Editing Psychotherapy (section)

=== Adherence ===
Patient [[Compliance (medicine)|adherence]] to a course of psychotherapy—continuing to attend sessions or complete tasks—is a major issue.

The dropout level—early termination—ranges from around 30% to 60%, depending partly on how it is defined. The range is lower for research settings for various reasons, such as the selection of clients and how they are inducted. Early termination is associated on average with various demographic and clinical characteristics of clients, therapists and treatment interactions.<ref name=adherence>Jennifer L. Strauss, Vito S. Guerra, Christine E. Marx, A. Meade Eggleston Ph.D, Patrick S. Calhoun Ph.D [https://books.google.com/books?id=uiuXxI6wBSQC&pg=PA215 Chapter 9: Improving Patient Treatment Adherence: A Clinician's Guide] {{webarchive|url=https://web.archive.org/web/20160416081953/https://books.google.co.uk/books?id=uiuXxI6wBSQC&pg=PA215 |date=16 April 2016 }} In: Improving Patient Treatment Adherence: A Clinician's Guide. Edited by Hayden Bosworth. Springer Science & Business Media, 3 July 2010</ref><ref>{{Cite journal |last1= Wierzbicki |first1= Michael |last2= Pekarik |first2= Gene |title= A meta-analysis of psychotherapy dropout |journal= [[Professional Psychology: Research and Practice]] |volume= 24 |issue= 2 |pages= 190–5 |year= 1993 |doi= 10.1037/0735-7028.24.2.190}}</ref> The high level of dropout has raised some criticism about the relevance and efficacy of psychotherapy.<ref>{{cite journal |last= Egan |first= Jonathan |title= Dropout and related factors in therapy |url= http://www.lenus.ie/hse/bitstream/10147/121474/1/DropoutRelatedfactorsPSI.pdf |journal= The Irish Psychologist |year= 2005 |volume= 32 |issue= 2 |pages= 27–30 |url-status= live |archive-url= https://web.archive.org/web/20110721125420/http://www.lenus.ie/hse/bitstream/10147/121474/1/DropoutRelatedfactorsPSI.pdf |archive-date= 21 July 2011 |df= dmy-all }}</ref>

Most psychologists use between-session tasks in their general therapy work, and cognitive behavioral therapies in particular use and see them as an "active ingredient". It is not clear how often clients do not complete them, but it is thought to be a pervasive phenomenon.<ref name=adherence/>

From the other side, the adherence of therapists to therapy protocols and techniques—known as "treatment integrity" or "fidelity"—has also been studied, with complex mixed results.<ref>{{cite book |author1= Dinger Ulrike |author2= Zilcha-Mano Sigal |author3= Dillon Justina |author4= Barber Jacques P |year= 2015 |title = Therapist Adherence and Competence in Psychotherapy Research |journal= The Encyclopedia of Clinical Psychology |pages= 1–5|doi= 10.1002/9781118625392.wbecp340 |isbn= 9781118625392 }}</ref> In general, however, it is a hallmark of evidence-based psychotherapy to use fidelity monitoring as part of therapy outcome trials and ongoing quality assurance in clinical implementation.