When patients do not finish treatment as planned, it is natural for clinicians to wonder, “What happened?” Research shows attrition rates in treatment validation studies can be around 25-30% (Shear, Frank, Houck, & Reynolds, 2005; Shear et al. 2016). Attrition rates in practice settings may be comparable, or even higher.
In the absence of documented evidence, several possible explanations can be considered when attempting to account for treatment non-completion. Possibilities include interactive factors (dynamics of the clinician-patient relationship), internal factors (patient’s interior life; physical health), and external factors (logistical matters; environmental events), or a combination of determinants.
Conscientious clinicians may look first to interactive factors to find a possible cause, consistent with ethical mandates for lifelong learning and continuous practice improvement. However, caution against over-emphasizing interactive factors is also warranted due to the “illusion of control” embedded in attributions related to the clinician’s behavior. Internal and/or external factors may well constitute the ultimate explanation(s).
A case example is provided describing the treatment course of a bereaved mother whose young adult son died traumatically. The patient abruptly discontinued grief therapy, without explanation. A review of how the clinician processed this event illustrates the ambiguity of “not knowing,” attending to one’s own feelings, using peer consultation, respecting patient autonomy, and seeking gentle closure. Participant feedback and discussion is encouraged.
Learning Objectives
1. Discuss non-completion rates reported for treatment validation studies as context for attrition in clinical settings.
2. Identify three categories of variables which could account for patients’ discontinuing treatment.
3. Discuss best clinical practices for handling patient non-completion in the absence of documented reasons.
Presented by:
Louis A. Gamino, PhD, ABPP, FT Professor of Psychiatry & Behavioral Sciences, Baylor College of Medicine – Temple, TX
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