Clients who drop out of therapy can increase the strain on community mental health services. Dropping out is classified as terminating treatment prior to reaching outcome goals or the recommended number of sessions. When clients drop out, they often end up back in treatment repeatedly, creating a burden on overtaxed mental health resources and clinicians. Therapists who treat clients that drop out of treatment may experience a sense of incompetency that can impair their ability to effectively treat other clients. Additionally, the repetitive nature of starting and stopping treatment seen in clients who drop out can limit the therapists’ availability to treat other clients in need. In order to address this issue and develop strategies to decrease dropout rates, Joshua K. Swift of the Department of Psychology at the University of Alaska in Anchorage recently led a study that analyzed over 83,000 client records from 669 different studies.
Swift examined primarily studies addressing mood issues and anxiety. The therapies assessed were individual and cognitive in nature and were designed to be completed in fewer than 20 sessions. The results revealed that the most common type of drop out was described as failure to complete therapy, which occurred in nearly 20% of the clients studied. The findings also revealed that the highest dropout rates were found in the youngest clients and those being treated for either an eating problem or personality disorder. Additionally, dropout rates were disproportionately high for clients who were treated at a teaching clinic by a clinician in training.
This study provided evidence that supports previous research. Namely, the results showed that most dropouts are client initiated. However, there is still confusion with respect to a clear definition of a dropout. Swift believes that this term needs to be clarified in order to gauge accurate rates of dropouts in the clinical population. The results of this study also underscore the need for additional research that explores different therapy approaches, settings, and goals. Swift believes understanding the rates of dropout in anxiety clients versus substance abuse clients could help clinicians target factors that lead to premature termination. It is also important to look at how different modes of treatment, such as family therapy and marital therapy, vary with respect to client retention. Swift added, “Although premature discontinuation is occurring at a lower rate than what was estimated 20 years ago (Wierzbicki & Pekarik, 1993), it is still a significant problem, with about 1 in every 5 clients dropping out of therapy.”
Swift, J. K., Greenberg, R. P. (2012). Premature discontinuation in adult psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology. Advance online publication. doi: 10.1037/a0028226
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