure among CBT for specific disorders suggested that some treatments may need to be refined so as to include research advances in areas such as memory and learning (Arch and Craske, 2011). It is reasonable to assert that patient, therapist, and dyadic-relational factors, as well as technical variables associated with the type of interventions chosen and their effective delivery, all combine to determine the treatment success or failure (Boswell et al, 2011).…”