Drop‐outs in psychotherapy: a change of perspective

Leichsenring, Falk; s., Lea; Steinert, Christiane

doi:10.1002/wps.20588

Cited by 22 publications

(17 citation statements)

References 8 publications

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“…Our results reflect men’s complex trajectories in and out of services depending on a variety of factors. Appraising dropout itself as universally problematic and always avoidable has recently been challenged (Leichsenring et al, 2019). This is because for some men (and clients in general), dropping out of therapy may not necessarily reflect a negative outcome, but more so a process of weighing up the relative cost and necessity of engagement with a therapy service at a given time, and as a bridge to effective self-management.…”

Section: Discussionmentioning

confidence: 99%

Men’s Dropout From Mental Health Services: Results From a Survey of Australian Men Across the Life Span

et al. 2021

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While increasing numbers of Australian men are accessing mental health services, the sustainability of their therapy engagement varies significantly, with many men being lost to follow-up. The current study investigated dropout rates in a large community-based male sample to highlight the reasons for, and potential predictors of, men dropping out of mental health care services. Data were drawn from an online survey of 1907 Australian men (aged 16–85; M = 44.1 years) reflecting on their broad experiences in mental health therapy. Participants responded to bespoke items assessing their past dropout experience and reasons for dropping out, the odds of which were modeled in relation to demographics and predictors (e.g., therapist engagement strategies, alignment to traditional masculinity and pre-therapy feelings of optimism, shame, and emasculation). The overall dropout rate from therapy was 44.8% ( n = 855), of which 26.6% ( n = 120) accessed therapy once and did not return. The most common reasons for dropout were lack of connection with the therapist (54.9%) and the sense that therapy lacked progress (20.2%). Younger age, unemployment, self-reported identification with traditional masculinity, the presence of specific therapist engagement strategies, and whether therapy made participants feel emasculated all predicted dropout. Current depressive symptoms and suicidality were also higher amongst dropouts. Therapists should aim to have an honest discussion with all clients about the importance of therapy fit, including the real likelihood of dropout, in order to ensure this does not deter future engagement with professional services.

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Section: Discussionmentioning

confidence: 99%

Men’s Dropout From Mental Health Services: Results From a Survey of Australian Men Across the Life Span

et al. 2021

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“…Improving available treatments: tailoring the treatment more specifically to the patient For improving available treatments, a primary focus on the large proportion of patients who do not benefit sufficiently from available treatments or who drop out prematurely is promising (non-responders and drop-outs). Examining, for example, the reasons for prematurely dropping-out allows to identify the limitations of existing treatments (Leichsenring et al, 2019). This type of research will provide important information about patients' needs and for improving treatments.…”

Section: Methodological Improvementsmentioning

confidence: 99%

Toward a paradigm shift in treatment and research of mental disorders

2019

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Mental disorders are common and represent a significant and worldwide public health concern (Smith, 2011; Vigo et al., 2016; Patel et al., 2018). The global burden of disease due to mental illness accounts for 21-32% of years lived with disability and 7-13% of disability-adjusted life-years (Vigo et al., 2016). The Lancet commission on global mental health and sustainable development just recently estimated a loss of US$16 trillion to the global economy due to mental disorders in the period 2010-2030 (Patel et al., 2018). Psychotherapy and pharmacotherapy are the two key available treatments presently offered to millions of subjects with mental disorders around the world. However, recent evidence suggests that their effects are overestimated due to several factors, such as publication bias,

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“…Vulnerable patients tend to be interpersonally detached and aloof in therapy, disavowing the need for closeness; at the same time, they have to receive attention and admiration from their clinicians (Ogrodniczuk & Kealy, 2013). Not surprisingly, it is very difficult for clinical practitioners to establish a good therapeutic relationship with these patients (Ronningstam, 2012); accordingly, the risk of premature treatment termination (drop-out) is very high, especially in youth clinical populations (e.g., Hilsenroth, Holdwick, Castlebury, & Blais, 1998;Karver, De Nadai, Monahan, & Shirk, 2018;Leichsenring, Sarrar, & Steinert, 2019). Therapists of different theoretical orientations should be capable of tolerating and managing their strong and disruptive emotional responses to these patients (i.e., the countertransference) in the clinical situation and repairing the alliance ruptures that typically occur in treatment (Hayes, Gelso, & Hummel, 2011;Safran & Muran, 2000).…”

mentioning

confidence: 99%

Clinician Emotional Responses and Therapeutic Alliance When Treating Adolescent Patients With Narcissistic Personality Disorder Subtypes: A Clinically Meaningful Empirical Investigation

Tanzilli

Gualco²

2020

Journal of Personality Disorders

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This study examined clinician emotional responses and therapeutic alliance in psychotherapy with adolescent patients with specific subtypes of narcissistic personality disorder (NPD). A national sample of therapists (N = 58) completed the Therapist Response Questionnaire for Adolescents to identify patterns of clinician response, the Working Alliance Inventory to evaluate the quality of alliance, and the Shedler-Westen Assessment Procedure-II for Adolescents to assess the personality pathology of a patient in their care. The results showed that the grandiose narcissistic subtype was positively related to angry/criticized and disengaged/hopeless therapist responses and negatively related to warm/attuned response. The fragile subtype was positively related to overinvolved/worried therapist response. The high-functioning/exhibitionistic subtype was negatively related to angry/criticized response. Lower quality of therapeutic alliance was positively associated with the grandiose subtype. Moreover, the empirically founded prototypes of therapist responses to adolescent patients with NPD subtypes strongly resemble theoretical-clinical accounts. The clinical implications are addressed.

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Drop‐outs in psychotherapy: a change of perspective

Cited by 22 publications

References 8 publications

Men’s Dropout From Mental Health Services: Results From a Survey of Australian Men Across the Life Span

Men’s Dropout From Mental Health Services: Results From a Survey of Australian Men Across the Life Span

Toward a paradigm shift in treatment and research of mental disorders

Clinician Emotional Responses and Therapeutic Alliance When Treating Adolescent Patients With Narcissistic Personality Disorder Subtypes: A Clinically Meaningful Empirical Investigation

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