[acb-hsp] Factors Associated with Premature Termination

[J.Rayl]

Factors associated with premature
termination of psychotherapy
 by children.
by Woo Sik Chung , John T. Pardeck , John W. Murphy
Identifying children who fail to complete psychotherapy
 is critical for two reasons: Those who drop out do not receive needed clinical services;
and clinics have invested a great deal
of
 costly staff time in the treatment. If factors which lead to premature termination
 can be identified, practitioners can take appropriate preventive actions.
Limited research has been conducted on the reasons children prematurely drop out
of
 treatment; however, a number of
 factors have been identified with adult populations. These include the importance
of
 client input into the treatment plan (Heine & Trosman, 1960), client satisfaction
with his or her therapist (Garfield, 1963), practical problems that confront the
client (e.g., transportation) (Becham, 1992), and social class (Garfield, 1986).
The few notable studies that have explored why children drop out of psychotherapy
 prematurely include one by Gould, Shaffer, and Kaplan (1985) who report that demographic,
personality, and psychopathology measures offer little explanation. However, Lasky
and Salmone (1977) found that the client's age and gender may be factors that influence
continuation
of
 treatment. Viale-Val, Rosenthal, Curtiss, and Marohn (1984) report that adolescents
as a specific age group often do not complete treatment. They also found that race
and social class were possible predictors
of early termination
. Further, they report that if a child had an initial positive reaction to treatment,
early
termination was unlikely.
Given the fact that past research has identified only a limited number of
 variables associated with premature
termination of
 treatment by children, the present research explores factors that have been found
to be associated with older populations who experience this serious clinical problem.
Specifically, the purpose
of this study was to explore the influence of
 satisfaction with the treatment plan, the therapist, and related treatment variables
on early
termination
. Other practical concerns related to the client's family, including financial matters,
were also explored.
METHOD
The sample included 72 children who had dropped out of psychotherapy
 prematurely over a one-year period.
Of these, 45 participated in the research. The average age of
 the participants was 13.5 years with an age range from 6 to 18 years. There were
22 males and 23 females.
The 45 children in the survey were receiving inpatient services from a midwestern
psychiatric hospital prior to premature
termination
. The psychiatric services included a children's unit (ages 4 to 12), a preadolescent
unit (ages 10 to 14), and an adolescent unit (ages 12 to 18). The following list
identifies the psychological problems treated in each unit:
Children's unit: ineffective coping techniques; aggression/harm to self or others;
impulsive, active mood/unable to stay on task in groups; depressed mood, sad affect/tearfulness;
out
of parental/school control; lack of boundaries; encopresis; and enuresis.
Preadolescent unit: depressive symptoms; suicidal behavior; aggressive behavior;
history of
 running away; and history of sexual abuse.
Adolescent Unit: self-destructive behavior; aggressive behavior; elopement risk;
depression; alteration in social norms; sexual abuse; anxiety; defiance
of
 authority; substance abuse; family conflicts; and manipulative behaviors.
The research instrument which explored the phenomenon of early treatment termination
 was composed
of
 12 items and a comment section. The survey was conducted by telephone, and the adult
caretaker was interviewed for all children under 18 years
of age (98% of
 the cases). A one-group chi-square was the primary statistical test used in the
data analysis.
FINDINGS AND CONCLUSIONS
As noted in Table 1, several of
 the survey items indicated statistically significant results. One important finding
is that the child's family was generally supportive
of early treatment
termination; however, the results were not statistically significant when the role
of
 financial considerations in the
termination process was analyzed.
As would be expected, the therapist plays a significant role in the early treatment
termination
 process. Item 3 shows that over 60% of
 the respondents did not feel that the physicians were professional and caring. A
similar pattern is found in Item 4 for the staff; however, these results are not
statistically significant.
Findings in Items 5 and 6 are statistically significant. It can be concluded from
these data that the atmosphere
of the hospital contributed to early treatment termination
, and that the respondents viewed the facilities as generally restrictive and controlling.
However, there was no statistically finding that other patients contributed to premature
termination.
