PSYCHOTHERAPY ENGAGERS VERSUS NON-ENGAGERS

treatment has begun (Gunzburger, Henggeler, & Watson, 1985). Other environmental
factors such as lack of transportation and difficulty getting time off work or school (Beck
et al., 1987; Cross & Warren, 1984) have surprisingly not had consistent relation to
dropout (Barrett et al., 2008).
Strategies for reducing psychotherapy dropout that were discussed in the Barrett
et al. (2008) paper included: role induction (i.e. clarifying therapist and client roles),
motivational interviewing, changing the treatment services model to better meet the
changing demands of mental health treatment and managed care, therapist feedback, and
strengthening the therapeutic relationship. Role induction (also referred to as pretherapy
preparation) has been shown to improve client attendance (Walitzer, Dermen, & Connors,
1999). 11 of the 16 studies reviewed by Walitzer et al. (1999) found that pretherapy
training reduced rates of dropout. Techniques that clarify the therapist and client roles
and give an overview of therapy have been found to improve attendance (Hoehn-Saric et
al., 1964) and decrease dropout (Jacobs, Charles, Jacobs, Weinstein, & Mann, 1972).
Brief motivational interviewing (brief MI; Rollnick & Heather, 1992), when
integrated into the initial intake evaluation, has been related to nearly 50% reductions in
dropout rates (Carroll, Libby, Sheehan, & Hyland, 2001), as discussed in the Barrett et al.
(2008) paper. For example, Carroll et al. (2001) investigated the effects of brief MI
intake evaluations on dropout. Dropouts for this study (Carroll et al., 2001) were
individuals who did not begin treatment sessions after attending an initial intake
evaluation. 60 individuals referred for a substance abuse evaluation by a child welfare
worker were randomly assigned to one of two conditions: either a standard evaluation or
an evaluation enhanced by brief MI techniques. The participants who received the brief
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