Investigating Dissatisfied Dropout from Short Term Psychoanalytic Psychotherapy for Adolescents with Depression: A Single-Case Study

Dropout from therapy is a significant concern for providers of adolescent psychotherapy due to the potential impact on resources and outcomes. Some of those who drop out do so as they are dissatisfied with their treatment, however there is little research into the therapeutic processes that precede dissatisfied dropout. This single case study aims to further our understanding of the interactional processes that are implicated in psychoanalytic therapy, where the client dropped out and remained dissatisfied with their treatment. The research material consisted of audio-recordings of sessions from one case of Short Term Psychoanalytic Psychotherapy (STPP) from the IMPACT study, a randomised controlled trial of psychotherapy for adolescents with depression. The therapy was selected from a sample of ‘dissatisfied dropouts’, that had been identified in a previous study of participants who stopped therapy as they did not feel it was helpful. The therapy was with a female who dropped out of therapy after eight sessions and was deemed to have been ‘dissatisfied’ with her treatment. Three sessions were selected for analysis, drawn from the beginning, middle and end phases of treatment. The sessions were transcribed verbatim and analysed using discourse analysis. The findings identified specific actions the therapist took to attempt to construct the young person’s problem as psychological in nature, which the young person most often rejected. Over the course of therapy, the young person’s responses shifted from implicitly rejecting the therapist’s interventions to explicitly rejecting them. The findings suggest that initial rejection of the therapist’s construction of the ‘problem’ may be an indicator of upcoming dissatisfied dropout and suggestions for further research include investigating whether such dissatisfied dropouts can be reduced through adaptation of technique.