Decreasing Premature Termination from Psychotherapy

Requests for reprints should be sent to Roberta Trattner Sherman, 2512 Rock Creek Dr., Bloomington, IN 47401, or to Craig A, Anderson, Department of Psychologv, PO. Box 1892, Rice University, Houston, TX 77251. in group psychotherapy drop out early. The consequences of such dramatically high dropout rates are numerous. The most ub\'ious one is that patients who are seeking help for a problem are probably not getting the help they want or need because they drop out of therapy before their problem is solved. Luborsky, Auerback, Chandler, and Cohen (1971) reviewed treatment factors as they relate to therapeutic outcome and found that length of treatment is frequently positively correlated with outcome. Although this finding is probably confounded with dropout rates, treatment is obviously hampered when patients fail to persevere in that treatment. Like\\-ise, Lorr, \-1cNair, Michaux, and Riskin (1962) ha\'e reported a positive relation between length of therapy and outcome. Another negative consequence of premature termination is that it can reinforce a client's view that his or her problems cannot be solved. That is, when clients drop out of treatment after one or two sessions with no symptom relief, it reinforces a belief that their problems are not amenable to the therapy process, Such a belief probably exacerbates the current problem and decreases the likelihood of seeking assistance for future problems. If therapy is sought in the future, the negative belief may lead the client to approach therapy with a negative set, thereby decreasing the chances of therapy success. What is needed is a fresh approach to the dropout problem, Rather than trying to identify terminators and remainers, it may be more productive to find a general mechanism that will influence all clients to remain in therapy for some minimal amount of time, Se\'eral approaches to reducing dropout rates have received somewhat limited attention. One approach consists of reminding clients of missed or upcoming appointments (Panepinto & Higgins, 1969; Turner & Vernon, 1976). Panepinto and Higgins (1969), for example, reduced firstmonth dropout rates in an alcohol clinic from 51% to 28% simply by sending appointment letters to the patients whenever they missed a scheduled visit. A second approach involves pretherapy client preparation. Hoehn-Saric et ai. (1964) found that an initial" anticipatory socialization" interview significantly reduced dropping out of therapy, Their interview was intended (1) to provide a rational basis for patients to accept psychotherapy as a way of helping them; (2) to clarify the roles of patient and therapist; and (3) to provide a general outline of the course of treatment. Other researchers have had some success with similar procedures (e.g" Garrison, 1978; Heitler, 1976; Holmes & Urie, 1975; Piper, Oebbane, Garant, & aienvenu, 1979). These techniques, though useful, are time-consuming and expenDECREASING PREMATURE TERMINATION FROM PSYCHOTHERAPY