Research digest: psychotherapy dropout

Introduction

This edition’s digest presents studies examining the premature ending, or ‘dropout’ of psychotherapeutic treatment. Although the first study below suggests that patients are more likely to refuse or drop out of drug treatment than psychotherapy (Swift, Greenberg, Tompkins, & Parkin, 2017), around one in five psychotherapy cases are thought to end prematurely (Swift & Greenberg, 2012), suggesting that this is a common clinical phenomenon that warrants further investigation.

In the articles below, a range of patient factors are hypothesised to be linked to treatment dropout rates, including severity of diagnosis (Wampers et al., 2018), depressive symptoms (Fernandez, Salem, Swift, & Ramtahal, 2015), and experience of childhood trauma (Miles & Thompson, 2016). Although Swift and Greenberg’s meta-analysis (2014) finds that treatment modality does not substantially affect dropout rates, therapist factors are also thought to make a significant contribution (Xiao et al., 2017). Acknowledging that therapy dropout can be understood as a negative therapeutic reaction linked to the transference relationship, one study uses the Psychotherapy Process Q-Set to compare patient and therapist activities in completed and incomplete mentalisation-based treatments (Philips, Karlsson, Nygren, Rother-Schirren, & Werbart, 2018). Two other studies investigate the impact of the interaction between therapist and patient on dropout rates, one by examining associations between nonverbal synchrony and treatment completion (Paulick et al., 2018), and another by asking whether ethnic/first language matching between therapist and client is predictive of retention rates (Presley & Day, 2018).

Finally, a large-scale survey of reasons for early termination (Anderson, Bautista, & Hope, 2019) and two qualitative/mixed-methods analyses of patient interviews (O’Keeffe, Martin, Target, & Midgley, 2019; Hundt et al., 2018) attempt to understand this subject from the patient’s perspective, and hig