PSYCHOTHERAPY ENGAGERS VERSUS NON-ENGAGERS

discussed in previous paragraphs above. Differing perceptions of treatment or outcome
may complicate the definition of dropout, since clients may believe that additional
therapy sessions will not be helpful and end treatment, whereas therapists may consider
such clients to have dropped out. However, it is not clear whether a client should be
considered a dropout if the client does not consider himself or herself a dropout – perhaps
the client felt that enough help was obtained and ended treatment. Thus, it is unclear how
much therapist judgment should play a role in determining whether a client is a drop out,
especially when there are no clearly observable markers for seeing whether the client has
achieved their therapeutic goals (Barrett et al., 2008).
Predictors of psychotherapy dropout in the Barrett et al. (2008) paper were
discussed using Andersen’s (1968, 1995) model that focuses on four broad categories of
influence on patient use of services: patient characteristics, enabling factors/barriers,
need factors, and environmental factors. Patient characteristics (i.e. patient demographic
variables) have been the most frequently studied client factors (Barrett et al., 2008).
Mixed findings have been found for age; most research has shown minimal relationship
between dropout and age (Cartwright, 1955; Craig & Huffine, 1976; Frank, Gliedman,
Imber, Nash, & Stone, 1957; Rubenstein & Lorr, 1956), but two recent studies (Edlund et
al., 2002; Thormahlen et al., 2003) have found that clients younger than 25-30 years old
are more likely to drop out than older clients. More consistent findings have been found
for socioeconomic status. Clients with lower socioeconomic status are more likely to
drop out than those with higher socioeconomic status (Baekeland & Lundwall, 1975;
Wierzbicki & Pekarik, 1993).
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