Psychotherapy Dropout: Using the Adolescent Psychotherapy Q-Set to Explore the Early In-Session Process of Short-Term Psychodynamic Psychotherapy

Research suggests that short-term psychodynamic psychotherapy (STPP) is an effective treatment for depression in adolescence, yet treatment dropout is a major concern and what leads to dropout is poorly understood. Whilst studies have begun to explore the role of patient and therapist variables, there is a dearth of research on the actual therapy process and investigation of the interaction between patient and therapist. This study aims to address this paucity through the utilisation of the Adolescent Psychotherapy Q-set (APQ) to examine the early treatment period. The sample includes 69 adolescents aged 16–18 years with major depressive disorder receiving STPP as part of the First Experimental Study of Transference Work–in Teenagers (FEST-IT) trial. Of these, 21 were identified as dropouts and were compared to completers on pre-treatment patient characteristics, symptomatology, functioning, and working alliance. APQ ratings available for an early session from 16 of these drop out cases were analysed to explore the patient-therapist interaction structure. Results from the Q-factor analysis revealed three distinct interaction structures that explained 54.3% of the total variance. The first described a process of mutual trust and collaboration, the second was characterised by patient resistance and emotional detachment, the third by a mismatch and incongruence between therapist and adolescent. Comparison between the three revealed interesting differences which taken together provide further evidence that the reasons why adolescents drop out of therapy vary and are multidimensional in nature.

Early Dropout in Men Voluntarily Undergoing Treatment for Intimate Partner Violence in Norway

This study investigated psychotherapy dropout rates and predictors of dropping out of therapy early. We enrolled 1,166 men voluntarily admitted to psychotherapy for violent behavior against a female partner. In total, 315 (23.8%) subjects dropped out of therapy within the first 3 sessions. Dropouts were significantly younger, more likely to have a non-Norwegian ethnic background, less likely to have received previous mental health care, and were more likely to have been treated by a student therapist. Among those treated by a student therapist, unemployment was strongly associated with early dropout. Unadjusted and adjusted results were similar. Clients and therapists may benefit by matching unemployed men with experienced therapists. Finally, the high dropout rates among ethnically non-Norwegian clients points to a need for special treatment approaches for this subgroup.