Psychotherapy discontinuation

Psychotherapy discontinuation, also known as unilateral termination, patient dropout, and premature termination, is a patient's decision to stop mental health treatment before they have received an adequate number of sessions. In the United States, the prevalence 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 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, confidence, and thus their effectiveness 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 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