Recent Innovations in Psychology

Recent Innovations in Psychology

Premature Dropout from Psychotherapy and Counseling among Clients to Psychological and Psychiatric Clinics: The Role of Demographic Characteristics, Self-esteem and Anxiety

Document Type : Original Article

Authors
Somayeh Safarzade 1
Mahnaz Joukar Kamalabadi 2
Faridehsadat Hoseini 3
Seyed Mousa Golestaneh 4
1 PhD. Student in Psychology, Persian Gulf University, Bushehr, Iran
2 Assistant Professor, Department of Psychology, Persian Gulf University, Bushehr, Iran
3 Associate Professor, Department of Psychology, Persian Gulf University, Bushehr, Iran
4 Associate professor, Department of Psychology, Persian Gulf University, Bushehr, Iran
10.22034/rip.2024.484087.1065
Abstract
Psychotherapy has been demonstrated to be an efficacious intervention for the treatment of mental disorders. However, over the past decade, there has been a notable rise in client dissatisfaction with the psychotherapy process and an increase in the number of premature dropouts from treatment sessions. The objective of the present study was to examine the influence of demographic characteristics, self-esteem and anxiety on the phenomenon of premature termination of psychotherapy and counseling. The research method employed in the present study was that of a descriptive cross-sectional study. The study population comprised all clients attending psychology and psychiatry clinics in Mashhad. The intended sample comprised 87 references, selected by purposive sampling between September 2023 and April 2024. The Outcome Questionnaire-45 (OQ-45), the Beck Anxiety Inventory (BAI), the Rosenberg Self-Esteem Scale (RSE) and the Demographic Information Questionnaire for Patients (DIQFP) were employed as instruments for the measurement of the variables under investigation. The findings indicated that gender, age, anxiety, and self-esteem were associated with early discontinuation of psychotherapy and counseling (P < 0.05) and predicted 39% of the variance. No statistically significant correlation was identified between clinical diagnosis and premature dropout of psychotherapy and counseling (P > 0.05). The results of the study indicated that demographic characteristics, anxiety, and self-esteem are predictive premature dropout of psychotherapy and counseling. It is anticipated that the findings of the present study will provide a foundation for further investigation of the psychotherapy process and treatment sessions by clinical professionals.
Keywords
anxiety
demographic characteristics
premature dropout
psychotherapy
self-esteem

Subjects

References

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Arnow, B. A., Blasey, C., Manber, R., Constantino, M. J., Markowitz, J. C., Klein, D. N., Thase, M. E., Kocsis, J. H., & Rush, A. J. (2007). Dropouts versus completers among chronically depressed outpatients. Journal of Affective Disorders, 97(1-3), 197–202. https://doi.org/10.1016/j.jad.2006.06.017

Banyard, H., Behn, A. J., & Delgadillo, J. (2021). Personality Disorders and Their Relation to Treatment Outcomes in Cognitive Behavioural Therapy for Depression: A Systematic Review and Meta-analysis. Cognitive Therapy and Research, 45, 561–576. https://doi.org/10.1007/s10608-021-10203-x

Barber, J. P., & Solomonov, N. (2019). Toward a personalized approach to psychotherapy outcome and the study of therapeutic change. World psychiatry: Official Journal of the World Psychiatric Association (WPA), 18(3), 291–292. https://doi.org/10.1002/wps.20666

Barkham, M., Lutz, W., & Castonguay, L. G. (Eds.). (2021). Bergin and Garfield's handbook of psychotherapy and behavior change. John Wiley & Sons. URL: https://psycnet.apa.org/record/2021-81510-000

Barrett, M. S., Chua, W.-J., Crits-Christoph, P., Gibbons, M. B., & Thompson, D. (2008). Early withdrawal from mental health treatment: Implications for psychotherapy practice. Psychotherapy: Theory, Research, Practice, Training, 45(2), 247–267. https://doi.org/10.1037/0033-3204.45.2.247

Beck, A. T., Epstein, N., Brown, G., & Steer, R. (1988). Beck Anxiety Inventory [Database record]. APA PsycTests. https://psycnet.apa.org/doi/10.1037/t02025-000

Beck, A. T., Steer, R. A., Ball, R., & Ranieri, W. (1996). Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients. Journal of personality assessment, 67(3), 588–597. https://doi.org/10.1207/s15327752jpa6703_13

Borgogna, N. C., McDermott, R. C., Berry, A., Lathan, E. C., & Gonzales, J. (2020). A multicultural examination of experiential avoidance: AAQ – II measurement comparisons across Asian American, Black, Latinx, Middle Eastern, and White college students. Journal of Contextual Behavioral Science, 16, 1–8. https://doi.org/10.1016/j.jcbs.2020.01.011

