Given the high prevalence of client unilateral termination from psychotherapeutic services, elucidating client reasons for ending therapy is an important activity for researchers. Three studies were designed to shed light on reasons for both premature and appropriate termination from the perspective of adult clients and therapists: 1) In Study 1, I examined data from the Canadian Community Health Survey, Cycle 1.2, to establish base rates of client reasons for psychotherapy termination in Canada, along with their demographic and clinical correlates, 2) In Study 2, I used training clinic data to examine client and therapist perspectives of reasons for termination, working alliance, and barriers to treatment participation in mutual versus unilateral terminators, and 3) In Study 3, I collected data from Canadian clinical psychologists to examine their perspectives of client reasons for early versus later termination, and their use of engagement strategies to reduce client-initiated unilateral termination. In Study 1, 43.1 percent of respondents reported terminating therapy for reasons other than feeling better or completing treatment. In general, individuals with low income and diagnosable mental disorders had significantly increased odds of premature termination. Study 2 revealed that when clients made unilateral decisions to end therapy, therapists were only partially aware of either the extent of clients’ perceptions of their success in therapy or with their dissatisfaction with therapy. Although working alliance and barriers to treatment participation were rated as lower in the context of unilateral termination by both clients and therapists than in the context of mutual decisions to terminate therapy, all clients, in general, rated the early alliance and barriers to treatment as higher than did their therapists. In Study 3 psychologists assigned differential importance to reasons for termination depending on whether termination was before versus after the third session. Theoretical orientation (CBT versus other) did not influence views of reasons for termination, but influenced use of some engagement strategies. Results are discussed in terms of research and clinical implications.

The present study examined predictors of couple therapy dropout in the VA medical centers using six different dropout criteria. The most accurate dropout definitions included using a statistical modeling procedure to determine whether the client's rate of change at the final session was greater than average of change for all clients; clients who were still demonstrating gains greater than the average rate of change at the final session were considered to have terminated prematurely. A total of 177 couples (354 individuals) who sought therapy in the VA medical centers in Charleston, SC and San Diego, CA were examined. With a few exceptions, demographic variables generally did not predict dropout. A couple's relationship adjustment and response to conflict were significant predictors of dropout. The content of therapy sessions predicted dropout only when dropout was defined, at least in part, by client's rate of change at the final session, suggesting that such methods of defining premature termination are the most sensitive to the therapy process. Therapists' characteristics, including gender and level of experience, did not predict dropout across all six definitions of dropout.

Thesis (Psy.D.)--Rutgers University, 2010. / "Graduate Program in School Psychology." Includes bibliographical references (p. 67-75).

Thesis (M.Ed.)--Memorial University of Newfoundland, 1989. / Typescript. Bibliography: leaves 145-157. Also available online.

Thesis (M.Ed.)--Memorial University of Newfoundland. / Typescript. Bibliography: leaves 105-114. Also available online.

Thesis (Ed. D.)--University of Northern Colorado, 1989. / Vita. Includes abstract. Includes bibliographical references (leaves [167]-175).

Thesis (Ph. D.)--Ohio State University, 1980. / Includes vita. Includes bibliographical references (leaves 105-109). Available online via OhioLINK's ETD Center.

Introduction: A systematic review was undertaken to identify any psychological predictors of treatment dropout for individuals diagnosed with an eating disorder, to help inform psychological therapy and reduce attrition. An empirical study was conducted to understand developmental psychological mechanisms at play in the aetiology and maintenance of eating disordered symptomology by assessing reflective functioning and attachment from a trans-diagnostic perspective. Methods: Twenty-one papers were identified through a systematic search of databases using predefined extraction criteria, identifying psychological predictors of treatment dropout in eating disorders. Fourteen female adolescents with a diagnosis of an eating disorder were recruited to the empirical study from CAMHS inpatient and outpatient departments in NHS Scotland, as well as eighteen same age controls from local secondary schools. Participants completed questionnaires regarding eating behaviour, difficulties in emotion regulation, reflective functioning and were interviewed using the Adult Attachment Projective. Results: The systematic review revealed varied psychological predictors of dropout falling onto a continuum ranging from maturity fears to interpersonal difficulties. Results did not significantly differ for inpatient or outpatient treatment or diagnosis. The empirical study found adolescents with an eating disorder to have significantly more difficulties with their emotion regulation and reflective functioning as well as a more insecure attachment style when compared to controls, none of which were weight dependent. Conclusion: Further research is required to operationalise a definition of dropout. Although eating disorders can be seen as a defence mechanism to control and avoid emotional distress, this actually exacerbates them and causes disengagement from treatment. Clinical interventions need to focus on therapeutic rapport from the outset of treatment in order to reduce interpersonal difficulties leading to attrition. The results of the empirical study support the use of early intervention and person centred therapies for adolescents with an eating disorder, even when acutely starved. Specifically therapies that target reflective functioning and take insecure attachment styles into account may improve psychological efficacy and engagement.

