Reducing psychotherapy dropouts: Maximizing perspective convergence in the psychotherapy dyad

Premature termination of psychotherapy is a pervasive problem-30 to 60% of psychotherapy clients drop out of treatment before its completion. This review summarizes 3 decades of research on the topic. Client, therapist, and administrative variables have been extensively investigated. Because of a variety of methodological problems, this literature is highly contradictory, and results are difficult to reconcile, with only socioeconomic status (SES) and ethnicity emerging as consistent predictors of dropout. Research looking at interactive and multidimensional factors such as working alliance, satisfaction, patient likability, and expectations has proven more useful than research on client, therapist, and administrative variables. Findings suggest that dropouts might be minimized if differences between therapists' and patients' perspectives on the therapeutic enterprise are acknowledged and recognized as legitimate targets for intervention.