PSYCHOTHERAPY ENGAGERS VERSUS NON-ENGAGERS

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increasingly demonstrated that weak or poor therapeutic alliances are related to increased dropout (Tryon & Kane, 1993; Johansson & Eklund, 2005; Lingiardi, Filippucci, & Baiocco, 2005; Meier, Donmall, McElduff, Barrowclough, & Heller, 2006; Mohl, Martinez, Ticknor, Huang, & Cordell, 1991; Samstag, Batchelder, Muran, Safran, & Winston, 1998). Consequently, several researchers have suggested attentiveness to the presence of alliance ruptures or weakenings as a promising strategy for decreasing early treatment withdrawal (Castonguay et al., 2004; Safran, Muran, Samstag, & Stevens, 2001). Summary. In summary, the two major reviews of the literature on dropout found that psychotherapy dropout occurs frequently (as evidenced by the 47% dropout rate found by Wierzbicki and Pekarik, 1993), is affected by many factors (e.g., client demographics, enabling factors/barriers, need factors, and environmental factors; Barrett et al., 2008), and that there are a number of strategies for reducing dropout (e.g., role induction, motivational interviewing, changing the treatment services model, therapist feedback, and strengthening the therapeutic relationship; Barrett et al., 2008). Limitations of the research on psychotherapy dropout include the lack of conclusive findings on the factors causing psychotherapy dropout due to the differing definitions used across different studies. In addition, little research has been done thus far on determining whether specific therapist helping skills, or the timing of those skills, are related to dropout. Early dropout. It is important to examine early dropout separately from dropout occurring later on, because early dropout may occur for a different set of factors than 15
later dropout (Barrett et al., 2008). In this section, I review the literature on early dropout, as the present study will focus on early dropouts from psychotherapy. Pekarik (1983) examined termination status (i.e., early dropout, late dropout, and appropriate termination) in relation to the post-therapy adjustment of outpatient psychotherapy clients. Clients were 64 outpatients at four clinics of a community mental health center. Therapists were 12 psychotherapists (3 Ph.D. psychologists, 6 with M.A.s in psychology, 1 M.S.W., 1 B.S.W., and 1 with a B.A. in human services) who described themselves as eclectic in orientation. Therapists had an average of five and a half years of professional experience. Six therapists were male; six therapists were female. The measure of post-therapy adjustment was the Brief Symptom Inventory (BSI; Derogatis & Spencer, 1982), which clients completed pre-therapy (prior to their intake session) and post-therapy (3 months after the intake date). Results of the study indicated that appropriate terminators had better BSI scores than dropouts at follow-up, t(63) = 4.80, p < .001, and that later dropouts were better adjusted than early dropouts who had attended only one or two sessions, χ 2 (1) = 6.88, p < .01. Limitations of the study include that the adjustment measure was not administered closely to the dropout date (thus, other factors may have affected the adjustment score), that the findings may not apply to other types of therapists who are not eclectic in theoretical orientation, and that no effect-size information was reported. Tryon (1986) investigated client and counselor characteristics in relation to whether clients returned for therapy after completing an initial intake session in a university counseling center. Counselors were 9 practicum trainees (5 female, 4 male). Clients were 203 people (128 female, 75 male) who had come to a university counseling 16
Page 1 and 2: ABSTRACT Title of Document: PSYCHOT
Page 3 and 4: PSYCHOTHERAPY ENGAGERS VERSUS NON-E
Page 5 and 6: Table of Contents List of Tables ..
Page 7 and 8: Last Third of the Intake: Helping S
Page 9 and 10: List of Figures Figure 1: Approval-
Page 11 and 12: therapists (Hill & Lent, 2006), tha
Page 13 and 14: third of the intake) and types of t
Page 15 and 16: “completed treatment” - from a
Page 17 and 18: ange on the OQ-45.2 when beginning
Page 19 and 20: Wierzbicki and Pekarik (1993) condu
Page 21 and 22: Enabling factors or barriers refer
Page 23: MI evaluation were statistically si
Page 27 and 28: male) at a university counseling ce
Page 29 and 30: = 12.3, p < .001, and lower rates o
Page 31 and 32: F(1, 261) = 40.64, p < .001. Limita
Page 33 and 34: clinic in a medium-sized Midwestern
Page 35 and 36: Summary. In summary, there are seve
Page 37 and 38: quality of the technique (e.g., app
Page 39 and 40: therapist behaviors which may be be
Page 41 and 42: of the three judges. Based on an ex
Page 43 and 44: theoretical orientation. Furthermor
Page 45 and 46: occur after closed questions, and I
Page 47 and 48: Elliott’s (1985) system used in t
Page 49 and 50: 8 women who were interviewed to det
Page 51 and 52: lasted 20 minutes for each type, tr
Page 53 and 54: corresponded to similar categories
Page 55 and 56: does not provide restatements, refl
Page 57 and 58: presenting concerns, psychosocial h
Page 59 and 60: counselors was reported. Minimal fa
Page 61 and 62: (1991); and Tryon (2003). At the en
Page 63 and 64: counselor’s emphasis from gatheri
Page 65 and 66: composed of volunteer undergraduate
Page 67 and 68: Table 3 Tryon (2003) Mean Number an
Page 69 and 70: therapy service at the university (
Page 71 and 72: treatment outcome (which means the
Page 73 and 74: Chapter 3: Statement of the Problem
Page 75 and 76:
engagement, and f) a definition of
Page 77 and 78:
the intake session, and about 4% wi
Page 79 and 80:
Research Question 9: Do proportions
Page 81 and 82:
Chapter 4: Method The present study
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Indian and Portuguese; aged 20-28,
Page 85 and 86:
or abandoned by romantic partners.
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Intake sessions. When clients arriv
Page 89 and 90:
unitizer had a unit in a meaningful
Page 91 and 92:
Table 4 Proportions of Helping Skil
Page 93 and 94:
Table 6 Proportions of Helping Skil
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to the last third of the session, a
Page 97 and 98:
second to last third, F(1, 3858) =
Page 99 and 100:
Estimated Likelihood (%) 12 10 8 6
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significant, F(1, 3856) = 3.95, p =
Page 103 and 104:
Research Question 7: Do proportions
Page 105 and 106:
Page 107 and 108:
Research Question 10: Do proportion
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Client Avoidant Attachment Scale Av
Page 115 and 116:
Client Outcome Expectations How con
Page 117 and 118:
minimal encouragers since the 2009
Page 119 and 120:
In contrast, information about the
Page 121 and 122:
duration. This null finding diverge
Page 123 and 124:
Limitations Although the present st
Page 125 and 126:
for need for therapy and “How con
Page 127 and 128:
Appendix A: Preliminary Tests of Th
Page 129 and 130:
Barrett, M., Chua, W., Crits-Christ
Page 131 and 132:
Dodd, J. (1970). A retrospective an
Page 133 and 134:
Hampton-Robb, S., Qualls, R. C., &
Page 135 and 136:
Hill, C. E. (2009). Helping skills:
Page 137 and 138:
Johansson, H., & Eklund, M. (2005).
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Ligiero, D. P., & Gelso, C. J. (200
Page 141 and 142:
Pekarik, G. (1983). Follow-up adjus
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Stiles, W. B. (1978). Verbal respon
Page 145:
Willer, J. (2009). The beginning ps
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PSYCHOTHERAPY ENGAGERS VERSUS NON-ENGAGERS

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