The effectiveness of systematic client preparation for psychotherapy on dropout rate

One of the most difficult problems facing the psychotherapist is that far too many of those entrusted to his/her care drop out of treatment prior to its satisfactory completion. The extent of the problem is reflected in the findings that in outpatient psychiatric clinics 20% to 57% of clients fail to return after the first visit (Blenkner, 1954; Dodd, 1971; Fiester & Rudestam, 1975; Gallagher & Kantner, 1961; Katz & Solomon, 1958; Overall & Aronson, 1963; Rosenthal & Frank, 1958; Weiss & Schaie, 1958), and 31% to 56% attend no more than four treatment sessions (Craig & Huffine, 1976; Frank, 1961; Gallagher & Kantner, 1961; Kurz & Garfield, 1952; Lindsay, 1965). The evidence has suggested that only about 8.5% to 17% of dropouts were doing well whereas the vast majority (83% to 91.5%) could not be classified as doing well (Straker, Devenloo, & Moll, 1967; Yalom, 1966). Further, it appears that those who terminate early from psychotherapy rarely go to seek therapy elsewhere (Garfield, 1963; Riess & Brandt, 1965).

With insufficient resources to treat clients needing mental health treatment, research efforts were made to predict those clients likely to prematurely terminate from psychotherapy. These efforts have failed to produce a multiple regression equation that successfully predicts the psychotherapy dropout (Baekeland & Lundwall, 1975). Thus, client preparation for psychotherapy programs have been developed both (a) to optimize the client's continuance in psychotherapy and (b) to enhance the client's utilization of the experience to increase successful outcomes.

This study (a) developed a videotape utilizing an informational framework and modeling of desired client behaviors and (b) tested the effectiveness of this videotape on enhancing successful outcomes in psychotherapy. Dependent variables were change in clients' attitudes and expectations about psychotherapy as measured by the inventory Expectations About Counseling-Form B (Tinsley, Workman, & Kass, 1980) and number of sessions attended by clients.

The results suggested that the videotape was effective in significantly increasing the number of psychotherapy sessions attended and in significantly reducing the dropout rate in the experimental group over a control group. The videotape had no effect in changing attitudes and expectancies as measured by the EAC-B. In addition, it was found that previous counseling significantly increased attendance over those clients who had no previous counseling.

It was concluded that a videotape incorporating modeling and an informational framework of successful psychotherapy behaviors has considerable promise in enhancing successful psychotherapy outcomes by increasing attendance and decreasing dropouts in the early stages of psychotherapy.