Dropping out of therapy in context of an RCT: a qualitative analysis

OBJECTIVE: This study explored the multifaceted processes underlying psychotherapy dropout by conducting a multi-method qualitative analysis of logbooks, therapist reports and post-interviews of 46 cases of dropout from a randomized controlled trial. METHOD: The data from the 46 cases were subjected to descriptive-interpretative qualitative research to identify common themes and constructs, and to an ideal-type analysis to discover case-wise variation. This triangulation of methods facilitated the development of a layered understanding of dropout. RESULTS: The descriptive-interpretative qualitative research produced four themes related to dropout (i.e., repetition of interpersonal patterns, intra-personal balance between gains and losses of symptoms, dropout reasons related to the RCT procedure, and therapist unresponsiveness). The ideal-type analysis differentiated six types of dropout (i.e., "I got out of therapy what I needed," "Therapy did not meet my expectations," "Therapist directed towards dropout," "I did not feel heard by the therapist," "I am too overwhelmed by the therapy," "Therapy is not practically feasible for me"). CONCLUSIONS: The similarities and differences among the cases revealed by the analyses indicate that reasons for psychotherapy dropout are layered and involve an interplay of patient, therapist, relational and contextual factors. Methodological pluralism is thus advantageous when investigating the processes influencing dropout.