Client/Clinician Discrepancies in Perceived Problem Improvement and the Potential Influence on Dropout Response

Article

Abstract

This paper examines the possibility that clinicians working in an alcohol and other drug (AOD) treatment service may lack appreciation of problem improvement in clients who choose to dropout against clinical advice. Underlying this investigation is the belief that if clinicians are indeed unperceptive of problem improvement amongst this population then this may explain why retention based responses to client dropout continue to be promoted, despite evidence to suggest that they are ineffective and/or unnecessary. Outcome data obtained from a sample of 75 AOD treatment clients and their respective clinicians at baseline and 2-month follow-up are reported. Analysis of these data suggest a client/clinician discrepancy in perceived problem improvement was evident in the study setting: clinicians reported significantly less problem improvement in the first 2 months of service attendance as compared to their clients and this discrepancy was most pronounced if the client had dropped out of treatment.

Keywords

Dropout Retention Treatment fit Treatment outcome 

Notes

Acknowledgements

This study was undertaken with financial assistance from the Waitemata District Health Board and the John Dobson memorial scholarship. The authors would like to thank participating clients and staff of the AOD treatment service for their cooperation. The authors would also like to acknowledge Jenny Wolf and Robert Steenhuisen for their support of the project and Amanda Wheeler (Director, Clinical Research and Resource Centre) for her input over the course of the study.

References

  1. Adamson, S. J., Sellman, D., & De Zwart, K. (2004). National Telephone Survey of the Alcohol and Drug Workforce. Paper presented at the Cutting Edge National Addiction Conference, Palmerston North.Google Scholar
  2. Andreasson, S., & Ojehagen, A. (2003). Psychosocial treatment for alcohol dependence. In M. Berglund, S. Thelander & E. Jonsson (Eds.), Treating Alcohol and Drug Abuse: An Evidence Based Review (pp. 43–188). Weinheim: Wiley-VCH.CrossRefGoogle Scholar
  3. CRUFAD (2000). K-10 symptom scale, from http://www.crufad.unsw.edu.au/K10/k10info.htm.
  4. Dench, S., & Bennett, G. (2000). The impact of brief motivational intervention at the start of an outpatient day programme for alcohol dependence. Behavioural and Cognitive Psychotherapy, 28(2), 121–130.Google Scholar
  5. Edlund, M. J., Wang, P. S., Berglund, P. A., Katz, S. J., Lin, E., & Kessler, R. C. (2002). Dropping out of mental health treatment: patterns and predictors among epidemiological survey respondents in the United States and Ontario. American Journal of Psychiatry, 159(5), 845–851.CrossRefPubMedGoogle Scholar
  6. Garfield, S. L. (1994). Research on Client Variables in Psychotherapy. In A. E. Bergen & S. L. Garfield (Eds.), Handbook of Psychotherapy and Behavior Change (Fourth ed., pp. 190–228). New York: John Wiley & Sons, Inc.Google Scholar
  7. Gariti, P., Alterman, A. I., Holub-Beyer, E., Volpicelli, J. R., Prentice, N., & O’Brien, C. P. (1995). Effects of an appointment reminder call on patient show rates. Journal of Substance Abuse Treatment, 12(3), 207–212.CrossRefPubMedGoogle Scholar
  8. Hatchett, G. T., & Park, H. L. (2003). Comparison of four operational definitions of premature termination. Psychotherapy: Theory, Research, Practice, Training, 40(3), 226–231.CrossRefGoogle Scholar
  9. Hunsley, J., Aubry, T. D., Erstervelt, C. M., & Vito, D. (1999). Comparing therapist and client perspectives on reasons for psychotherapy termination. Psychotherapy, 36(4), 380–388.Google Scholar
  10. Kessler, R. C., Andrews, G., Colpe, L. J., Hiripi, E., Mroczek, D. K., Normand, S. L., et al. (2002). Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine, 32(6), 959–976.CrossRefPubMedGoogle Scholar
  11. Moyer, A., Finney, J. W., Swearingen, C. E., & Vergun, P. (2002). Brief interventions for alcohol problems: a meta-analytic review of controlled investigations in treatment-seeking and non-treatment-seeking populations. Addiction, 97(3), 279–292.CrossRefPubMedGoogle Scholar
  12. Ogrodniczuk, J. S., Joyce, A. S., & Piper, W. E. (2005). Strategies for Reducing Patient Initiated Premature Termination of Psychotherapy. Harvard Review of Psychiatry, 13(2), 57–70.CrossRefPubMedGoogle Scholar
  13. Pekarik, G. (1985a). Coping with dropouts. Professional Psychology: Research & Practice, 16(1), 114–123.CrossRefGoogle Scholar
  14. Pekarik, G. (1985b). The effects of employing different termination classification criteria in dropout research. Psychotherapy, 22(Spring), 87–91.Google Scholar
  15. Pekarik, G. (1992). Relationship of clients’ reasons for dropping out of treatment to outcome and satisfaction. Journal of Clinical Psychology, 48(1), 91–98.CrossRefPubMedGoogle Scholar
  16. Petry, N. M., Martin, B., Cooney, J. L., & Kranzler, H. R. (2000). Give them prizes, and they will come: contingency management for treatment of alcohol dependence. Journal of Consulting and Clinical Psychology, 68(2), 250–257.CrossRefPubMedGoogle Scholar
  17. Phillips, E. L. (1985). Psychotherapy Revised: New Frontiers in Research and Practice. Hillsdale: Lawrence Erlbaum Associates.Google Scholar
  18. Presley, J. H. (1987). The clinical dropout: a view from the client’s perspective. Social Casework: The Journal of Contemporary Social Work, 603–608.Google Scholar
  19. Pulford, J., Adams, P., & Sheridan, J. (2006). Unilateral treatment exit: a failure of retention or a failure of treatment fit? Substance Use & Misuse, 41(14), 1901–1920.CrossRefGoogle Scholar
  20. Pulford, J., & Wheeler, A. (2007). Documenting client attendance norms: raw data and implications for treatment practice. Journal of Substance Use, 12(2), 95–102.CrossRefGoogle Scholar
  21. Scamardo, M., Bobele, M., & Biever, J. L. (2004). A new perspective on client dropouts. Journal of Systemic Therapies, 23(2), 27–38.CrossRefGoogle Scholar
  22. Silverman, W. H., & Beech, R. P. (1979). Are dropouts, dropouts? Journal of Community Psychology, 7(3), 236–242.CrossRefPubMedGoogle Scholar
  23. Simpson, D. D., Joe, G. W., & Brown, B. S. (1997). Treatment retention and follow-up outcomes in the Drug Abuse Treatment Outcome Study (DATOS). Psychology of Addictive Behaviors, 11(4), 294–307.CrossRefGoogle Scholar
  24. Sobell, M. B., & Sobell, L. C. (2000). Stepped care as a heuristic approach to the treatment of alcohol problems. Journal of Consulting and Clinical Psychology, 68(4), 573–579.CrossRefPubMedGoogle Scholar
  25. Zwick, R., & Attkisson, C. C. (1985). Effectiveness of a client pretherapy orientation videotape. Journal of Counseling Psychology, 32(4), 514–524.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.School of Population Health, Faculty of Medical & Health SciencesUniversity of AucklandAucklandNew Zealand
  2. 2.School of Pharmacy, Faculty of Medical & Health SciencesUniversity of AucklandAucklandNew Zealand
  3. 3.Clinical Research & Resource Centre (CRRC)HendersonNew Zealand

Personalised recommendations