A evasão no ensino superior é um fenômeno que tem ganhado atenção nas últimas décadas, pois pode trazer consequências negativas tanto para as instituições quanto para os estudantes. Assim, compreender os motivos que fazem as pessoas permanecerem ou largarem seus cursos pode auxiliar no desenvolvimento de intervenções que visem minimizar esse problema. Esta dissertação teve como objetivo principal descrever qualitativamente e quantitativamente este fenômeno no curso diurno de Psicologia da UFGRS. Para tanto, foram realizados dois estudos empíricos e um artigo teórico. O primeiro estudo consistiu-se em um levantamento, realizado de forma online, com 74 estudantes matriculados no curso de psicologia (26% do total de matriculados), onde se utilizou um questionário de dados gerais e acadêmicos, além de instrumentos que dão subsídios à investigação da evasão. O segundo estudo consistiu-se num estudo de caso coletivo, onde foram realizadas entrevistas semi-estruturadas, com 6 ex-alunos do referido curso, posteriormente submetidas à análise temática de conteúdo. Como resultados pode-se observar que estão associadas à evasão ou à intenção de evasão questões como o baixo comportamento exploratório, o compromisso com a meta de graduar-se, a dificuldade de relacionamento com colegas, questões relativas à organização estrutural/curricular do curso, entre outras. Para além da simples descrição, buscou-se ao longo da dissertação o diálogo com os modelos internacionais de evasão. Salienta-se a necessidade de elaboração de um modelo de evasão aplicável ao contexto nacional e espera-se que este trabalho contribua de alguma forma para a construção futura deste. / Dropout in higher education is a phenomenon that has gained attention in recent decades, as it may bring negative consequences for both institutions and students. Thus, understanding the reasons that make people persist or withdrawal from their courses can assist in developing interventions that aim to minimize this problem. This dissertation aimed to describe qualitatively and quantitatively this phenomenon at the Psychology course at UFGRS. Thus, we conducted two empirical studies and a theoretical article. The first study consisted in an online survey, with 74 matriculated students (26% of all students matriculated), where a questionnaire was used for collect general and academic data, as well instruments that give subsidies investigation the evasion. The second study consisted in a collective case study, where six former students of psychology were submited to a semi-structured interview, who was subjected by a thematic content analysis. As results could be observed that low exploratory behavior, commitment to attaining the college degree, the difficulty in peer relationships, issues of organizational structure/curriculum of the course, among others, were related to the droptou or to the intend to. Beyond the simple description, we sought throughout the dissertation a dialogue with international dropout models. We emphasize the need to develop dropout model applicable to the national context and it is hoped that this work contributes in some way to build this in the future.

A evasão no ensino superior é um fenômeno que tem ganhado atenção nas últimas décadas, pois pode trazer consequências negativas tanto para as instituições quanto para os estudantes. Assim, compreender os motivos que fazem as pessoas permanecerem ou largarem seus cursos pode auxiliar no desenvolvimento de intervenções que visem minimizar esse problema. Esta dissertação teve como objetivo principal descrever qualitativamente e quantitativamente este fenômeno no curso diurno de Psicologia da UFGRS. Para tanto, foram realizados dois estudos empíricos e um artigo teórico. O primeiro estudo consistiu-se em um levantamento, realizado de forma online, com 74 estudantes matriculados no curso de psicologia (26% do total de matriculados), onde se utilizou um questionário de dados gerais e acadêmicos, além de instrumentos que dão subsídios à investigação da evasão. O segundo estudo consistiu-se num estudo de caso coletivo, onde foram realizadas entrevistas semi-estruturadas, com 6 ex-alunos do referido curso, posteriormente submetidas à análise temática de conteúdo. Como resultados pode-se observar que estão associadas à evasão ou à intenção de evasão questões como o baixo comportamento exploratório, o compromisso com a meta de graduar-se, a dificuldade de relacionamento com colegas, questões relativas à organização estrutural/curricular do curso, entre outras. Para além da simples descrição, buscou-se ao longo da dissertação o diálogo com os modelos internacionais de evasão. Salienta-se a necessidade de elaboração de um modelo de evasão aplicável ao contexto nacional e espera-se que este trabalho contribua de alguma forma para a construção futura deste. / Dropout in higher education is a phenomenon that has gained attention in recent decades, as it may bring negative consequences for both institutions and students. Thus, understanding the reasons that make people persist or withdrawal from their courses can assist in developing interventions that aim to minimize this problem. This dissertation aimed to describe qualitatively and quantitatively this phenomenon at the Psychology course at UFGRS. Thus, we conducted two empirical studies and a theoretical article. The first study consisted in an online survey, with 74 matriculated students (26% of all students matriculated), where a questionnaire was used for collect general and academic data, as well instruments that give subsidies investigation the evasion. The second study consisted in a collective case study, where six former students of psychology were submited to a semi-structured interview, who was subjected by a thematic content analysis. As results could be observed that low exploratory behavior, commitment to attaining the college degree, the difficulty in peer relationships, issues of organizational structure/curriculum of the course, among others, were related to the droptou or to the intend to. Beyond the simple description, we sought throughout the dissertation a dialogue with international dropout models. We emphasize the need to develop dropout model applicable to the national context and it is hoped that this work contributes in some way to build this in the future.