Psychotherapy discontinuation
   HOME

TheInfoList



OR:

Psychotherapy discontinuation, also known as unilateral termination, patient dropout, and premature termination, is a patient's decision to stop
mental health Mental health encompasses emotional, psychological, and social well-being, influencing cognition, perception, and behavior. It likewise determines how an individual handles stress, interpersonal relationships, and decision-making. Mental health ...
treatment before they have received an adequate number of sessions. In the United States, the
prevalence In epidemiology, prevalence is the proportion of a particular population found to be affected by a medical condition (typically a disease or a risk factor such as smoking or seatbelt use) at a specific time. It is derived by comparing the number o ...
of patient dropout is estimated to be between 40–60% over the course of treatment however, the overwhelming majority of patients will drop after two sessions. An exhaustive meta-analysis of 146 studies in Western countries showed that the mean dropout rate is 34.8% with a wide range of 10.3% to 81.0%. The studies from the US (''n'' = 85) had a dropout rate of 37.9% (range: 33.0% to 43.0%).


Differing definitions

Psychotherapy discontinuation can mean different things to different researchers or clinicians. Although the important aspects of what discontinuation consist of (client's decision, symptoms not adequately reduced) typically remain constant, there can still be differences of how these are measured. For example, one researcher may designate that completing 50% of sessions will mark the client as a treatment completer, where another may designate this amount at 75%. When looking at patient dropout rates, these inconsistencies can make the data difficult to understand. But the same patients might be considered non-completes in another study.


Associated issues


Poor patient outcomes

Patient dropout is associated with numerous problems, such as: loss of potential patient improvement, poorer outcomes, increased likelihood of over-utilizing resources, and disruption in group therapy settings. Intuitively, these patients lose out on the benefits they may have received if they continued treatment. They also face poorer outcomes and fewer benefits of therapy compared to those who continue with treatment. Further, patients who discontinue treatment are more likely to be characterized as chronic patients, resulting in over-utilization of services, up to twice as much as "appropriate" terminators. In a
group therapy Group psychotherapy or group therapy is a form of psychotherapy in which one or more therapists treat a small group of clients together as a group. The term can legitimately refer to any form of psychotherapy when delivered in a group format, i ...
session, premature discontinuation of one member may in turn adversely affect the other members of the group.


Narcissistic injury

Narcissistic injury is a possible outcome of patient dropout, where therapists and clinicians may feel a diminished sense of self and may even feel inadequate. They may interpret a patient's discontinuation of treatment as a direct result of something they did. This can lead to lower
self-esteem Self-esteem is confidence in one's own worth or abilities. Self-esteem encompasses beliefs about oneself (for example, "I am loved", "I am worthy") as well as emotional states, such as triumph, despair, pride, and shame. Smith and Mackie (2007) d ...
,
confidence Confidence is a state of being clear-headed either that a hypothesis or prediction is correct or that a chosen course of action is the best or most effective. Confidence comes from a Latin word 'fidere' which means "to trust"; therefore, having ...
, and thus their
effectiveness Effectiveness is the capability of producing a desired result or the ability to produce desired output. When something is deemed effective, it means it has an intended or expected outcome, or produces a deep, vivid impression. Etymology The ori ...
which will negatively impact their delivery of treatments to other patients. There is no current research as to how often this occurs in patient dropout cases.


Clinician and administrative losses

Less apparent are the effects non-completes have on the entire mental health care system. Clinicians experience losses in the form of time spent on patient intakes, missed appointments prior to termination, and other
diagnostic Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine " cause and effect". In systems engine ...
work performed. Administratively, these inefficiencies contribute to long waiting lists, which in turn: deny services to others, worsen community perception, and create lost income for clinics. Cyclically, long waiting lists have shown some increased dropout effects, further exacerbating the problem.


Predicting at-risk patients

Predicting patients at risk of dropping treatment is a difficult task that is still being researched. However, there are different factors associated with patient dropout that are worth identifying. There are several meta-analysis studies that addressed these issues.


Patient characteristics

Patient characteristics are anything
innate {{Short pages monitor