PSYCHOTHERAPY ENGAGERS VERSUS NON-ENGAGERS

Chapter 1: Introduction
Psychotherapy dropout is a widespread and serious problem that can result in
adverse effects on clients, therapists, and the mental health system. The phenomenon of
psychotherapy dropout is widespread: the most recent meta-analyses found overall
dropout rates of 35% (Sharf, 2007) and 47% (Wierzbicki & Pekarik, 1993)—this means
that about one-third to one-half of psychotherapy clients do not complete the full course
of treatment. Clients who drop out of therapy prematurely often have poorer outcomes
than clients who continue until treatment goals are achieved (Archer, Forbes, Metcalf, &
Winter, 2000; Klein, Stone, Hicks & Pritchard, 2003; Moras, 1986; Pekarik, 1983).
Therapists may experience increased financial pressure, especially those who work on a
fee-for-service basis and are not paid for missed appointments, and may experience
feelings of failure or decreased morale (Danzinger & Welfel, 2001; Klein et al., 2003;
Motenko, Allen, Angelos & Block, 1995; Maslach, 1978; Pekarik, 1985; Sledge, Moras,
Hartley, & Levine, 1990). The mental health system can also be negatively impacted
when clients fail to show up for a scheduled therapy session, which poses a financial
burden on staff salaries, overhead, and lost revenue, as well as personnel losses resulting
from low morale and high staff turnover (Klein et al., 2003; Tantam & Klerman, 1979).
In addition, missed appointments deny access to others in need and limit the number of
people an agency or practice can serve (Joshi, Maisami, & Coyle, 1986).
One of the factors contributing to dropout may be the verbal behavior of the
therapist during the initial sessions of therapy (Tryon, 2003). Specifically, the
investigation of therapist verbal helping skills in relation to dropout is particularly
important given that helping skills training is an integral part of training beginning
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