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Adherence and Psychotherapy

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Improving Patient Treatment Adherence

Abstract

Psychotherapists target a wide range of clinical disorders, adopt diverse theoretical approaches, and operate within multiple treatment settings. As such, a unifying definition of adherence in the field of psychotherapy is not yet tenable. We therefore limit the scope of this chapter to an examination of adherence in the context of individual outpatient psychotherapy delivered to adult populations, with particular attention paid to evidence-based, cognitive-behavioral treatments. In this context, issues of adherence may be broadly summarized into two categories. The first, premature termination, has relevance across the full range of theoretical approaches. The second, failure to complete between-session tasks and exercises, is more specific to cognitive-behavioral interventions.

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References

  1. Ogrodniczuk JS, Joyce AS, Piper WE. Strategies for reducing patient-initiated premature termination of psychotherapy. Harv Rev Psychiatry. 2005;13(2):57–70.

    Article  PubMed  Google Scholar 

  2. Wierzbicki M, Pekarik G. A meta-analysis of psychotherapy dropout. Profess Psychol Res Prac. 1993;24:190–195.

    Article  Google Scholar 

  3. Mueller M, Pekarik G. Treatment duration prediction: client accuracy and its relationship to dropout, outcome, and satisfaction. Psychotherapy. 2000;37(2):117–123.

    Article  Google Scholar 

  4. Pekarik G. Relationship of expected and actual treatment duration for child and adult clients. J Clin Child Psychol. 1991;20:121–125.

    Article  Google Scholar 

  5. Pekarik G, Wierzbicki M. The relationship between clients’ expected and actual treatment duration. Psychotherapy. 1986;23(4):532–534.

    Article  Google Scholar 

  6. Elkin I, Shea MT, Watkins JT, et al. National Institute of Mental Health Treatment of Depression Collaborative Research Program. General effectiveness of treatments. Arch Gen Psychiatry. 1989;46(11):971–982; discussion 983.

    Article  PubMed  CAS  Google Scholar 

  7. Persons JB, Burns DD, Perloff JM. Predictors of dropout and outcome in cognitive therapy for depression in a private practice setting. Cogn Ther Res. 1988;12:557–575.

    Article  Google Scholar 

  8. Sledge WH, Moras K, Hartley D, Levine M. Effect of time-limited psychotherapy on patient dropout rates. Am J Psychiatry. 1990;147(10):1341–1347.

    PubMed  CAS  Google Scholar 

  9. Baekeland F, Lundwall L. Dropping out of treatment: a critical review. Psychol Bull. 1975;82(5):738–783.

    Article  PubMed  CAS  Google Scholar 

  10. Garfield SL. Research on client variables in psychotherapy. In: Berger AE, Garfield SL, eds. Handbook of psychotherapy and behavior change. 4th Ed. New York, NY: Wiley; 1994.

    Google Scholar 

  11. Edlund MJ, Wang PS, Berglund PA, Katz SJ, Lin E, Kessler RC. Dropping out of mental health treatment: patterns and predictors among epidemiological survey respondents in the United States and Ontario. Am J Psychiatry. 2002;159(5):845–851.

    Article  PubMed  Google Scholar 

  12. Arnow BA, Blasey C, Manber R, et al. Dropouts versus completers among chronically depressed outpatients. J Affect Disord. 2007;97(1–3):197–202.

    Article  PubMed  Google Scholar 

  13. Foulks EF, Persons JB, Merkel RL. The effect of patients’ beliefs about their illnesses on compliance in psychotherapy. Am J Psychiatry. 1986;143(3):340–344.

    PubMed  CAS  Google Scholar 

  14. Richmond R. Discriminating variables among psychotherapy dropouts from a psychological training clinic. Profes Psychol Res Pract. 1992;23:123–130.

    Article  Google Scholar 

  15. Rabinowitz J, Renert N. Clinicians’ predictions of length of psychotherapy. Psychiatr Serv. 1997;48(1):97–99.

    PubMed  CAS  Google Scholar 

  16. Barrett MS, Chua WJ, Crits-Christoph P, Gobbons MB, Thompson D. Early withdrawal from mental health treatment: implications for psychotherapy practice. Psychother Theor, Res, Pract, Train. 2008;45(2):247–267.

    Article  Google Scholar 

  17. Mukherjee S, Sullivan G, Perry D, et al. Adherence to treatment among economically disadvantaged patients with panic disorder. Psychiatr Serv. 2006;57(12):1745–1750.

    Article  PubMed  Google Scholar 

  18. Hilsenroth MJ, Handler L, Toman KM, Padawer JR. Rorschach and MMPI-2 indices of early psychotherapy termination. J Consult Clin Psychol. 1995;63(6):956–965.

