Abstract
A great deal of clinical research has sought to describe and suggest remedies for the client dropout phenomenon. However, few studies have addressed the equally pervasive, yet often ignored, non-engagement problem. An exploratory study was conducted to understand why many clients fail to engage in family therapy services after they have completed the initial intake. The results of the study suggest that therapist gender and experience level, clinic policies regarding videotaping sessions, family concerns, and changes in the presenting problem prior to the first session, had an impact on potential clients’ decision to engage in therapy. Implications and future research are discussed.
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References
Allgood, S.M., & Crane, R. (1991). Predicting marital therapy dropouts. Journal of Marital and Family Therapy, 17(1), 73–79.
Beakeland, F., & Lundwall, L. (1975). Dropping out of treatment: A critical review. Psychological Bulletin, 82, 738–783.
Bischoff, R.J., & Sprenkle, D.H. (1993). Dropping out of marriage and family therapy: A critical review of research. Family Process, 32, 353–375.
Carpenter, P.J., Marrow, G.R., Del Gaudio, A.C., & Ritzler, B.A. (1981). Who keeps the first outpatient appointment. American Psychiatric Association, 138(1), 102–105.
Coles, D. (1995). A pilot use of letters to clients before the initial session. Journal of Family Therapy, 16(4), 209–213.
Davis, H., & Dhillon, A.M. (1989). Prediction of early attrition from couple therapy. Psychological Reports, 65, 899–902.
Evans, J.M. (1999). Engaging families into therapy: Development of and enhancement of systems-oriented approach. Dissertation submitted to the Faculty of the Graduate School of the University of Maryland Baltimore County.
Festinger, D.S., Lamb, R.J., Kountz, M.R., Kirby, K.C., & Marlowe, D. (1995). Pretreatment dropouts as a function of treatment delay and client variables. Addictive Behaviors, 20(1), 111–115.
Folkins, C., Hersch, P., & Dahlen, D. (1980). Waiting time and no-show rate in community mental health center. American Journal of Community Psychology, 8(1), 121–123.
Garfield, S.L. (1989). Giving up on child psychotherapy: Who drops out? Comment on Weisz, Weiss, & Langmeyer. Journal of Consulting and Clinical Psychology, 57, 168–169.
Garfield, S. (1994). Research on client variables in psychotherapy. In: S.I. Garfield, A.E. Bergin (Eds.), Handbook of psychotherapy and behavior change (4th ed., pp. 190–228). New York: Wiley.
Grold, K. (2000). The openness to therapy assessment. Family Journal-Counseling & Therapy for Couples & Families, 81(1), 85–90.
Hersh, J.B., Cohen, P., Epstein, S., & Peca-Baker, T. (1989). Mental health first appointment no-shows. Journal of American Community Health, 37, 236–237.
Hochstadt, N.J., & Trybula, J. (1980). Reducing missed initial appointment in a community mental health center. Journal of Community Psychology, 8, 261–265.
Kicklighter, B.L. (2001). Effects of pretherapy contacts upon client attendance. Therapeutic alliance, session satisfaction and pretherapy anxiety at a university training facility, Dissertation submitted to the faculty of the University of Louisiana at Monroe.
Kiecolt-Glaser, J.K., & Newton, T.L. (2001). Marriage and health: His and hers. Psychological Bulletin, 127(4), 472–503.
Masi, M.V, Miller, R.B., & Olson, M.M. (2003). Differences in dropout rates among individual, couple and family therapy clients. Contemporary Family Therapy, 25(1), 63–72.
Miller, D., & Thelen, M.H. (1986). Knowledge and belief about confidentiality in psychotherapy. Professional Psychology: Research & Practice, 17(1), 15–19.
Mueck-Weymann, M., Moesler, T., Joraschy, P., Rebensburg, M., & Agelink, M.W. (2002). Depression modulates autonomic cardiac control: A physiopsychological pathway linking depression and mortality? Journal of Psychiatry, 5(3), 67–69.
Mueller, M., & Pekarik, G. (2000). Treatment duration prediction: Client accuracy and its relationship to dropout, outcome and satisfaction. Journal of Psychotherapy, 37(2), 117–123.
Murphy, J.M. (1990). Depression in the community: Findings from the Stirling county study. Canadian Journal of Psychiatry, 35(5), 390–396.
Pekarik, G. (1985). Comorbid alcoholism and depression: Treatment issues. Professional Psychology: Research and Practice, 16(1), 114–123.
Raynes, A.E., & Warren, G. (1971). Some characteristics of “drop outs” at first contact with a psychiatric clinic. Community Mental Health Journal, 7, 144–150.
Reis, B.F., & Brown, L.G. (1999). Reducing psychotherapy dropout: Maximizing perspective convergence in the psychotherapy dyad. Psychotherapy: Theory, Research, Practice, Training, 36(2), 123–136.
Shuman, A.L., & Shapiro, J.P. (2002). The effects of preparing parents for child psychotherapy on accuracy of expectations and treatment attendance. Community Mental Health Journal, 38(1), 3–16.
Sprenkle, D.H. (2003). Effectiveness research in marriage and family therapy. Alexandria, VA: American Association for Marriage and Family Therapy.
Stasiewicz, P.R., & Stalker, R. (1999). A comparison of three “interventions” on pretreatment dropout rates in an outpatient substance abuse clinic. Addictive Behaviors, 24(4), 579–582.
Szapocznik, J., Kurtines, W.M., Foote, F.H., Perez-Vidal, A., & Hervis, O.E. (1983). Conjoint versus one-person family therapy: Some evidence for the effectiveness of conducting family therapy through one person. Journal of Consulting and Clinical Psychology, 51, 889–899.
Thase, M.E., Salloum, I.M., & Cornelius, J.D. (2001). Coping with dropouts. Journal of Clinical Psychiatry, 62(20), 32–41.
Weiner-Davis, M., de Shazer, S., & Gingerich, J.W. (1987). Building on pretreatment change to construct the therapeutic solution: an exploratory study. Journal of Marital and Family Therapy, 13(4), 359–363.
Wierzbicki, M., & Pekarik, G. (1993). A meta-analysis of psychotherapy dropout. Professional Psychology: Research and Practice, 24(2), 190–195.
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Meng-ning Wang, MA, a doctoral student, and Jonathan Sandberg, PhD, a faculty member in the Marriage and Family Therapy Program at Syracuse University at Syracuse University are co-first authors. Amy Zavada, MA, Tziporah Rosenberg, MA, Aaron Jeffrey, MA, and Justin McPheters, MA, are doctoral students, and Mona Mittal, PhD, and Anne Gosling, PhD, are faculty in the same program.
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Wang, Mn., Sandberg, J., Zavada, A. et al. “Almost There”...Why Clients Fail to Engage in Family Therapy: An Exploratory Study. Contemp Fam Ther 28, 211–224 (2006). https://doi.org/10.1007/s10591-006-9001-3
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DOI: https://doi.org/10.1007/s10591-006-9001-3