Applicants for Psychotherapy and the Problem of Early Termination Sol L. Garfield, Ph.D.
ABSTRACT: The current paper is essentially an evaluation and critique of a recent paper by Riess and Brandt {1965), pertaining to the general problem of dropouts in psychotherapy. These authors presented conclusions which were at variance with many of the previous findings in this area. In addition to evaluating the previous report in the light of other research, the present paper offers some possible explanations for apparent discrepancies in findings. Variation in findings may be due to a number of methodological considerations, including the definition of dropout and the adequacy and type of samples studied. Little data on significant patient variables were provided in the previous study.
A paper by Riess and Brandt (2965) published in this Journal pertaining to the general problem of dropouts in psychotherapy presented some interpretations and conclusions which appeared to be at variance with many of the previously published findings in this area. These authors offered interpretations and critical comments on previous studies which did not appear to be justified or accurate, and they also omitted reference to variables of importance. The present paper, therefore, attempts to evaluate the report of Riess and Brandt in the light of reports of other investigators and to offer some possible explanations for apparent discrepancies in findings. PRIOR FINDINGS AND ANALYSIS The major findings in the paper by Riess and Brandt are that a significant number of patients who withdrew before even beginning therapy entered (3z.7~o) or applied (xo.8~o) for treatment elsewhere and that, by contrast, only a small number (8~o) of those who actually began therapy, and then dropped out, sought treatment elsewhere. The authors draw some inferences from these findings and take issue with the reports and interpretations of others concerning the problem of early termination of psychotherapy. In essence, they state that the authors of previous studies have drawn erroneous conclusions by combining pretherapy and Dr. Garfield is Professor of Psychology and Director, Clinical Psychology Program, Teachers College, Columbia University, 325 West z2o St., New York, N. Y. zoo27. Community Mental Health Journal, Vol. 5 (1), 1969
?0
Sol L, Garfield
71
in-therapy dropouts and by not following up their cases. While the latter contention has merit, the former can be shown to be incorrect. They also contend that previous studies have conveyed the impression "that all dropouts were assumed to have changed their minds concerning their need for psychological treatment." By contrast, their study purports to negate this conclusion by showing that a number of such cases begin therapy elsewhere and are not really dropouts from therapy. A brief summary of the actual findings in the study by Riess and Brandt and an appraisal of their conclusions follow. Basically, their study was a telephone follow-up of 5oo consecutive applicants for psychotherapy at the Postgraduate Center for Mental Health in New York City. Of this group, 37.2% withdrew before therapy, most of them not even appearing for an intake appointment. The latter accounted for over 26% of the entire number of applicants. Of those who showed up for an intake interview, "fS~o were rejected by the center and just over 54% withdrew. Five months after the last application, 68.9% of those who had begun individual psychotherapy were still in treatment. Unfortunately, the kinds of data reported make it difficult to compare them with those of other studies in this area. On the basis of some of the data presented, it appears that of those who dropped out, somewhat over half had seven or more therapy sessions while over 43% had fewer than seven sessions. However, in another section of their paper (p. 578), they state that 2o.2% of their patients dropped out during the first ten interviews. Since some of the patients had begun therapy five months before the data analysis was begun and therapy was not yet concluded, it is not possible to determine the median length of treatment and comparisons with other studies are limited. The authors' main analysis is concerned with a comparison of those applicants who failed to begin therapy and of those who dropped out during therapy. They contend that "a considerable number of pretherapy dropouts do not reject psychotherapy as such, but reject it only at a given clinic. These pseudo-rejectors undergo treatment somewhere else" (p. 576 ). These individuals are then contrasted with 25 patients who terminated treatment before the seventh interview. In the latter group, only 8% entered treatment elsewhere as compared with 35.7% of the former group. As a result, the authors conclude that the groups are different. The pretherapy dropouts are presumed to seek and enter therapy elsewhere, whereas the in-therapy dropouts do not. They also state that there is no justification for combining these two groups "into one group of premature terminators" as others have done in the past. It is here that one must take exception to the authors' conclusion and their interpretation of the literature. COMPARISON OF STUDIES In the first place, Riess and Brandt state that previous investigators have combined the two groups of patients, but this actually is not the case in a large number of studies. These authors omit reference
