Treatment Compliance and Early Termination of Therapy: A Comparative Study

Abstract

Background: Compliance in therapy appears to be linked to the process of therapeutic alliance. A positive patient–therapist relationship usually leads to successful completion of therapy. The aim of this study was to compare evidence, collected at two time periods in a Community Mental Health Center in Athens, on factors affecting treatment compliance. The hypothesis was that by modifying the therapeutic team’s functioning, noncompliance could be reduced. Methods: Epidemiological data were collected from child and adolescent out-patient files at two time periods: time period A, 1990–1994, n = 455 (sample A) and time period B, 2000–2002, n = 476 (sample B). Variables pertaining to the patient, his family and recommended treatment were examined. Student’s t test and the Pearson χ² test were used in order to explore the correlation of the variables with treatment completion in each sample. Logistic regression analyses were used to determine whether the effect of each variable on treatment completion differed between the two samples. Results: In sample A, most patients (58.6%) did not comply with therapy. The type of recommended treatment, the number of sessions, season of admission and the type of presented problem were found to correlate with treatment completion. Between the two time periods, certain modifications were implemented in the team’s functioning (less diagnostic sessions, focused psychotherapy techniques, less time interval between referral and first diagnostic appointment). A significant reduction in the early termination rate (45.7%) was noted in sample B. The type of recommended treatment, the number of sessions, the family’s situation, the mother’s educational level and the patient’s gender were related to treatment completion in sample B. The effect of the type of proposed treatment and the mean number of sessions of the completed treatments differed significantly between the two samples. Conclusions:Early termination rates in therapy decreased between two time periods. This decrease may be attributed to modifications in the team’s functioning, aimed at improving the therapeutic relationship. The limitation of this study is that only those factors pertaining to the service’s organization and functioning were investigated.

Patient and Clinician Perceptions of Therapeutic Alliance as Predictors of Improvement in Depression

“…Accordingly, training in establishing effective relationships should not be narrowly construed as an instruction in a discrete set of manualizable techniques, but rather as learning to be sensitively attuned to each patient’s personal characteristics and appropriately responding to the patient’s unique interests and needs [38,39]. Related, particular modifications in the team’s general functioning can foster significant increases in compliance, which is in turn related to the process of therapeutic alliance [40,41]. Finally, our findings further suggested that therapists may be able to forecast patients that are less likely to obtain positive outcomes, highlighting possibilities to intervene timely.…”

Predictors of Premature Termination of Day Treatment for Personality Disorder

“…Second, although we took a comprehensive approach to identifying significant predictors, undoubtedly, we failed to include all potentially important variables. Third, we did not consider how the activities during treatment might have contributed to patients’ decisions to terminate [32]. Finally, we did not consider whether patients who terminated later in treatment differed systematically from patients who terminated earlier in treatment.…”

Adolescent adherence to psychosocial treatment: Mental health clinicians' perspectives on barriers and promoters

“…Research into the clinicians' contributions to adherence has focused on the contribution of the therapeutic alliance (Barber et al, 2006;Barber, Khalsa, & Sharpless, 2010;Lazaratou, Anagnostopoulos, Vlassopoulos, Tzavara, & Zelios, 2006;Murdock, Edwards, & Murdock, 2010;Perron, Zeber, Kilbourne, & Bauer, 2009;Priebe & Mccabe, 2008;Sharf, Primavera, & Diener, 2010). In addition, research has begun to investigate specific adherence strategies employed by clinicians to maintain psychosocial adherence.…”