How do adolescents end open-ended psychoanalytic psychotherapy? Exploring dropout in a community-based clinic

ABSTRACT

Dropout from psychotherapy among adolescents is a common occurrence. Adolescents’ need for independence can be in direct conflict with therapeutic relationships, particularly in open-ended psychotherapy where endings need to be negotiated. The present study was a service evaluation, which aimed to identify how open-ended once-weekly psychoanalytic psychotherapy ends with adolescents, and whether dropout could be predicted from a range of adolescent and treatment factors. The sample comprised 443 adolescents, aged 14–24, who had received psychoanalytic psychotherapy in a community-based clinic. Logistic regression was used to estimate the effects of predictors on the odds of dropout. Adolescents were categorised based on how treatment ended: adolescents’ unilateral decision (43%), mutually agreed between adolescent and therapist (27%), initiated by changed external circumstances such as relocation (23%) or a referral to another service (6%). Younger adolescents and those from more disadvantaged backgrounds were most at risk of dropout. Missed sessions early in treatment were also predictive of dropout. Neither therapist change nor the number of services was significantly associated with dropout. This study shows that dropout is a frequent occurrence in open-ended psychoanalytic psychotherapy. Further research is needed to explore how young people at risk of dropout can be better supported to attend treatment to ensure they receive the maximum benefits. Moreover, research is required to identify how therapists can optimally respond to missed sessions, to avoid subsequent dropout and to facilitate positive and appropriate treatment endings.

KEYWORDS:

• Adolescent
• dropout
• psychoanalytic psychotherapy
• therapy
• young people

Acknowledgments

The authors thank the Brent Centre’s team for their valuable comments and suggestions in helping us to prepare this article for publication.

Disclosure statement

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

Patient anonymisation statement

Potentially personally identifying information presented in this article that relates directly or indirectly to an individual, or individuals, has been changed to disguise and safeguard the confidentiality, privacy and data protection rights of those concerned, in accordance with the Journal’s anonymisation policy.

Additional information

Funding

SOK is funded by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria (NENC) (NIHR200173). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

Notes on contributors

Greta Steponaityte

Greta Steponaityte is a child and adolescent psychotherapist in Doctoral training at the Tavistock and Portman NHS Trust. At the time of the study, she worked as a research psychologist at the Brent Centre for Young People.

Sally O’Keeffe

Sally O’Keeffe is a mental health research fellow in the NIHR Applied Research Collaboration North East and North Cumbria, based at Newcastle University. Her research focuses on mental health support for children and families, and she has a particular interest in interventions for youth depression and self-harm.