As indicated in Table 1, the treatment plan (Items 8 and 9) plays a statistically
significant role; 67%
of
 the respondents reported that the child's treatment plan was not adequately explained,
and 72% felt it did not meet the child's needs.
Outside responsibilities (Item 10) did not appear to be a factor. As would be expected,
there were statistically significant findings for Item 11: 67%
of
 the respondents felt the treatment was too restrictive and that outpatient therapy
probably would have been more desirable. Item 12 shows statistically significant
findings which suggest that a large percentage
of
 the respondents would not bring the child back to the facility if more treatment
were needed.
Further analysis of the data (not reported in Table 1), through the use of
 the Mann-Whitney U statistical test showed that age and gender
of
 the children were not statistically significant; that is, these factors had no impact
on how the respondents answered each survey item.
The following comments are indicative of
 those made by the respondents and help explain why the children dropped out
of treatment early.
1. Doctor never returned patient's parents' phone calls, and they were never able
to speak with the doctor in person. Patient needed help, not a baby-sitter.
2. Patient was exposed to others who were much worse off. Parents called three times
per day for 3 days, and patient was informed
of
 the call only once. Patient never met the doctor. Staff did not help arrange follow-up
counseling. The patient was even more depressed than before.
[TABULAR DATA FOR TABLE 1 OMITTED]
3. Too many patients and too many restrictions. Needed more freedom. Needed more
information and input from doctor and staff.
4. Parents felt they should have had more contact with doctors. Mother saw the doctor
only one time in two weeks. Patient is now receiving outpatient treatment at other
facilities.
Some important conclusions can be drawn from this study. It is clear that the therapist
plays a critical role in the process; if the therapist is professional and caring,
the child is more likely to remain in treatment. Further, the treatment plan should
be adequately explained and meet the needs
of
 the child. It should be noted, however, that these conclusions are tentative and
that additional research needs to be conducted on the problem
of premature termination of
 treatment.
REFERENCES
Becham, E. E. (1992). Improvement after evaluation in psychotherapy of
 depression: Evidence
of a placebo effect? Journal of Clinical Psychology, 45, 945-950.
Garfield, S. L. (1963). A note on patient' reasons for terminating therapy. Psychological
Reports, 13, 38.
Garfield, S. L. (1986). Research on client variables in psychotherapy
. In S. L. Garfield, & A. E. Bergin (Eds.),
Psychotherapy and behavior change (pp. 213-256). New York: Wiley.
Heine, R. W., & Trosman, H. (1960). Initial expectations of
 the doctor-patient interaction as a factor in continuance in
psychotherapy. Psychiatry, 23, 275-278.
Gould, M. S., Shaffer, D., & Kaplan, D. (1985). The characteristics of
 dropouts from a child psychiatry clinic. Journal
of the American Academy of Child Psychiatry, 24, 316-328.
Lasky, R. G., & Salmone, P. R. (1977). Attraction to psychotherapy: Influences of
 therapist status and therapist-patient age similarity. Journal
of Clinical Psychology, 33, 511-516.
Viale-Val, G., Rosenthal, R., Curtiss, G., & Marohn, R. (1984). Dropout from adolescent
psychotherapy: A preliminary study. Journal of the American Academy of
 Child Psychiatry, 23, 562-568.
John W. Murphy, Ph.D., Professor, Department of Sociology, University of
 Miami, Coral Gables, FL 33124.
John T. Pardeck, Ph.D., LCSW, Professor, School of
 Social Work, Southwest Missouri State University, Springfield, MO 65804.
Reprint request to Woo Sik Chung, Ph.D., Associate Professor, Graduate School of
 Social Work, Boston College, Chestnut Hill, MA 02167.
-1-
Questia, a part of Gale, Cengage Learning. www.questia.com
Publication Information:
Article Title: Factors Associated with Premature Termination of Psychotherapy by
Children. Contributors: Woo Sik Chung - author, John T. Pardeck - author, John W.
Murphy - author. Journal Title: Adolescence. Volume: 30. Issue: 119. Publication
Year: 1995. Page Number: 717+. COPYRIGHT 1995 Libra Publishers, Inc.; COPYRIGHT 2002
Gale Group
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