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Chisholm, S. M., Crowther, J. H., & Ben-Porath, Y. S. (1997). Selected MMPI-2 scales' ability to predict premature termination and outcome from psychotherapy. Journal of Personality Assessment, 69(1), 127–144. https://doi.org/10.1207/s15327752jpa6901_7

Clarkin, J. F., & Levy, K. N. (2004). The influence of client variables on psychotherapy. Bergin and Garfield’s handbook of psychotherapy and behavior change, 5, 194-226. URL: https://levylab.la.psu.edu/wp-content/uploads/sites/9/2

Colak, M., Bingol, O. S., & Dayi, A. (2023). Self-esteem and social media addiction level in adolescents: The mediating role of body image. Indian Journal of Psychiatry, 65(5), 595–600. https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_306_22

Connell, J., Grant, S., & Mullin, T. (2007). Client initiated termination of therapy at NHS primary care counseling services. Counseling and Psychotherapy Research, 6, 60–67. https://doi.org/10.1080/14733140600581507

Cottone, J. G., Drucker, P., & Javier, R. A. (2002). Gender differences in psychotherapy dyads: Changes in psychological symptoms and responsiveness to treatment during 3 months of therapy. Psythotherapy: Theory, Research, Practice, Training, 39(4), 297-308. https://doi.org/10.1037/0033-3204.39.4.297

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Edlund, M. J., Wang, P. S., Berglund, P. A., Katz, S. J., Lin, E., & Kessler, R. C. (2002). Dropping out of mental health treatment: patterns and predictors among epidemiological survey respondents in the United States and Ontario. The American Journal of Psychiatry, 159(5), 845–851. https://doi.org/10.1176/appi.ajp.159.5.845

Elbaky, G. B. A., Hay, P. J., le Grange, D., Lacey, H., Crosby, R. D., & Touyz, S. (2014). Pre-treatment predictors of attrition in a randomized controlled trial of psychological therapy for severe and enduring anorexia nervosa. BMC Psychiatry, 14(1), 69. https://doi.org/10.1186/1471-244X-14-69

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Fernandez, E., Salem, D., Swift, J. K., & Ramtahal, N. (2015). Meta-analysis of dropout from cognitive behavioral therapy: Magnitude, timing, and moderators. Journal of Consulting and Clinical Psychology, 83(6), 1108–1122. https://doi.org/10.1037/ccp0000044

Flückiger, C., Meyer, A., Wampold, B. E., Gassmann, D., Messerli-Bürgy, N., & Munsch, S. (2011). Predicting premature termination within a randomized controlled trial for binge-eating patients. Behavior therapy, 42(4), 716–725. https://doi.org/10.1016/j.beth.2011.03.008

Fortuna, L. R., Alegria, M., & Gao, S. (2010). Retention in depression treatment among ethnic and racial minority groups in the United States. Depression and Anxiety, 27(5), 485–494. https://doi.org/10.1002/da.20685

Gamache, D., Savard, C., Lemelin, S., Côté, A., & Villeneuve, E. (2018). Premature psychotherapy termination in an outpatient treatment program for personality disorders: a survival analysis. Comprehensive psychiatry, 80, 14–23. https://doi.org/10.1016/j.comppsych.2017.08.001

García, J. A., Y Olmos, F. C., Matheu, M. L., & Carreño, T. P. (2019). Self esteem levels vs global scores on the Rosenberg self-esteem scale. Heliyon, 5(3), e01378. https://doi.org/10.1016/j.heliyon.2019.e01378

