Dropout from psychodynamic psychotherapies: a systematic review of correlated factors

Abstract

Dropout from psychotherapy is a complex and significant concern that affects patients, therapists, and mental health service providers. Although there is a growing fascination with experimental inquiries into the value and efficacy of psychodynamic therapies, there have been limited endeavours to explicitly scrutinise this topic so far. The aim of this study was to conduct a systematic review of the literature concerning individual psychodynamic therapy for adults, with the objective of identifying factors associated with treatment dropout. Employing the PRISMA method, pertinent documents were extracted from the APA PsychNet, PubMed, Cochrane Central Register of Controlled Trials, and ProQuest databases. The final review consisted of fourteen empirical studies. The median treatment dropout rate was 34.5%. Various factors, including patient characteristics, patient needs, patient beliefs, and environmental factors, were associated with treatment dropout. None of the studies conducted a specific assessment of the consequences of treatment dropout or the effectiveness of strategies aimed at minimising it. Implications for clinical practice and research are discussed.

Keywords:

• Psychotherapy dropout
• psychodynamic psychotherapy
• systematic review

Disclosure statement

No potential conflict of interest was reported by the author(s).

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Notes on contributors

Payvand Jalali

Payvand Jalali is a doctoral candidate in Clinical Psychology and a counselor based in Vancouver, BC, who specializes in psychoanalytic approaches to psychotherapy. Having graduated from the Comprehensive Psychoanalytic Program at Hamava Institute in Tehran, he is especially interested in working with young adults with a broad range of mental health issues. Payvand is a Persian translator and co-translator of many psychological books. His recent work, “Abyss of Madness” by George E. Atwood, demonstrates his commitment to making insightful psychological literature accessible to a wider audience.

Fariba Zarani

Fariba Zarani is an assistant professor of clinical psychology at Shahid Beheshti University in Tehran, Iran. She is also a registered clinical psychologist, bringing her specialized skills in health psychology to her private practice in Tehran. Currently serving as the core faculty as well as the educational administrator of the Department of Psychology, her influence extends to administrative leadership. Beyond her administrative contributions, she has made significant scholarly contributions, having published numerous scientific articles and supervised a number of theses in the fields of clinical and health psychology.

Leili Panaghi

Leili Panaghi is an Assistant Professor of Community Medicine at Shahid Beheshti University. She also serves as the Head of the Center of Education and Rehabilitation of Children with Autism. With a prolific research background, she has published numerous scientific articles and supervised multiple graduate theses. She is proficient in both quantitative and qualitative research methods, and has provided valuable guidance as a methodology advisor in various studies and dissertations.

R. Dennis Shelby

R. Dennis Shelby is a clinical practitioner in Chicago and Chesterton, Indiana, specializing in psychoanalytic theory and the treatment of specific populations like gay men, lesbian women, long-term HIV survivors, and individuals with war-related trauma. He serves as the Training and Supervising Analyst and Director of Distance Learning at the Chicago Psychoanalytic Institute. Active in the American Psychoanalytic Association, he holds roles like CO-Chair of the Distance Education Study group and has been involved in committees related to advocacy relations, gender, and sexuality. He is also Professor Emeritus at the Institute for Clinical Social Work, affiliated with international institutions in Tehran and Chengdu, China, and serves on the Editorial Boards of prestigious journals like the Journal of the American Psychoanalytic Association.