Viktor Koltko and Dr. Tyler Pedersen, Career and Counseling Center
Introduction
Premature termination from treatment is a common problem across all psychotherapeutic settings. Dropout undermines the potential benefits of therapy to those in need and also reduces overall cost-effectiveness of treatment. Research indicates that those who terminate unilaterally from therapy are more likely to be dissatisfied with services, are less likely to have improved, and are typically more impaired and hence in need of services. Current research yields no consensus as to the causes of early client termination from therapy. Results of prior studies indicate that wait-time before and between sessions, client improvement, dislike of the therapist, dissatisfaction with services provided, contextual concerns (travel, time constraints, child care, etc.) and the therapeutic process all contribute to premature termination.
This study explored the most common reasons for non-return after intake at the Brigham Young University counseling center.
Methods
Participants included 103 student-clients who sought counseling services at the Brigham Young University counseling center and who did not return after the first attended intake session. Students who consented were invited to complete an online questionnaire consisting of 123 total items. The survey included measures examining the client’s reasons for discontinuing therapy, a measure of current psychological distress, and a checklist of presenting problems.
Results
In response to the question “Why did you discontinue therapy?”, the option “Because my problems improved and I no longer felt a need for counseling” had the highest modal score of participants selecting it as a “Very great influence.” On a 1-5 scale from “Very slight influence” to “Very great influence,” the highest mean scores were: improved problems (2.77), dissatisfaction with therapy (2.37), “Other reasons” (2.34), and scheduling problems (2.24).When forced to rank each contributing factor to discontinuance, improvement of problems was chosen as the number one factor by 30% of study participants. 27% marked dissatisfaction with counseling services as the most influential factor in discontinuance. 16% said that “time restraints (scheduling conflicts)” was the greatest factor. 13% said that “moving away from the area” was the greatest factor. Qualitative data collection of responses indicates that the most referenced factors were successful abatement of problems, dissatisfaction with counseling services, and scheduling difficulties due to high demand
Discussion
While those who ‘drop out’ of therapy after only an intake session do so for a variety of reasons, there appear to be three most common reasons for discontinuance: abatement of symptoms, dissatisfaction with counseling services, and difficulties in scheduling appointments.
While the first of these indicates the strength of services in a university counseling center, the latter two are significant barriers to treatment. The initial results of this study indicate that there are opportunities for short term treatment resulting in significant gains to client mental health. Concurrently, many of those seeking psychological services are not receiving the help that they desire. The reasons for this are unknown, but may involve the initial severity of presenting problems, a mismatch between client and counselor expectations of therapy, a client’s history in psychotherapy, and the initial approach of the therapist. Exploring each of these reasons further will provide valuable tools to clinicians. There may be a prevailing approach to treatment which is highly beneficial to one subset of student-patients, but unsatisfactory to a second subset. Further research hopes to discover the differences between these two groups. If predictive characteristics of each group were identified, clinicians may be able to identify, before intake, which patients require an alternative approach.
Research on this project continues, and results have been presented at the annual Utah University and College Counseling Center Conference. Proposals have been submitted for presentation at the annual convention of the American Psychological Association, as well as the annual meeting of the Society for Psychotherapy Research in Copenhagen, Denmark