Strategies for Reducing Patient-Initiated Premature Termination of Psychotherapy

Abstract

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.

Interventions to increase attendance at psychotherapy: A meta-analysis of randomized controlled trials.

“…A further 7 studies used samples that had a variety of diagnoses, and it was usually impossible to disaggregate the proportion of the sample with different disorders. The fact that diagnosis was a significant moderator of intervention effectiveness highlights two issues: (1) where patients present with co-morbid psychological problems (i.e., various diagnoses), this is likely to indicate a level of complexity which attendance interventions fail to match, and (2) future trials of attendance strategies need to reliably record the patient groups on which interventions are being tested (Ogrodniczuk et al, 2005). Specific diagnoses permit inferences about well evidenced deficits and problems (i.e., inertia/rumination in depression and avoidance/escape in anxiety), and prompt the development and testing of theoretically driven interventions that target the disorder specific mechanisms creating TR and PT in reliably identified patient groups.…”

“…Barrett et al (2008) and Walitzer et al (1999) included studies of both child/family and adult psychotherapy services, whereas Ogrodniczuk et al, (2005) focussed on adult psychotherapy. All three reviews discussed the pros and cons of diverse attendance strategies and agreed that interventions to reduce TR and PT did show promise.…”

“…During the past 10 years, three qualitative reviews have evaluated the evidence that intervention strategies are effective at increasing attendance at psychotherapy (Barrett et al, 2008;Ogrodniczuk et al, 2005;Walitzer et al, 1999). Barrett et al (2008) and Walitzer et al (1999) included studies of both child/family and adult psychotherapy services, whereas Ogrodniczuk et al, (2005) focussed on adult psychotherapy.…”

Psychoeducation with problem-solving (PEPS) therapy for adults with personality disorder: a pragmatic randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of a manualised intervention to improve social functioning

“…Given emerging evidence that good clinical care is as effective as 'active' treatments, 95,98-100 more should be done to understand the barriers to, and facilitators of, the implementation of good care. Both qualitative and quantitative investigation is indicated.…”

Understanding Barriers to Retention after a Clinical Treatment Trial Drop Out: Translating Qualitative Research and Theory to Practice

“…This burden is also alarming given the coexistence of cancer and depression being associated with significantly increased mortality [5][6][7][8]. Existing psychosocial intervention studies have been based almost exclusively on White populations [9,10], fail to describe the ethnic composition of the sample, completely omit discussion of ethnic minority sample description, were not conducted in public care systems, or provide little explanation of attrition problems [11][12][13].…”