Application of the transtheoretical model to reduce dropout from outpatient psychotherapy.

Abstract

This study investigated the utility of a central construct of the Transtheoretical Model (TTM), Stage of Change, as an ad hoc predictor of premature termination (PT) from outpatient psychotherapy. In addition, a TTM-derived telephone Motivational Interview technique was evaluated for its effect on PT rates among participants theoretically at greatest risk for PT (i.e., Precontemplation and Contemplation stages of change). Adult participants (N = 214) completed the Stage of Change Scale (McConnaughy et al., 1983; 1989) upon admission to an outpatient mental health clinic. Precontemplators and Contemplators were assigned to either a treatment or notreatment control condition. An at-large control condition was comprised primarily of individuals in the Action and Maintenance stages of change. Treatment conditions were generally equivalent across variables demonstrated to impact PT, such as age, gender, and diagnostic category. Contrary to prediction, individuals in the Contemplation stage of change at intake were least likely to PT from therapy (PT = < /=2 sessions including intake), and attended more sessions within 6 weeks post-intake than did individuals in either the Action or Maintenance stages of change. A brief telephone Motivational Interview technique conducted with Contemplators did not impact the number of sessions attended within 6 weeks post-intake, nor PT rates between the treatment and notreatment control conditions. A discussion of the research, theoretical, and practical implications of these findings is included.