Why do clients discontinue therapy? Research demonstrates that at least one in every five clients terminates therapy prior to completion, with some studies showing as many as one in every two clients drop out in public behavioral health. This is certainly bad news for our overall psychotherapy effectiveness. It is critical that we identify the “why” behind these decisions and seek to find the “how” of increased retention.
Therapists can implement the following strategies for decreasing early terminations and improving psychotherapy effectiveness:
- Ensure clients are engaged. Research demonstrates that those who remain in psychotherapy experience better outcomes than those who terminate early. Clients engage when therapy aligns with their expectations, values, and attitudes, or what Barry Duncan has called the client’s theory of change. The sure-fire way to ensure that clients are engaged is by measuring outcomes. Clients who do not show early change wind up on the dropout list. Monitoring outcomes allows us to know when clients are at risk for early termination and when to take action to prevent it. This is what the Partners for Change Outcome Management System (PCOMS) and Better Outcomes Now (BON) software are all about.
- Establish a positive alliance. More than 1,000 studies demonstrate the importance of the therapeutic alliance and its robust relationship to outcome. This boils down to making the alliance a priority in each encounter and ensuring the client not only feels the relational bond, but also agrees with the therapist about the goals and methods of therapy. One way to make this happen is by measuring the alliance and getting client feedback in every session. This again is what PCOMS and BON are all about.
- And perhaps obvious by now, implement a proven therapy outcome management system. Measuring outcomes and the alliance has not only been demonstrated to decrease early terminations and improve outcomes, it also reduces length of stay and overall costs. In addition, involved parties - from funders to the clients themselves - expect evidence of outcomes and results. Call it a return on investment - or a return on effort. Using data from PCOMS and BON ensures that such a return happens.
Psychotherapy is effective in treating a broad range of conditions and diagnoses. When we take steps to decrease therapy termination and increase measurable results using a reliable therapy outcome management system, everyone benefits.