72
Community Mental Health Journal
to most of these studies and refer by name to only two investigations, neither of which is particularly pertinent to the issue under discussion. One of these studies (Affleck and Garfield, 296~ ) was not concerned with gathering data on this problem but was concerned with the ability of a psychiatric staff to predict length of stay in psychotherapy of 46 patients, almost all of whom came for at least one treatment interview. These patients had each been seen by a social worker and a psychiatrist and were judged to merit a try at psychotherapy as a result of discussion at the staff meeting. Furthermore, their median length of stay was eight interviews and not four as stated by Riess and Brandt. A similar criticism can be made of the latter's interpretation of the other study referred to in this regard, that by Imber, Frank, Gliedman, Nash, and Stone (2956). This was a study of suggestability and social class with a sample of 57 patients. Even so, only 36% of the sample was in the category of less than four interviews and the number of those with no interviews, although not specified, was undoubtedly less. Clearly neither of these studies was appropriate as a basis of comparison. If, instead, other studies more appropriate to the problem at hand are used, the argument advanced by Riess and Brandt is seriously weakened. Several of these are referred to here. Garfield and Kurz (295z) studied 56o completed or dosed cases who had had at least one therapy interview. In another study by Garfield and Affleck (2959), a group of 235 patients were studied, all of whom had at least one therapy interview. Similar criteria have been used in the research studies in the Veterans Administration (Lorr, Katz, & Rubenstein, 2958; Rubenstein & Lorr, 2956 ) and in studies by Kurland (2956), Rosenthal and Frank (2958), and Schaffer and Myers (2954). Actually, such studies as well as others (Gibby, Stotsky, Miller & Hiler, 2953) have specifically excluded those patients who were offered therapy but refused it. There would thus appear to be little justification for the criticism by Riess and Brandt that studies have failed to make this discrimination. This is not to say that some studies have failed to separate these categories of patients. However, these were neither alluded to by the authors nor do they change the general findings concerning the problem of early termination in outpatient psychotherapy. In all of the studies just mentioned, all the early terminators had actually begun psychotherapy. In fact, an individual cannot really be viewed as a premature terminator or dropout from psychotherapy if he has not in fact begun psychotherapy. While some of the past studies may have some deficiencies, the consistency of the findings concerning early dropouts from therapy is too marked and their implications are too important to be lightly brushed aside. In this connection, it may be worthwhile to comment also on Riess and Brandt's criticism of the use of the median in studies in this area. While the use of the median to dichotomize groups of patients in order to study variables predictive of continuation has its limitations, it is a clearly designated measure which
Sol L. Garfield
73
allows one to compare groups and which also communicates dearly the point at which half of the patients have terminated therapy. The median length of treatment in a wide variety of studies and summarized in the studies previously mentioned varies from three to twelve interviews. The overall median appears to be in the neighborhood of six to eight interviews. The report by Rogers (i96o), for example, of over 5 ~ community clinics showed that by the eighth interview, over half of the clients had terminated treatment. Such a finding appears to hold for community clinics, Veterans Administration clinics, and medical school clinics. As already mentioned, most of the studies did not include any "pretherapy cases." The focus was on cases that actually began therapy. As has been pointed out repeatedly, the findings suggest that current therapeutic approaches either fail or are unsuited to large segments of the population (Garfield & Kurz, -r95z; Garfield & Affleck, I959; Lief, Lief, Warren, & Heath, ~965; Rosenthal & Frank, 5958 ). Because of such consistent findings, a number of investigations have been conducted which have attempted to explore variables which might be related to length of stay in psychotherapy. These have included a number of social class variables such as education and occupation, other variables including age, sex, diagnosis, source of referral, and also personality variables such as level of anxiety, defensiveness, ego strength, assumed motivation for therapy, and others. While some studies have secured positive results concerning the relationship of some of these variables to length of stay, others have failed to replicate their findings. It would appear, however, that some aspects of social class are potentially significant in this regard, both in terms of qualities and expectations in the client, and also in terms of the ease with which middle-dass therapists work with patients of diverse backgrounds. For example, although level of education as an abstract variable has not always been shown