Clinical outcomes of psychotherapy dropouts: does dropping out of psychotherapy necessarily mean failure?

• Published in: Revista brasileira de psiquiatria Vol. 40; no. 2; pp. 123 - 127
• Main Authors: Lopes, Rodrigo Cunha Teixeira, Gonçalves, Miguel M., Sinai, Diana, Machado, Paulo P. P.
• Format: Journal Article
• Language: English
• Published: Brazil Associação Brasileira de Psiquiatria (ABP) 01.04.2018; Associação Brasileira de Psiquiatria
• Subjects: Adult; Ciências Médicas; Cognitive Behavioral Therapy - statistics & numerical data; Depressive Disorder, Major - therapy; Female; Follow-Up Studies; Humans; Male; Medicina Clínica; Narrative Therapy - statistics & numerical data; Original; Outcome assessment; Patient Compliance; Patient dropout; Patient Dropouts - psychology; Patient Dropouts - statistics & numerical data; Psychiatric Status Rating Scales; PSYCHIATRY; Psychotherapy; Science & Technology; Self Report; Time Factors; Treatment Outcome; Unipolar depression; outcome assessment; Patient dropout; psychotherapy; unipolar depression
• ISSN: 1516-4446; 1809-452X; 1809-452X
• DOI: 10.1590/1516-4446-2017-2267

Objective: A large proportion of psychotherapy patients remain untreated, mostly because they drop out. This study compares the short- and long-term outcomes of patients who dropped out of psychotherapy to those of therapy completers. Methods: The sample included 63 patients (23 dropouts and 40 completers) from a controlled clinical trial, which compared narrative therapy vs. cognitive-behavioral therapy for major depressive disorder. Patients were assessed at the eighth session, post-treatment, and at 31-month follow-up. Results: Dropouts improved less than completers by the last session attended, but continued to improve significantly more than completers during the follow-up period. Some dropout patients improved with a small dose of therapy (17% achieved a clinically significant change before abandoning treatment), while others only achieved clinically significant change after a longer period (62% at 31-month follow-up). Conclusion: These results emphasize the importance of dealing effectively with patients at risk of dropping out of therapy.Patients who dropped out also reported improvement of depressive symptoms without therapy, but took much longer to improve than did patients who completed therapy. This might be attributable to natural remission of depression. Further research should use a larger patient database, ideally gathered by meta analysis. This study was conducted at Centro de Investigação em Psicologia (UID/PSI/01662/2013), Universidade do Minho, supported by Fundação para a Ciência e Tecnologia and the Portuguese Ministry of Science, Technology and Higher Education through national funds, and co-financed by Fundo Europeu de Desenvolvimento Regional (FEDER) through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-007653) and through a doctoral grant to RTL (SFRH/BD/47343/2008). The authors would like to thank the patients, therapists, and staff at the psychological service at Universidade do Minho who participated in the various segments of this study, with special thanks to Ca´tia Von Doellinger, who helped with data collection at follow-up and statistical analysis. An earlier version of this paper was presented at the 42nd International Meeting of the Society for Psychotherapy Research, held in Bern, Switzerland, in June 2011.