Xiao Henry, Castonguay Louis G, Hayes Jeffrey A, Janis Rebecca A, Locke Benjamin D
Center for Counseling and Psychological Services, Pennsylvania State University, University Park, PA, USA.
Department of Psychology, Pennsylvania State University, University Park, PA, USA.
Psychother Res. 2023 Feb;33(2):146-157. doi: 10.1080/10503307.2022.2082897. Epub 2022 Jun 23.
The literature regarding dropout from psychotherapy has suffered from issues of diverse operationalization of the construct. Some have called for a more uniform definition to aid in generalization across research; this study aimed to assess the viability of such a definition by examining the rate of occurrence for three distinct definitions simultaneously. In addition, therapist and center level variances are explored to further understand the differences between definitions. We compared the prevalence rates and overlap of three distinct operationalizations of dropout (based on last session attendance, therapist judgment, and symptom change) using data gathered from a national practice research network (2977). Higher-order therapist and center-level effects were assessed for each definition. There was very little overlap among definitions, with less than one percent of clients simultaneously meeting criteria for all three definitions. Additionally, therapist and center effects were found for each definition, especially notable for therapist-rated and last-session attendance definitions of dropout. Rather than a singular definition of dropout, these results instead suggest that multiple, specific, and unique definitions more accurately depict clinical reality, and future research might benefit from uncovering predictors of different "classes" of dropouts and examining the different practices of therapists and centers.
关于心理治疗中退出治疗的文献一直存在该概念操作化多样的问题。一些人呼吁采用更统一的定义，以有助于研究结果的推广；本研究旨在通过同时考察三种不同定义的发生率，评估这样一个定义的可行性。此外，还探讨了治疗师和治疗中心层面的差异，以进一步了解不同定义之间的区别。我们使用从一个全国性实践研究网络收集的数据（2977例），比较了三种不同的退出治疗操作化定义（基于最后一次治疗的出席情况、治疗师的判断和症状变化）的患病率和重叠情况。对每个定义评估了更高阶的治疗师和治疗中心层面的效应。各定义之间的重叠非常少，同时符合所有三种定义标准的客户不到1%。此外，每个定义都发现了治疗师和治疗中心的效应，在治疗师评定的和基于最后一次治疗出席情况的退出治疗定义中尤为明显。这些结果表明，不是单一的退出治疗定义，而是多个、具体且独特的定义更准确地描述了临床现实，未来的研究可能会受益于揭示不同“类型”退出治疗的预测因素，并考察治疗师和治疗中心的不同做法。
