I am really interested in how the process of dropouts is managed in psychotherapy. I am writing a thesis on this topic and would really appreciate contributions in thought on the matter. Particularly around how early dropouts (1-3 sessions) are managed in everyday psychotherapy practice. Are there enforced guidelines around follow up? Is there any Australian data on the percentage of dropouts in the first few appointments that have been stratified between resolved status and those that are unsatisfied with their experience? Also what systems do therapists have in place to identify and support unsatisfied dropouts?
Psychotherapy is therapeutic interaction or treatment contracted between a trained professional and a client, patient, family, couple, or group. The problems addressed are psychological in nature and can vary in terms of their causes, influences, triggers, and potential resolutions. Accurate assessment of these and other variables depends on the practitioner's capability and can change or evolve as the practitioner acquires experience, knowledge, and insight.
Psychotherapy includes interactive processes between a person or group and a qualified mental health professional (psychiatrist, psychologist, clinical social worker, licensed counselor, or other trained practitioner). Its purpose is the exploration of thoughts, feelings and behavior for the purpose of problem solving or achieving higher levels of functioning.[1] Psychotherapy aims to increase the individual's sense of his/her own well-being. Psychotherapists employ a range of techniques based on experiential relationship building, dialogue, communication and behavior change that are designed to improve the mental health of a client or patient, or to improve group relationships (such as in a family).
Psychotherapy may also be performed by practitioners with different qualifications, including psychiatry, clinical psychology, counseling psychology, clinical or psychiatric social work, mental health counseling, marriage and family therapy, rehabilitation counseling, school counseling, hypnotherapy, play therapy, music therapy, art therapy, drama therapy, dance/movement therapy, occupational therapy, psychiatric nursing, psychoanalysis and those from other psychotherapies. It may be legally regulated, voluntarily regulated or unregulated, depending on the jurisdiction. Requirements of these professions vary, and often require graduate school and supervised clinical experience. Psychotherapy in Europe is increasingly seen as an independent profession, rather than restricted to psychologists and psychiatrists as stipulated in some countries.
The term psychotherapy covers a great deal of territory both in terms of specific applications (CBT, DBT, ACT, psychodynamic, Rogerian, Family, Individual, Group, etc.) It also covers many specific diagnostic issues and many without specific diagnoses such as "I just don't feel my life is they way I feel it should be". So the issue of drop out may simply be a patient that isn't ready to fully engage in therapy, or found a therapist that did not really fit well with their needs, or got worse, or realized what they needed after a couple of meetings, or couldn't afford treatment, or lost transportation, or etc. To study this I would focus on a particular form of therapy with particular diagnoses and a particular modality. The way the question is presently framed, is like "why don't plants sometimes grow beyond a few days". Much depends on the plant, the environment, weather conditions, time of year, etc. I think this problem is minimized by therapists who clearly differentiate an evaluation phase that precedes a formal treatment phase. That gives time to carefully select the kind of therapy, understand the nature of the patient's diagnosis and treatment needs, and realistically assess whether the timing is right to start.
When therapist are on vacation are on vacation or unavailable to clients, they have an obligation to have another clinician available in case the client needs assistance. If the therapist feels that he is not able to make progress with the client, he may refer the client to someone else with the clients agreement.
I not sure what occurs when clients drop out of therapy. If they are extremely resistant and difficult, the therapist may relish the fact that the client has left. As therapist, we are often philosophical believing that the teacher scenario applies to clients as well. That scenario says that when the student is ready, the teacher will appear. In consideration of drop out rate, client readiness is an essential component to be examined.
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