Dissatisfied dropout from school‐based humanistic counselling: A theory‐building case series

Abstract

IntroductionDissatisfied dropout costs services financially and impacts client well‐being. Research is limited on reasons for dissatisfied dropout in adolescents. Preliminary research suggests it may be due to feeling uncomfortable with silences, not knowing what to talk about, or unresolved ruptures. This study aimed to understand and refine the theory about the reasons for adolescent dissatisfied dropout from school‐based humanistic counselling (SBHC).MethodA theory‐building series of case studies was conducted with three dissatisfied dropout adolescent cases who received SBHC during a randomised controlled trial. Gaps in the theory were established by exploring the themes in one case. Testing and developing the theory with additional cases involved comparing themes and theory statements to case data. The final theory integrated data across the three cases.ResultsTherapeutic relationship difficulties and client factors were the principal, overlapping reasons for dissatisfied dropout. Relationship difficulties included a poor therapeutic alliance, the counsellor persisting with their own agenda, repetitive client/counsellor interactions with silences, the client not feeling able to trust the counsellor with a risk issue and a lack of knowledge about humanistic counselling. Client factors included the client's hesitancy and ambivalence to talk about their feelings in the counselling.ConclusionThe results fitted with, but elaborated on and extended, the theory that a poor alliance, silences and misconceptions about counselling may lead to dissatisfied dropout. Emerging findings suggest the client's negative perception about disclosing their feelings and a lack of metacommunication about any difficulties in the therapeutic relationship may lead to dissatisfied dropout from SBHC.

How do we know whether treatment has failed? Paradoxical outcomes in counseling with young people

“…Sigificant levels of correlation between helpfulness ratings and scores on both the BLRI and WAI-S may be attributed to the content (i.e., client accounts of what was helpful or hindering in counseling) underlying the helpfulness ratings. A substantial cluster of hindering process narratives generated by clients referred to alliance ruptures or more general failure to develop mutual understanding with the counselor (Ralph and Cooper, 2022;Pattison and Cooper, 2024). The scatterplot (Figure 1), which visually displays the distribution of cases across a two-dimensional space defined by YP-CORE scores and helpfulness ratings derived from qualitative interviews, is suggestive of a range of interpretations that may have heuristic value in relation to the design of further studies.…”

“…Sigificant levels of correlation between helpfulness ratings and scores on both the BLRI and WAI-S may be attributed to the content (i.e., client accounts of what was helpful or hindering in counseling) underlying the helpfulness ratings. A substantial cluster of hindering process narratives generated by clients referred to alliance ruptures or more general failure to develop mutual understanding with the counselor ( Ralph and Cooper, 2022 ; Pattison and Cooper, 2024 ).…”

“…This secondary analysis was not pre-registered. Further information on the primary study is available in published reports on the overall findings (Cooper, 2021;Cooper et al, 2021), qualitative analysis of experiences of clients receiving counseling (Raynham et al, 2023;, interviews with parents and carers (Longhurst et al, 2022), and single case analyses of poor outcome cases (Ralph and Cooper, 2022;Pattison and Cooper, 2024). The overall picture that emerged from these analyses was that counseling was generally viewed as valuable by clients and their families.…”