Dropout in psychotherapies – Predictors and parameters to prevent premature termination in psychotherapies

Research area: Psychological & psychiatric interventions

Duration: November 2016 – September 2017
Publication: LBI-HTA Project report No. 100: https://eprints.aihta.at/1157/

Language: German

Background:
Psychotherapy describes (similar to the somatic treatment of persons) a process, which is enclosed by the start of therapy and the end of therapy and which is held in a treatment contract between the patient and the therapist. Consequently, a psychological disorder of a person marks the start of therapy and the coping or healing the end of psychotherapy. However, different factors can accelerate the end of psychotherapy in that it comes to a premature termination of therapy. On the part of the patients, a discontinuation of therapy may be influenced by the severity of a disorder or by internal and external stigmatization (e.g. in the course of a disease, life situations, or designs). Psychotherapists may for their part also contribute to unintended patients’ dropouts - e.g. through non-structural interventions that do not lead to a sufficiently viable, therapeutic alliance with patients.

Project aim:
The aim of the project is to identify different factors which can lead to the (premature or unplanned) termination of psychotherapy. These factors are to be summarized by means of clusters and, along with their characteristics, provide information about the processes involved in psychotherapies. Finally, potentially beneficial factors, which are supposedly decisive for the continuation of psychotherapy, will also be collected. In summary, a set of factors is planned, which systematically aims to record dropout reasons in psychotherapies and which thereby helps to avoid the discontinuation of treatment.

In this context, the following research questions are put forward:

1. Which theoretical foundations or "schools of thought" deal with the premature termination of psychotherapies?
2. Which factors are described in the literature
   • … causing the discontinuation of psychotherapy?
   • … that are supposed to have a positive impact on the continuation of psychotherapy in order to reach the planned end of treatment?
3. a) What are the differences in the target groups of psychotherapies (individuals / couples / families / groups - with a focus on adult patients)?

b) What are the differences with regard to the psychotherapy settings (e.g. inpatient / outpatient)?

c) What influence do accompanying treatments (such as, for example, psychopharmacotherapy) have with regard to therapy (dis)continuation of therapy?

Methods:

Ad Question 1) Handsearch; experts in psychotherapy research;

Ad Questions 2 and 3) systematic literature search in several databases and hand search;

Schedule / milestones:

November – January 2016: Scoping, project protocoll, literature search and analysis
February - April 2017: Dropout theories related to psychotherapy
May – September 2017: data extraction and finalisation of the report
October 2017: review process