PSYCHOTHERAPY ENGAGERS VERSUS NON-ENGAGERS

Limitations
Although the present study provides interesting findings about therapist helping
skills, client attachment style, and client self-rated need for therapy with regard to
psychotherapy engagement, the findings must be considered within the limitations of the
study. One salient consideration is the low statistical power and limited generalizability
due to the small sample size. Since the sample size is so small, the power to detect a
significant effect when it actually exists is greatly reduced. In addition, the findings have
limited generalizability since the significant findings from the study could be artifacts of
the specific sample used and may not reflect the nature of outpatient psychodynamically-
oriented individual adult psychotherapy. However, though the sample size is small, this is
the largest study to-date looking at helping skills used in thirds of intake sessions, and
Marmarosh et al. (2009) had similar attachment style findings with 31 engagers and 17
post-third-therapy-session dropouts. In addition, having therapists who worked with both
engagers and non-engagers allowed for some control over therapist variables.
Another consideration to keep in mind is that the study utilized graduate student
therapists rather than more experienced, licensed psychotherapists. It is possible that
since the therapists for the study were graduate students in training, they were more
easily de-railed from typical beginning, middle, and end-of-session tasks with the
dropouts. However, the current study utilized equal numbers of engagers and non-
engagers for each therapist, and controlled for therapist effects. Marmarosh et al. (2009)
reported similar findings regarding anxious attachment and dropout in a study including 6
licensed therapists and 15 trainees, which suggests that similar results on attachment may
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