to be related to continuation in psychotherapy, clients with less than some high school education generally have a higher "dropout" rate than do individuals who are high school graduates or who have had some education at the college level (Garfield & Affleck, 5959; Rosenthal & Frank, 5958 ). COMMENT ON DATA In view of the above, it is of some significance that Riess and Brandt present practically no data about the subjects they studied. Data on diagnosis, severity of disturbance, age, education, and other significant social class variables which may have some relevance for attitudes toward psychotherapy and length of stay are completely lacking. Without knowing basic characteristics of the population, it is obviously difficult to generalize. It is conceivable that the general findings reported in clinics across the country may not hold for clinics with somewhat selected or atypical populations. In fact, the study by Lief, et al. (~96I), demonstrates this most dramatically. It reports only a small dropout rate from psycho-
74
Community Mental Health Journal
therapy prior to the sixth interview in working with clients who are predominantly a college population and almost half of whom have had some graduate work. In terms of such findings, it is important to know something of the population sampled in any study concerning psychotherapy. One does not know if the Postgraduate Center attracts people who are more interested in psychotherapy or are more sophisticated about it than a Veterans Administration or community psychiatric clinic, Actually, the finding that 5z.8% of the applicants who applied actually began therapy is slightly higher than that reported for a number of clinics (Rogers, x96o). It would also appear that only about 25% of those who had an intake interview refused psychotherapy whereas the findings for other clinics have ranged from 29% to 35% (Garfield & Kurz; Kurland; Rosenthal & Frank). Thus one might infer that the sample studied is somewhat different from those in most clinics and generalization is precarious. The problem of early termination has clearly been a problem in Veterans Administration clinics, in outpatient clinics associated with medical schools, and in community clinics. As several of us have evaluated this situation, it is apparent that there is a problem with the so-called "reluctant client" in terms of conventional approaches to psychotherapy. It also appears that newer approaches, perhaps, are required to cope with such individuals. Nothing in the study by Riess and Bran& would appear to contradict the plausibility of such deductions. CONCLUSION In terms of all of this, the conclusion by Riess and Bran& that a considerable number of "pretherapy dropouts" do not reject psychotherapy is a statement which in no way contradicts the findings on early termination in psychotherapy reported in the literature. As already emphasized, the latter dealt with patients who began therapy and were not concerned with those who never began therapy. Certainly, the fact that about one-third of the patients who did not come for an intake interview entered treatment somewhere else is not a surprising or contradictory finding. The fact that the majority of those who applied for treatment did not begin treatment anywhere is perhaps of greater interest or concern. REFERENCES Affleck, D. C., & Garfield, S. L. Predictivejudgments of therapists and duration of stay in psychotherapy.Journal of Clinical Psychology, I96I, I7, 134-I37. Garfield, S. L., & Affleck, D. C. An appraisal of duration of stay in outpatient psychotherapy. Journal of Nervous and Mental Diseases, I959 , I29 , 492-498. Garfield, S. L., & Kurz, M. Evaluation of treatment and related procedures in I216 cases referredto a mental hygiene clinic. Psychology Quarterly, i952 , 26, 414-424. Gibby, R. G., Stotsky,B. A., Miller, D. R., & Hiler, E. W. Predictionof duration of therapy from the RorschachTest. Journal of Consulting Psychology, i953, I7, 348-3549 Imber, S. D., Frank, J. D., Gliedman, L. H., Nash, E. H., & Stone, A. R. Suggestability, social class and the acceptanceof psychotherapy.Journal of Clinical Psychology, i956 , I2, 341-344.
Sol L. Garfield
75
Kurland, S. H. Length of treatment in a mental hygiene clinic. Psychology Quarterly Supplement, x956, 3o, 83-9o. Lief, H. I., Leif, V. F., Warren, C. O., & Heath, R. G. Low dropout rate in a psychiatric clinic. Archives of General Psychiatry, 196x, 5, 2oo-2II. Lorr, M., Katz, M. M., & Rubenstein, E. A. The prediction of length of stay in psychotherapy. Journal of Consulting Psychology, x958, 22, 32x-327. Riess, B. F., & Brandt, L. W. What happens to applicants for psychotherapy. Community Mental Health Journal, 1965, z, 175-x8o. Rogers, L. S. Dropout rates and results of psychotherapy in government aided mental hygiene clinics. Journal of Clinical Psychology, x96o, I6, 89-9z. Rosenthal, D., & Frank, J. D. The fate of psychiatric clinic outpatients assigned to psychotherapy. Journal of Nervous and Mental Disease, i958, I27, 33o-343. Rubenstein, E. A., & Lorr, M. A comparison of terminators and remainers in outpatient psychotherapy. Journal of Clinical Psychology, i956, 12, 345-349. Schaffer, L., & Myers, J. K. Psychotherapy and social stratification: an empirical study of practice in a psychiatric outpatient clinic. Psychiatry, i954, 27, 83-93.