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References
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Anderson, K. N. (2015). Premature termination of outpatient psychotherapy: Predictors, reasons, and outcomes (Doctoral dissertation. Available from ProQuest dissertations and Theses database.) University of Nebraska. URL: https://digitalcommons.unl.edu/psychdiss/74/
Arnow, B. A., Blasey, C., Manber, R., Constantino, M. J., Markowitz, J. C., Klein, D. N., Thase, M. E., Kocsis, J. H., & Rush, A. J. (2007). Dropouts versus completers among chronically depressed outpatients. Journal of Affective Disorders, 97(1-3), 197–202. https://doi.org/10.1016/j.jad.2006.06.017
Banyard, H., Behn, A. J., & Delgadillo, J. (2021). Personality Disorders and Their Relation to Treatment Outcomes in Cognitive Behavioural Therapy for Depression: A Systematic Review and Meta-analysis. Cognitive Therapy and Research, 45, 561–576. https://doi.org/10.1007/s10608-021-10203-x
Barber, J. P., & Solomonov, N. (2019). Toward a personalized approach to psychotherapy outcome and the study of therapeutic change. World psychiatry: Official Journal of the World Psychiatric Association (WPA), 18(3), 291–292. https://doi.org/10.1002/wps.20666
Barkham, M., Lutz, W., & Castonguay, L. G. (Eds.). (2021). Bergin and Garfield's handbook of psychotherapy and behavior change. John Wiley & Sons. URL: https://psycnet.apa.org/record/2021-81510-000
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Chisholm, S. M., Crowther, J. H., & Ben-Porath, Y. S. (1997). Selected MMPI-2 scales' ability to predict premature termination and outcome from psychotherapy. Journal of Personality Assessment, 69(1), 127–144. https://doi.org/10.1207/s15327752jpa6901_7
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Fernandez, E., Salem, D., Swift, J. K., & Ramtahal, N. (2015). Meta-analysis of dropout from cognitive behavioral therapy: Magnitude, timing, and moderators. Journal of Consulting and Clinical Psychology, 83(6), 1108–1122. https://doi.org/10.1037/ccp0000044
Flückiger, C., Meyer, A., Wampold, B. E., Gassmann, D., Messerli-Bürgy, N., & Munsch, S. (2011). Predicting premature termination within a randomized controlled trial for binge-eating patients. Behavior therapy, 42(4), 716–725. https://doi.org/10.1016/j.beth.2011.03.008
Fortuna, L. R., Alegria, M., & Gao, S. (2010). Retention in depression treatment among ethnic and racial minority groups in the United States. Depression and Anxiety, 27(5), 485–494. https://doi.org/10.1002/da.20685
Gamache, D., Savard, C., Lemelin, S., Côté, A., & Villeneuve, E. (2018). Premature psychotherapy termination in an outpatient treatment program for personality disorders: a survival analysis. Comprehensive psychiatry, 80, 14–23. https://doi.org/10.1016/j.comppsych.2017.08.001
García, J. A., Y Olmos, F. C., Matheu, M. L., & Carreño, T. P. (2019). Self esteem levels vs global scores on the Rosenberg self-esteem scale. Heliyon, 5(3), e01378. https://doi.org/10.1016/j.heliyon.2019.e01378
Goddard, E., Wingrove, J., & Moran, P. (2015). The impact of comorbid personality difficulties on response to IAPT treatment for depression and anxiety. Behaviour Research and Therapy, 73, 1-7. https://doi.org/10.1016/j.brat.2015.07.006
Greenspan, M., & Kulish, N. M. (1985). Factors in premature termination in long-term psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 22(1), 75–82. https://doi.org/10.1037/h0088529
Hanevik, E., Røvik, F. M. G., Bøe, T., Knapstad, M., & Smith, O. R. F. (2023). Client predictors of therapy dropout in a primary care setting: a prospective cohort study. BMC psychiatry, 23(1), 358. https://doi.org/10.1186/s12888-023-04878-7
Harpaz-Rotem, I., & Rosenheck, R. A. (2011). Serving those who served: retention of newly returning veterans from Iraq and Afghanistan in mental health treatment. Psychiatric services (Washington, D.C.), 62(1), 22–27. https://doi.org/10.1176/ps.62.1.pss6201_0022
Immel, N., Dagnino, P., & Hunger-Schoppe, C. (2022). Associations between patient personality, symptomatic change and therapy dropout. Clinical Psychology & Psychotherapy, 29(3), 922–932. https://doi.org/10.1002/cpp.2670
Kegel, A. F., & Flückiger, C. (2015). Predicting Psychotherapy Dropouts: A Multilevel Approach. Clinical Psychology & Psychotherapy, 22(5), 377–386. https://doi.org/10.1002/cpp.1899
Khazaie, H., Rezaie, L., Shahdipour, N., & Weaver, P. (2016). Exploration of the reasons for dropping out of psychotherapy: A qualitative study. Evaluation and Program Planning, 56, 23–30. https://doi.org/10.1016/j.evalprogplan.2016.03.002
Kullgard, N., Holmqvist, R., & Andersson, G. (2022). Premature Dropout From Psychotherapy: Prevalence, Perceived Reasons and Consequences as Rated by Clinicians. Clinical psychology in Europe, 4(2), e6695. https://doi.org/10.32872/cpe.6695
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  • Receive Date 17 October 2024
  • Revise Date 16 November 2024
  • Accept Date 19 November 2024
  • First Publish Date 06 December 2024