In Brief

Clinicians may prevent early, client-initiated therapy termination by showing a therapy introduction videotape to patients before they attend their first session, says a new study.

Published in the June 2006 issue of Professional Psychology: Research and Practice (Vol. 37, No. 3), the study tested a therapy preparation technique at a health maintenance organization (HMO).

Over the course of nearly one year, lead researcher Brendali Reis, PhD, associate faculty member at Widener University in Chester, Pa., tried out two dropout-prevention procedures with 125 clients at an outpatient clinic in California. Participants were primarily white, college-educated, married women with adjustment, mood or anxiety disorders. Half the participants watched a 12-minute videotape introducing the overall goals of therapy and how to best benefit from it--things like being open, honest and willing to express feelings. The other half watched a videotape about the development of the HMO. Two-thirds of the participants worked collaboratively with therapists to estimate and agree upon the length of their treatment, while the other third did not discuss treatment duration. After each client's termination, therapists completed a questionnaire on the extent to which each of the patients who terminated therapy could be considered dropouts. The study defined clients as terminated if they failed to schedule a new appointment within 30 days of the last session, no-show or cancellation, or had two consecutive no-shows or patient cancellations without immediate rescheduling.

Dropout scores were significantly lower for videotape-prepared participants than for those who merely watched the HMO videotape. Yet dropout rates remained the same for those who discussed treatment duration versus those who did not, regardless of whether clients also watched the preparation video.

A feedback session held with the providers at the study's conclusion provided potential insight as to why: Therapists speculated that clients who had the therapy-length conversation may have misinterpreted its intent and felt "hurried along" in their treatments, given accessibility and coverage limitations often put on health plans through HMOs. "Therapy preparation is a simple thing to do, and can be done with brochures or audiotapes, not just videotapes," says Reis. "It's surprising that it's not more used."

Reis plans to further examine how therapists can play a bigger role in refining patients' therapy expectations.

-A. Cynkar 

Further Reading

For further information, see 'Termination in Psychotherapy: A Psychodynamic Model of Processes and Outcomes' by A. Joyce, W. Piper, J. Ogrodniczuk and R. Klein (APA, 2007).