    Article  PubMed  CAS  Google Scholar 

  19. Hilsenroth MJ, Castlebury FD, Holdwick DJ, Jr., Blais MA. The effects of DSM-IV Cluster B personality disorder symptoms on the termination and continuation of psychotherapy. Psychotherapy. 1998;35:163–176.

    Article  Google Scholar 

  20. Barber JP, Morse JQ, Krakauer ID, Chittams J, Crits-Christoph P. Change in obsessive-compulsive and avoidant personality disorders following time-limited supportive-expressive therapy. Psychotherapy. 1997;24:133–143.

    Article  Google Scholar 

  21. Smith TE, Koenigsberg HW, Yeomans FE, Clarkin JF, Selzer MA. Predictors of dropout in psychodynamic psychotherapy. J Psychother Pract Res. 1995;4:205–213.

    PubMed  Google Scholar 

  22. Seibel CA, Dowd ET. Reactance and therapeutic noncompliance. Cogn Ther Res. 1999;23:373–379.

    Article  Google Scholar 

  23. Reis BF, Brown LG. Preventing therapy dropout in the real world: the clinical utility of videotape preparation and client estimate of treatment duration. Profes Psychol Res Pract. 2006;37:311–316.

    Article  Google Scholar 

  24. McNeil B, May R, Lee V. Perceptions of counselor source characteristics by premature and successful terminators. J Counsel Psychol. 1987;34:86–89.

    Article  Google Scholar 

  25. Horvath AO, Bedi RP. The alliance. In: Norcross JC, ed. Psychotherapy relationships that work: Therapist contributions and responsiveness to patients. New York, NY: Oxford University Press; 2002:37–69.

    Google Scholar 

  26. Orlinsky DE, Grawe K, Parks BK. Process and outcome in psychotherapy – noch einmal. In: Garfield AEBSL, ed. Handbook of psychotherapy and behavior change. Vol. 4. New York, NY: Wiley; 1994:270–376.

    Google Scholar 

  27. Horvath AO, Symonds BD. Relation between working alliance and outcome in psychotherapy: a meta-analysis. J Counsel Psychol. 1991;38:139–149.

    Article  Google Scholar 

  28. Martin DJ, Garske JP, Davis MK. Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. J Consult Clin Psychol. Jun 2000;68(3):438–450.

    Article  PubMed  CAS  Google Scholar 

  29. Mohl PC, Martinez D, Ticknor C, Huang M, Cordell L. Early dropouts from psychotherapy. J Nerv Ment Dis. Aug 1991;179(8):478–481.

    Article  PubMed  CAS  Google Scholar 

  30. Tryon GS, Kane AS. The helping alliance and premature termination. Counsel Psychol Quarter. 1990;3:223–238.

    Article  Google Scholar 

  31. Tryon GS, Kane AS. Relationship of working alliance to mutual and unilateral termination. J Counsel Psychol. 1993;40:33–36.

    Article  Google Scholar 

  32. Tryon GS, Kane AS. Client involvement, working alliance, and type of therapy termination. Psychother Res. 1995;5:189–198.

    Article  Google Scholar 

  33. Yeomans FE, Gutfreund J, Selzer MA, Clarkin J, Hull JW, Smith TE. Factors related to drop-outs by borderline patients: treatment contract and therapeutic alliance. J Psychothera Pract Res. 1994;3:16–24.

    CAS  Google Scholar 

  34. Strauss JL, Hayes AM, Johnson SL, et al. Early alliance, alliance ruptures, and symptom change in a nonrandomized trial of cognitive therapy for avoidant and obsessive-compulsive personality disorders. J Consult Clin Psychol. Apr 2006;74(2):337–345.

    Article  PubMed  Google Scholar 

  35. Beckham EE. Predicting patient dropout in psychotherapy. Psychotherapy. 1992;27:177–182.

    Article  Google Scholar 

  36. Samstag LW, Batchelder ST, Muran JC, Safran JD, Winston A. Early identification of treatment failures in short-term psychotherapy. An assessment of therapeutic alliance and interpersonal behavior. J Psychother Pract Res. 1998;7(2):126–143.

    PubMed  CAS  Google Scholar 

  37. Joyce AS, Piper WE. Expectancy, the therapeutic alliance, and treatment outcome in short-term individual psychotherapy. J Psychother Pract Res. 1998;7(3):236–248.

    PubMed  CAS  Google Scholar 

  38. Najavits LM, Strupp HH. Differences in the effectiveness of psychodynamic therapists: a process-outcome study. Psychotherapy. 1994;31:114–123.

    Article  Google Scholar 

  39. Piper WE, Ogrodniczuk JS, Joyce AS, McCallum M, Rosie JS, O’Kelly JG. Prediction of dropping out in time-limited, interpretive individual psychotherapy. Psychotherapy. 1999;36(2):114–122.