Interdisciplinary Meeting in Mental Health Area The A m e r i c a n Orthopsychiatric Association will meet in N e w York, March 3o-April 2. Current research, treatment, and c o m m u n i t y p r o g r a m s in mental health will be reviewed in terms of medical, behavioral, and social science. I n f o r m a t i o n is available at the A m e r i c a n Orthopsychiatric Association, 179o Broadway, N e w York, N. Y. ~oox 9
ABSTRACT: The current paper is essentially an evaluation and critique of a recent paper by Riess and Brandt {1965), pertaining to the general problem of dropouts in psychotherapy. These authors presented conclusions which were at variance with many of the previous findings in this area. In addition to evaluating the previous report in the light of other research, the present paper offers some possible explanations for apparent discrepancies in findings. Variation in findings may be due to a number of methodological considerations, including the definition of dropout and the adequacy and type of samples studied. Little data on significant patient variables were provided in the previous study.
A paper by Riess and Brandt (2965) published in this Journal pertaining to the general problem of dropouts in psychotherapy presented some interpretations and conclusions which appeared to be at variance with many of the previously published findings in this area. These authors offered interpretations and critical comments on previous studies which did not appear to be justified or accurate, and they also omitted reference to variables of importance. The present paper, therefore, attempts to evaluate the report of Riess and Brandt in the light of reports of other investigators and to offer some possible explanations for apparent discrepancies in findings. PRIOR FINDINGS AND ANALYSIS The major findings in the paper by Riess and Brandt are that a significant number of patients who withdrew before even beginning therapy entered (3z.7~o) or applied (xo.8~o) for treatment elsewhere and that, by contrast, only a small number (8~o) of those who actually began therapy, and then dropped out, sought treatment elsewhere. The authors draw some inferences from these findings and take issue with the reports and interpretations of others concerning the problem of early termination of psychotherapy. In essence, they state that the authors of previous studies have drawn erroneous conclusions by combining pretherapy and Dr. Garfield is Professor of Psychology and Director, Clinical Psychology Program, Teachers College, Columbia University, 325 West z2o St., New York, N. Y. zoo27. Community Mental Health Journal, Vol. 5 (1), 1969
?0
Sol L, Garfield
71
in-therapy dropouts and by not following up their cases. While the latter contention has merit, the former can be shown to be incorrect. They also contend that previous studies have conveyed the impression "that all dropouts were assumed to have changed their minds concerning their need for psychological treatment." By contrast, their study purports to negate this conclusion by showing that a number of such cases begin therapy elsewhere and are not really dropouts from therapy. A brief summary of the actual findings in the study by Riess and Brandt and an appraisal of their conclusions follow. Basically, their study was a telephone follow-up of 5oo consecutive applicants for psychotherapy at the Postgraduate Center for Mental Health in New York City. Of this group, 37.2% withdrew before therapy, most of them not even appearing for an intake appointment. The latter accounted for over 26% of the entire number of applicants. Of those who showed up for an intake interview, "fS~o were rejected by the center and just over 54% withdrew. Five months after the last application, 68.9% of those who had begun individual psychotherapy were still in treatment. Unfortunately, the kinds of data reported make it difficult to compare them with those of other studies in this area. On the basis of some of the data presented, it appears that of those who dropped out, somewhat over half had seven or more therapy sessions while over 43% had fewer than seven sessions. However, in another section of their paper (p. 578), they state that 2o.2% of their patients dropped out during the first ten interviews. Since some of the patients had begun therapy five months before the data analysis was begun and therapy was not yet concluded, it is not possible to determine the median length of treatment and comparisons with other studies are limited. The authors' main analysis is concerned with a comparison of those applicants who failed to begin therapy and of those who dropped out during therapy. They contend that "a considerable number of pretherapy dropouts do not reject psychotherapy as such, but reject it only at a given clinic. These pseudo-rejectors undergo treatment somewhere else" (p. 576 ). These individuals are then contrasted with 25 patients who terminated treatment before the seventh interview. In the latter group, only 8% entered treatment elsewhere as compared with 35.7% of the former group. As a result, the authors conclude that the groups are different. The pretherapy dropouts are presumed to seek and enter therapy elsewhere, whereas the in-therapy dropouts do not. They also state that there is no justification for combining these two groups "into one group of premature terminators" as others have done in the past. It is here that one must take exception to the authors' conclusion and their interpretation of the literature. COMPARISON OF STUDIES In the first place, Riess and Brandt state that previous investigators have combined the two groups of patients, but this actually is not the case in a large number of studies. These authors omit reference
