PSYCHOTHERAPY ENGAGERS VERSUS NON-ENGAGERS

Enabling factors or barriers refer to the influence of external factors on an
individual’s ability to show up for sessions or continue in treatment (Barrett et al., 2008).
An example of an enabling factor is referral source. Clients referred by outside agencies
or hotlines were more likely to not show up at the first treatment session than those
referred by religious groups, friends, or insurance companies (Hampton-Robb, Qualls, &
Compton, 2003). Barriers such as difficulty finding mental health services (Parker &
McDavis, 1983), greater distance traveled (Fraps, McReynolds, Beck, & Heisler, 1982),
placement on waiting lists (Festinger, Lamb, Marlowe, & Kirby, 2002; Stasiewicz &
Stalker, 1999), and longer waiting times from intake to first treatment session (Rodolfa,
Rapaport, & Lee, 1983) have been repeatedly linked with treatment dropout (Barrett et
al., 2008).
Need factors (i.e. severity of psychiatric condition) have had mixed findings in the
literature (Barrett et al., 2008). Although some studies suggest that psychotic clients are
less likely to drop out early on in the process compared to clients with less severe
diagnoses (Craig & Huffine, 1976; Dodd, 1970; Hoffman, 1985), other studies have
found that patients with more severe diagnoses are more likely to drop out (e.g., Sue,
McKinney, Allen & Hall, 1974). In looking at how severity of psychiatric condition
relates to dropout, it is difficult to determine whether improvement, or lack thereof, has
influenced a client’s decision to drop out without documentation of client distress before,
during, and after treatment (Hunsley, Aubry, Verstervelt, & Vito, 1999).
Environmental factors also have been examined in relation to psychotherapy
dropout (Barrett et al., 2008). Staff attitudes, the setting of the clinic, or clinic facilities
are more likely to affect clients in the initial phone call or intake evaluation than after
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