Investigating client dropout from psychotherapeutic treatments for personality disorders

Dropout from therapy for personality disorder (PD) represents a clinically-important but poorly understood phenomenon in the existing literature. The present grounded theory study explores the experiences of clients with PD, and their therapists, of treatment dropout from a National Health Service outpatient psychotherapy service, specialising in psychodynamic interventions for PD. Pre-therapy questionnaires for 20 clients were initially reviewed to generate hypotheses about the differences between treatment dropouts and completers, before a focus group was conducted with six therapists to explore their beliefs about and experiences of client dropout. Finally, six individual interviews were conducted with clients with PD, five of whom had dropped out from therapy at the host service. The final model highlighted the importance of clients’ treatment expectations, how they perceived their therapist’s behaviour, and their interpersonal history in making decisions about whether to stay in or drop out of therapy. The impact of therapy endings upon clients is also discussed, as well as therapists’ beliefs about managing complex clients, both individually and within a team, under current financial and clinical pressures. The findings are then discussed in relation to existing theory and research, and the clinical implications and limitations of the study are presented.