Negative outcome and attrition in psychotherapy.

Although the rate of negative outcome in psychotherapy is around 10%, there are virtually no studies that examine the phenomenon empirically using objective data. This study attempted to identify patients who would drop out of or remain in therapy using pretreatment subjective distress variables and pretreatment interpersonal functioning. Of those who remained, this study then distinguished among positive responders, negative responders, and nonresponders. Subjective distress was linearly related to outcome such that patients with higher levels of subjective distress improved while patients with lower levels deteriorated. Interpersonal functioning was curvilinearly related to outcome such that higher levels of difficulty were associated with positive and negative responders while lower levels were associated with non-responders. There was also an interaction between coping style and type of treatment such that more directive treatments were more effective with patients exhibiting externalizing coping styles than with patients exhibiting internalizing coping styles. The reverse was true for non-directive therapies