    Article  Google Scholar 

  40. Piper WE, Azim HFA, Joyce AS, McCallum M. Transference interpretations, therapeutic alliance and outcome in short-term individual psychotherapy. Arch Gen Psychiat. 1991;48:946–953.

    Article  PubMed  CAS  Google Scholar 

  41. Henry WP, Schacht TE, Strupp HH, Butler SF, Binder JL. Effects of training in time-limited dynamic psychotherapy: mediators of therapists’ responses to training. J Consult Clin Psychol. 1993;61:441–447.

    Article  PubMed  CAS  Google Scholar 

  42. Henry WP, Strupp HH, Butler SF, Schacht TE, Binder JL. Effects of training in time-limited dynamic psychotherapy: changes in therapist behavior. J Consul Clin Psychol. 1993;61(434–440).

    Google Scholar 

  43. Castonguay LG, Goldfried MR, Wiser S, Raue PJ, Hayes AM. Predicting the effect of cognitive therapy for depression: a study of unique and common factors. J Consult Clin Psychol. 1996;64(3):497–504.

    Article  PubMed  CAS  Google Scholar 

  44. Loeb KL, Wilson GT, Labouvie E, et al. Therapeutic alliance and treatment adherence in two interventions for bulimia nervosa: a study of process and outcome. J Consult Clin Psychol. 2005;73(6):1097–1107.

    Article  PubMed  Google Scholar 

  45. Pekarik G. Coping with dropouts. Profess Psychol: Res Pract. 1985;16:114–123.

    Article  Google Scholar 

  46. Detweiler JB, Whisman MA. The role of homework assignments in cognitive therapy for depression: potential methods for enhancing adherence. Clin Psychol: Sci Pract. 1999;6(3):267–282.

    Article  Google Scholar 

  47. Kazantzis N, Deane FP. Psychologists’ use of homework assignments in clinical practice. Profess Psychol: Sci Pract. 1999;30:581–585.

    Article  Google Scholar 

  48. Kazantzis N, Deane FP, Ronan KR. Homework assignments in cognitive and behavioral therapy: a meta-analysis. Clin Psychol: Sci Pract. 2000;7(2):189–202.

    Article  Google Scholar 

  49. Thase ME, Callan JA. The role of homework in cognitive behavior therapy for depression. J Psychothera Integr. 2006;16(2):162–177.

    Article  Google Scholar 

  50. Robinson P. Putting it on the street: homework in cognitive behavioral therapy. In: O’Donohue WT, Fisher JE, eds. General principles and empirically supported techniques of cognitive behavior therapy. New York, NY: Wiley; 2009:358–369.

    Google Scholar 

  51. Bryant MJ, Simons AD, Thase ME. Therapist skill and patient variables in homework compliance: controlling an uncontrolled variable in cognitive therapy outcome research. Cogn Ther Res. 1999;23:381–399.

    Article  Google Scholar 

  52. Burns DD, Nolen-Hoeksema S. Coping styles, homework compliance, and the effectiveness of cognitive-behavioral therapy. J Consult Clin Psychol. 1991;59(2):305–311.

    Article  PubMed  CAS  Google Scholar 

  53. Persons JB. Cognitive therapy in practice: A case formulation approach. New York, NY: Norton and Company; 1989.

    Google Scholar 

  54. Addis ME, Jacobson NS. Reasons for depression and the process and outcome of cognitive-behavioral psychotherapies. J Consult Clin Psychol. 1996;64(6):1417–1424.

    Article  PubMed  CAS  Google Scholar 

  55. Burns DD, Auerbach AH. Does homework compliance enhance recovery from depression? Psychia Ann. 1992;22:464–469.

    Google Scholar 

  56. Waddington L. The therapy relationship in cognitive therapy: a review. Behavi Cogn Psychother. 2002;30:179–191.

    Google Scholar 

  57. Burns DD, Nolen-Hoeksema S. Therapeutic empathy and recovery from depression in cognitive-behavioral therapy: a structural equation model. J Consult Clin Psychol. 1992;60(3):441–449.

    Article  PubMed  CAS  Google Scholar 

  58. Beck AT. Depression: causes and treatment. Philadelphia, PA: University of Pennsylvania Press; 1972.

    Google Scholar 

  59. Neimeyer RA, Feixas G. The role of homework and skill acquisition in the outcome of group cognitive therapy for depression. Behav Ther. 1990;21:281–292.

    Article  Google Scholar 

  60. Burns DD, Spangler DL. Does psychotherapy homework lead to improvements in depression in cognitive behavioral therapy: a structural equation model. J Consul Clin Psychol. 2000;68:46–56.

