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Premature therapy terminators, dropouts, or unilateral terminators?

April 3, 2015
by Terry L. Stawar, Ed.D.
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I was recently asked by one of my board members if we asked people who dropped out of services why they left. I had to admit that we didn’t do that. Like most, we conduct a very large client satisfaction survey annually and get good feedback from clients and parents of children in treatment.

We also conducted a referral source satisfaction survey for  many years, but seldom got any good actionable feedback. Mostly we got the same complaints from the same people every year, who did not like some of our policies.

Always one to blame the patient, Freud  believed  that premature termination of psychoanalysis was generally related to being unsuitable for therapy, due to  insufficient intelligence, the presence of psychosis, socioeconomic factors, or an early and dramatic manifestation of resistance that could not be overcome or worked through. 

Freud said, “The patient now regards the analyst as no more than a stranger who is making disagreeable demands on him and he behaves towards him exactly like a child who does not like the stranger and does not believe  anything he says.

Studies back in the 1950s indicated that 30% to 60% of those who initiated psychotherapy terminated  within the first six months and the modal number of visits for psychotherapy often ranged from one to three visits.

By the 1980s, conventional  wisdom was that about one-third of clients would  be premature terminators. In 2012 Joshua Swift from the University of Alaska conducted a meta analysis and  found a 20% drop out rate among adults in psychotherapy.

In 1974 Stanley P. Rosenzweig, From the Veteran Aministration's (VA) Clinic in Boston, examined dropout rates for group psychotherapy in a VA clinic setting. He looked at a number of patient and therapist variables but only found that lower levels of  education were associated with higher dropout rates.    

A 2007 Brazilian study, by Simone Hauck from the Hospital de Clinicas de Porto Alegre and her associates, examined  a sample  of  psychoanalytic  psychotherapy patients. They  found a modest dropout rate of only 12.5%. They concluded that the severity of psychopathology alone didn’t predict dropout, but patients with lower levels of insight, and immature defenses, especially narcissistic,  had higher  premature termination rates. 

In  a 1985 study, Marie Greenspan and Nancy Kulish from the Northland Clinic in Southfield Michigan studied the characteristics of 273 cases of “premature terminators”  from long term psychotherapy. They found that PhD psychologists had lower rates of premature terminators than MD or MSW therapists. Also therapists who had undergone personal therapy  tended to have lower rates of dropouts. Higher dropout rates were also seen  in patients who were Afro-American, had complaints of family or marital discord, were diagnosed as “depressive reactions” and were not middle-aged. 

In 1987 Anna Kokotovic and Terence Tracy  from the University of Illinois  looked at therapy dropouts  from a University Counseling Center and found that client satisfaction and the client’s  perception of the therapist’s  trustworthiness and expertise were associated with keeping scheduled appointments. Therapist attractiveness and client-therapist agreement on problem  identification were unrelated to appointment keeping.

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Terry Stawar

President/CEO (LifeSpring, Inc.)

Terry Stawar

@tstawar

planetterry.wordpress.com

Terry L. Stawar, EdD, is President and CEO of LifeSpring Health Systems, a community behavioral...