72
Community Mental Health Journal
to most of these studies and refer by name to only two investigations, neither of which is particularly pertinent to the issue under discussion. One of these studies (Affleck and Garfield, 296~ ) was not concerned with gathering data on this problem but was concerned with the ability of a psychiatric staff to predict length of stay in psychotherapy of 46 patients, almost all of whom came for at least one treatment interview. These patients had each been seen by a social worker and a psychiatrist and were judged to merit a try at psychotherapy as a result of discussion at the staff meeting. Furthermore, their median length of stay was eight interviews and not four as stated by Riess and Brandt. A similar criticism can be made of the latter's interpretation of the other study referred to in this regard, that by Imber, Frank, Gliedman, Nash, and Stone (2956). This was a study of suggestability and social class with a sample of 57 patients. Even so, only 36% of the sample was in the category of less than four interviews and the number of those with no interviews, although not specified, was undoubtedly less. Clearly neither of these studies was appropriate as a basis of comparison. If, instead, other studies more appropriate to the problem at hand are used, the argument advanced by Riess and Brandt is seriously weakened. Several of these are referred to here. Garfield and Kurz (295z) studied 56o completed or dosed cases who had had at least one therapy interview. In another study by Garfield and Affleck (2959), a group of 235 patients were studied, all of whom had at least one therapy interview. Similar criteria have been used in the research studies in the Veterans Administration (Lorr, Katz, & Rubenstein, 2958; Rubenstein & Lorr, 2956 ) and in studies by Kurland (2956), Rosenthal and Frank (2958), and Schaffer and Myers (2954). Actually, such studies as well as others (Gibby, Stotsky, Miller & Hiler, 2953) have specifically excluded those patients who were offered therapy but refused it. There would thus appear to be little justification for the criticism by Riess and Brandt that studies have failed to make this discrimination. This is not to say that some studies have failed to separate these categories of patients. However, these were neither alluded to by the authors nor do they change the general findings concerning the problem of early termination in outpatient psychotherapy. In all of the studies just mentioned, all the early terminators had actually begun psychotherapy. In fact, an individual cannot really be viewed as a premature terminator or dropout from psychotherapy if he has not in fact begun psychotherapy. While some of the past studies may have some deficiencies, the consistency of the findings concerning early dropouts from therapy is too marked and their implications are too important to be lightly brushed aside. In this connection, it may be worthwhile to comment also on Riess and Brandt's criticism of the use of the median in studies in this area. While the use of the median to dichotomize groups of patients in order to study variables predictive of continuation has its limitations, it is a clearly designated measure which
Sol L. Garfield
73
allows one to compare groups and which also communicates dearly the point at which half of the patients have terminated therapy. The median length of treatment in a wide variety of studies and summarized in the studies previously mentioned varies from three to twelve interviews. The overall median appears to be in the neighborhood of six to eight interviews. The report by Rogers (i96o), for example, of over 5 ~ community clinics showed that by the eighth interview, over half of the clients had terminated treatment. Such a finding appears to hold for community clinics, Veterans Administration clinics, and medical school clinics. As already mentioned, most of the studies did not include any "pretherapy cases." The focus was on cases that actually began therapy. As has been pointed out repeatedly, the findings suggest that current therapeutic approaches either fail or are unsuited to large segments of the population (Garfield & Kurz, -r95z; Garfield & Affleck, I959; Lief, Lief, Warren, & Heath, ~965; Rosenthal & Frank, 5958 ). Because of such consistent findings, a number of