    Article  CAS  Google Scholar 

  61. Walitzer KS, Dermen KH, Connors GJ. Strategies for preparing clients for treatment: a review. Behav Modification. 1999;23:129–151.

    Article  CAS  Google Scholar 

  62. Garrison JE. Written vs. verbal preparation of patients for group psychotherapy. Psychotherapy. 1978;15:130–134.

    Article  Google Scholar 

  63. Miller WR, Rollnick S. Motivational interviewing: Preparing people to change addictive behaviors. New York, NY: Guilford Press; 1991.

    Google Scholar 

  64. Sherman MD, Fischer E, Bowling UB, Dixon L, Ridener L, Harrison D. A new engagement strategy in a VA-based family psychoeducation program. Psychiat Service. 2009;60:254–257.

    Article  Google Scholar 

  65. Newman CF. The therapeutic alliance in short-term cognitive therapy. In: Safran JD, Muran JC, eds. The therapeutic alliance in brief psychotherapy. Washington, DC: American Psychological Association; 1998:95–122.

    Chapter  Google Scholar 

  66. Miranda J, Azocar F, Organista KC, Dwyer E, Areane P. Treatment of depression among impoverished primary care patients from ethnic minority groups. Psychiat Service. 2003;54:219–225.

    Article  Google Scholar 

  67. Burns DD, Adams RL, Anastopoulos AD. The role of self-help assignments in the treatment of depression. In: Leber EEBWR, ed. Handbook of depression: treatment, assessment, and research. Homewood: IL: Dorsey; 1985:634–668.

    Google Scholar 

  68. DiMatteo MR, DiNicola DD. Achieving patient compliance: The psychology of the medical practitioner’s role. New York, NY: Pergamon; 1982.

    Google Scholar 

  69. Turk DC, Salovey P. Cognitive-behavior treatment of illness behavior. In: Smith PMNTW, ed. Managing chronic illness: A biopsychological perspective. Washington, DC: American Psychological Association; 1995:245–284.

    Chapter  Google Scholar 

  70. Wankel LM. The importance of enjoyment to adherence and psychological benefits from physical activity. Int J Sports Psychol. 1993;24:151–169.

    Google Scholar 

  71. Miller WR. Motivation for treatment: a review with special emphasis on alcoholism. Psycholo Bull. 1985;98:84–107.

    Article  CAS  Google Scholar 

  72. Rothman AJ, Salovey P. Shaping perceptions to motivate healthy behavior: the role of message framing. Psychol Bull. 1997;121:3–19.

    Article  PubMed  CAS  Google Scholar 

  73. Broder MS. Making optimal use of homework to enhance your therapeutic effectiveness. J Rational-Emotive Cognitive-Behavioral Ther. 2000;18:3–18.

    Article  Google Scholar 

  74. Cox DJ, Tisdelle DA, Culbert JP. Increasing adherence to behavioral homework assignments. J Behav Med. 1988;11:519–522.

    Article  PubMed  CAS  Google Scholar 

  75. Shelton JL, Levy RL. Behavioral assignments and treatment compliance: A handbook of clinical strategies. Champaign, IL: Research Press; 1981.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA

    Jennifer L. Strauss (Investigator)

  2. Mid-Atlantic Research Educational and Clinical Center Health Scientist, Durham VAMC Center for Health Services Research in Primary Care, Durham, NC, USA

    Jennifer L. Strauss (Investigator)

  3. Psychology, Durham Veterans Affairs Medical Center, Durham, NC, USA

    Vito S. Guerra (Postdoctoral Scholar)

  4. Biological Psychiatry, Duke University Medical Center, Durham, NC, USA

    Christine E. Marx (Associate Professor)

  5. Veterans Affairs Mid-Atlantic Mental Illness, Research, and Clinical Center, Durham Veterans Affairs Medical Center, Durham, NC, USA

    A. Meade Eggleston Ph.D (Psychology Fellow)

  6. Medical Psychology, Duke University Medical Center, Durham, NC, USA

    Patrick S. Calhoun Ph.D (Assistant Professor)

Authors
  1. Jennifer L. Strauss
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  2. Vito S. Guerra
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  3. Christine E. Marx
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  4. A. Meade Eggleston Ph.D
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  5. Patrick S. Calhoun Ph.D
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Correspondence to Jennifer L. Strauss .

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Editors and Affiliations

  1. Duke University Medical Center, Erwin Road 2424, Durham, 27705, North Carolina, USA

    Hayden Bosworth

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Strauss, J.L., Guerra, V.S., Marx, C.E., Eggleston, A.M., Calhoun, P.S. (2010). Adherence and Psychotherapy. In: Bosworth, H. (eds) Improving Patient Treatment Adherence. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-5866-2_9

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  • DOI: https://doi.org/10.1007/978-1-4419-5866-2_9

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