Premature termination of treatment is a significant problem in individual psychotherapy as well as in group therapy for its high prevalence and numerous negative consequences. A meta-analysis conducted of 125 studies on psychotherapy dropout revealed that the average outpatient psychotherapy dropout rate was 46.8% across a wide range of settings, diagnoses, and treatment patients [1]. In individual psychotherapy, early termination has been associated with reduced treatment efficacy [2,3]. Also, the fact that issues related to the termination are not explored can lead to feelings of dissatisfaction, failure and discouragement in patients and ultimately to their functional deterioration [4,5]. In group psychotherapy, dropping out and irregular attendance can have negative repercussions on the other members and disrupt group cohesion, itself an essential factor in treatment continuance [6]. Members who attend regularly do not want to repeat themselves and may experience feelings of insecurity, anxiety or anger [7].

There are several reasons why a patient might initiate premature termination such as anxiety about self-disclosing or disagreement with therapist about which problems should be addressed, but the specific factors remain largely unknown [7]. Among socio demographic variables, minority racial status, less-educated and lower income groups have been related with dropout rates with a moderate effect size [1]. However, when other related variables are taken into account such as patient expectations, the relationship between socioeconomic status and dropout is diminished [8]. Another issue in the premature termination literature concerns the various definitions of dropout, each method of operationalizing it having its own strengths and weaknesses. Studies that defined dropout in terms of failure to attend a scheduled session reported lower dropout rates than did studies defining dropout based on therapist judgment or the number of sessions attended [1]. Additionally, factors related to dropout depend on clinical contexts and diagnoses. Individuals with Borderline Personality Disorder (BPD) exhibit high dropout rates [9] and utilize health care services more frequently than any other psychiatric group [10].

The reported dropout rates in BPD patients range from 16% to 67% depending on treatment modalities and definitions [11-15]. A younger age has been found to be a consistent predictor of dropout from outpatient psychotherapy in BPD patients [13,16]. Also, higher [17] or lower baseline psychopathology [11], higher levels of anger and hostility [11-13,18] behavioral impulsiveness [18] and lower interpersonal distress [16] were all found as predictors of dropout rates in BPD individuals. Examining the relationship between specific personality disorder criteria and individual psychotherapy attendance, Hilsenroth et al. [19] found that criteria associated with low levels of interpersonal distress (e.g. lack of remorse in antisocial personality disorder) were associated with fewer sessions whereas criteria reflecting greater interpersonal distress (e.g. frantic effort to avoid real or imagined abandonment in BPD) were associated with greater attendance.

Citation: Jean G, Jean-Sébastien L, Julie S (2015) Relationship between Two Dimensions of Object Relations and Group Psychotherapy Attendance Rate in Borderline Personality Disorder Individuals . J Psychol Psychother 5:171. doi: 10.4172/2161-0487.1000171

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