Dropping Out of Child Psychotherapy: Issues for Research and Implications for Practice

Abstract

Dropping out of psychotherapy among children and adolescents is a significant problem affecting 40-60 percent of the cases receiving outpatient care. I review research on premature termination from treatment and current issues raised by that work. Our research work on dropping out of treatment among children referred for conduct disorder is highlighted to convey a risk factor and burden-of-treatment model to identify and explain who drops out of treatment and why. Factors that predict dropping out of treatment, the clinical outcomes of children who drop out and influences that moderate the impact of risk factors are discussed. A risk-factor model can aid clinical practice. Those in practice can readily test a variety of factors to determine whether such factors predict premature termination. Once at-risk cases are identified, interventions can be used early in treatment to retain cases. Efforts to establish a therapeutic alliance at the earliest points of contact within families is one such strategy. Some factors that place families at risk (e.g. high stress) may guide foci of treatment or initial clinic contacts. Clinical practice is an excellent venue for testing hypotheses about factors that place families at risk for premature termination and for intervening to improve participation in treatment.