Abstract

Objective: 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.

Method: 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 (N = 2977). Higher-order therapist and center-level effects were assessed for each definition.

Results: 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.

Conclusion: 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.

摘要

目的：关于从心理治疗中辍学的文献一直存在结构操作多样化的问题。一些人呼吁更统一的定义，以帮助跨研究进行推广；本研究旨在通过同时检查三个不同定义的出现率来评估此类定义的可行性。此外，还探讨了治疗师和中心水平的差异，以进一步了解定义之间的差异。

方法：我们使用从国家实践研究网络 ( N =  2977) 收集的数据比较了三种不同的辍学操作（基于上次会议出勤率、治疗师判断和症状变化）的流行率和重叠。每个定义都评估了高阶治疗师和中心级效果。

结果：定义之间几乎没有重叠，只有不到 1% 的客户同时满足所有三个定义的标准。此外，针对每个定义都发现了治疗师和中心效应，尤其是治疗师评定和最后一次会议出勤定义的辍学。

结论：与辍学的单一定义不同，这些结果表明多个、具体和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“类别”辍学的预测因素和检查治疗师的不同实践和中心。