The beginning of the end: a comparison of treatment completers and early dropouts in trainee-provided time-limited cognitive behavioral therapy

ABSTRACT

About one in five clients drops out of treatment prematurely. Premature termination has been found to correlate with patient, therapist, and treatment factors, as well as complex interpersonal processes, including ruptures in the therapeutic alliance. This study examines the therapeutic alliance using a qualitative approach to patient-, therapist-, and observer-based data. The sample includes five trainee therapists, each of whom worked with one patient who terminated after the first or second session, and one who completed a cognitive-behavioral therapy protocol. The session(s) preceding premature termination in the drop case and the corresponding session(s) in the completer case were examined. Rupture resolution process was prevalent in both groups, though confrontation ruptures seemed more prevalent with completers and withdrawal ruptures were more clinically impactful with dropouts. Therapist awareness of process and responsiveness or contribution to rupture were identified as potential factors contributing to patient retention.

KEYWORDS:

• Dropout
• alliance
• rupture
• resolution
• qualitative

Funding

The funder is the National Institute on Drug Abuse (NIDA) – the grant number provided (T32DA007233). The Behavioral Sciences Training in Drug Abuse Research is just the name of the program. More info here: https://taggs.hhs.gov/Detail/AwardDetail?arg_AwardNum=T32DA007233&arg_ProgOfficeCode=114

Disclosure statement

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

Additional information

Notes on contributors

Adelya A. Urmanche

Adelya Urmanche, M.A., is a clinical psychology doctoral student at Adelphi University. Interested in bridging the gap between treatment, research, and policy (particularly related to substance use disorders), she focuses her efforts on harm reduction practices, psychotherapy processes, and increasing access to empirically based substance abuse treatment.

Lauren M. Lipner

Lauren M. Lipner, Ph.D., is a postdoctoral fellow at the Gordon F. Derner School of Psychology at Adelphi University in New York, USA. Her research interests are in the field of psychotherapy process and outcome and focus specifically on therapeutic alliance rupture and repair and processes preceding premature treatment termination.

Sarah Bloch-Elkouby

Sarah Bloch-Elkouby, PhD, is an Assistant Clinical Professor in Psychiatry at Mount Sinai Beth Israel. Her clinical orientation follows a flexible mindset that integrates different treatment approaches tailored to her clients’ needs and preferences. Her research focuses on the process and outcome of psychotherapy among diverse populations as well as on the short- and long-term risk factors which put individuals at risk for suicidal behaviors.

Elaine Hunter

Elaine Hunter, PhD, is a PsyD candidate at Ferkauf Graduate School of Psychology, Yeshiva University, and a research coordinator at the Brief Psychotherapy Research Program at Mount Sinai Beth Israel.

Jerzy Kaufmann

Jerzy Kaufmann, M.A. is a doctoral student in clinical psychology at the New School for Social Research and research assistant at the Brief Psychotherapy Research Program. His research interests include the measurement of rupture-repair process in psychotherapy.

Jonathan T. Warren

Jonathan T. Warren is a doctoral student in Clinical Psychology at Ferkauf Graduate School of Psychology, Yeshiva University. His research interests are primarily in the area of psychotherapy process and outcome, with a focus on identifying and negotiating therapeutic alliance ruptures and repair strategies. Additionally, he researches shame, microaggressions, stigma, and depersonalization.

Gregory T. Weil

Gregory T. Weil, M.A., is a PhD candidate at the New School for Social Research and a member of the research staff at the Brief Psychotherapy Research Center. His research interest is in studying therapist attunement to and resolution of withdrawal rupture in psychotherapy.

Catherine F. Eubanks

Catherine F. Eubanks, PhD, is an associate professor of clinical psychology at the Ferkauf Graduate School of Psychology, Yeshiva University. She serves as Associate Director of the Brief Psychotherapy Research Program at Mount Sinai Beth Israel and maintains a small private practice. Her research interests include identifying and negotiating alliance ruptures, identifying therapist skills that are linked to effectiveness across theoretical orientations, and exploring how therapists' skills can be enhanced through training and supervision.

J. Christopher Muran

J. Christopher Muran, PhD, is Associate Dean and Full Professor at the Gordon F. Derner School of Psychology, Adelphi University, and Principal Investigator of the Mount Sinai Beth Israel Psychotherapy Research Program, Icahn School of Medicine at Mount Sinai.