Continuance and Satisfaction in Outpatient Psychotherapy

This study explored the effects of various patient, therapist and treatment variables on continuance and treatment satisfaction at an outpatient mental health center. One hundred patients who had terminated treatment between January 1, 1987 and March 31, 1989, were selected for study by stratified proportionate random sampling on the basis of the number of attended sessions. Patient variables included sociodemographic status, fees, degree of stress at time of intake, locus of control (external vs internal) and presenting problem causal attribution type (self, self-in-situation, environmental and situational). Therapist variables included age, gender, years of experience and professional discipline. Treatment variables were comprised of the patients' perceptions of the therapists' skills, the perceived quality of the professional relationship and the perception of concurrent logistical problems. The findings indicated that four variables contributed significantly to the variance in continuance; the quality of the professional relationship, the patient's degree of stress, social class and problem causal attribution type (multiple R² = .61, p ≤ .001). That is: patients who perceived the therapeutic relationship as a poor one, with low degrees of stress, who are from lower social classes, with problem causal attribution types of stimulus (other) or situation, were most likely to terminate within twelve sessions. Four variables were found to contribute significantly to the variance in overall satisfaction: perception of the professional's skills, the quality of the professional relationship, perception of a long initial wait for service and the ability to afford the fee (multiple R² = .83, p ≤ .001). That is: patients who perceived the professional's skills as ineffective, the quality of the professional relationship as a a poor or fair one, who felt they had initially waited too long for service and paid too high a fee, were most likely to be dissatisfied with the overall treatment experience. It was hypothesized that when the relationship between continuance and satisfaction was not a linear one; i.e., patients who dropped out after one session with high degrees of satisfaction, or patients who remained beyond twenty-five sessions with low degrees of satisfaction, the combination of variables for both continuance and satisfaction accounted for this phenomenon.