The aim of today’s article is to explore the new possible meanings of the concept of dropout in psychotherapy. We will do so by describing a study that explored how people make the decision to interrupt therapy . The study reported in the article A New Perspective On Client Dropouts by M. Scamardo, M. Bobele and JL Biever was conducted in 2004 at a training clinic of the Department of Psychology at Our Lady of the Lake University in San Antonio, Texas.
What does dropout in psychotherapy consist of?
In the past, this phenomenon has been identified mainly with the client’s resistance to accessing the change due to therapy , other times with the lack of motivation to undertake a process or more simply with the lack of cultural and economic resources .
Research in the field of Single Session Therapy has helped broaden the scope of the motivations that lead the client to conclude a therapy without explicitly declaring to the therapist the reasons for his choice.
What happens when a client suddenly ends therapy?
Client discontinuation of therapy generates a series of concerns in therapists, who consider abandonment of the process as a therapeutic failure (Berkham, 1992; Kadzin, Stolar, & Marcian 995; Pekarik, 1985, 1992; Pekarik & Finney-Owen, 1987; Pekarik & Wierzbick 986; Wierzbicki & Pekarik, 1993).
What did the study find?
The data analysis focused on three areas of interest:
- Clients’ prediction of therapy duration .
- How clients made the decision to discontinue therapy.
- How clients’ expectations of therapy changed over the course of therapy .
- Prediction of therapy duration:
- The study found that predictions about the length of therapy were influenced by whether or not they had had previous therapy experience . Those who had had previous therapy had some thought about the number of sessions they would need, but they were no more accurate in predicting the length of their current therapy than those without previous therapy experience.
- Most study participants based their estimates of therapy duration on their perceived severity of the problem : less severe problems were found to require fewer sessions. Clients who reported having many problems, or problems perceived as chronic, expected to have more sessions.
- How clients make the decision to discontinue therapy:
- Most participants reported that they made the decision to stop therapy because they perceived the intervention to be helpful, regardless of discussing the decision with their therapist . Even those who stopped therapy for personal reasons did not report any negative outcomes from therapy.
- Changing therapy expectations:
- After the intervention ended, there was a clear shift in participants’ expectations of therapy. Before therapy, they assumed that therapists would be authoritative and judgmental, telling clients what to do. After therapy, participants described therapists as understanding, empathetic, and helpful in solving problems.
Conclusion
This study has uncovered other possible reasons why clients stop therapy . From what has emerged, dropout seems to have little to do with traditional ideas of client resistance and premature abandonment, but rather with the expectations that clients have towards therapy (e.g. previous therapy experience, perception of the severity of the problem, the results of therapy). The results suggest that exploring these expectations with new clients from the beginning of therapy can facilitate the relationship with them, alleviate fears, provide treatment that is more suited to the needs expressed, and ultimately help therapists better understand their effectiveness .
Angelica Giannetti
Psychologist, Psychotherapist
Team of the Italian Center
for Single Session Therapy
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