investigations have been conducted which have attempted to explore variables which might be related to length of stay in psychotherapy. These have included a number of social class variables such as education and occupation, other variables including age, sex, diagnosis, source of referral, and also personality variables such as level of anxiety, defensiveness, ego strength, assumed motivation for therapy, and others. While some studies have secured positive results concerning the relationship of some of these variables to length of stay, others have failed to replicate their findings. It would appear, however, that some aspects of social class are potentially significant in this regard, both in terms of qualities and expectations in the client, and also in terms of the ease with which middle-dass therapists work with patients of diverse backgrounds. For example, although level of education as an abstract variable has not always been shown to be related to continuation in psychotherapy, clients with less than some high school education generally have a higher "dropout" rate than do individuals who are high school graduates or who have had some education at the college level (Garfield & Affleck, 5959; Rosenthal & Frank, 5958 ). COMMENT ON DATA In view of the above, it is of some significance that Riess and Brandt present practically no data about the subjects they studied. Data on diagnosis, severity of disturbance, age, education, and other significant social class variables which may have some relevance for attitudes toward psychotherapy and length of stay are completely lacking. Without knowing basic characteristics of the population, it is obviously difficult to generalize. It is conceivable that the general findings reported in clinics across the country may not hold for clinics with somewhat selected or atypical populations. In fact, the study by Lief, et al. (~96I), demonstrates this most dramatically. It reports only a small dropout rate from psycho-
74
Community Mental Health Journal
therapy prior to the sixth interview in working with clients who are predominantly a college population and almost half of whom have had some graduate work. In terms of such findings, it is important to know something of the population sampled in any study concerning psychotherapy. One does not know if the Postgraduate Center attracts people who are more interested in psychotherapy or are more sophisticated about it than a Veterans Administration or community psychiatric clinic, Actually, the finding that 5z.8% of the applicants who applied actually began therapy is slightly higher than that reported for a number of clinics (Rogers, x96o). It would also appear that only about 25% of those who had an intake interview refused psychotherapy whereas the findings for other clinics have ranged from 29% to 35% (Garfield & Kurz; Kurland; Rosenthal & Frank). Thus one might infer that the sample studied is somewhat different from those in most clinics and generalization is precarious. The problem of early termination has clearly been a problem in Veterans Administration clinics, in outpatient clinics associated with medical schools, and in community clinics. As several of us have evaluated this situation, it is apparent that there is a problem with the so-called "reluctant client" in terms of conventional approaches to psychotherapy. It also appears that newer approaches, perhaps, are required to cope with such individuals. Nothing in the study by Riess and Bran& would appear to contradict the plausibility of such deductions. CONCLUSION In terms of all of this, the conclusion by Riess and Bran& that a considerable number of "pretherapy dropouts" do not reject psychotherapy is a statement which in no way contradicts the findings on early termination in psychotherapy reported in the literature. As already emphasized, the latter dealt with patients who began therapy and were not concerned with those who never began therapy. Certainly, the fact that about one-third of the patients who did not come for an intake interview entered treatment somewhere else is not a surprising or contradictory finding. The fact that the majority of those who applied for treatment did not begin treatment anywhere is perhaps of greater interest or concern. REFERENCES Affleck, D. C., & Garfield, S. L. Predictivejudgments of therapists and duration of stay in psychotherapy.Journal of Clinical Psychology, I96I, I7, 134-I37. Garfield, S. L., & Affleck, D. C. An appraisal of duration of stay in outpatient psychotherapy. Journal of Nervous and Mental Diseases, I959 , I29 , 492-498. Garfield, S. L., & Kurz, M. Evaluation of treatment and related procedures in I216 cases referredto a mental hygiene clinic. Psychology Quarterly, i952 , 26, 414-424. Gibby, R. G., Stotsky,B. A., Miller, D. R., & Hiler, E. W. Predictionof duration of therapy from the RorschachTest. Journal of Consulting Psychology, i953, I7, 348-3549 Imber, S. D., Frank, J. D., Gliedman, L. H., Nash, E. H., & Stone, A. R. Suggestability, social class and the acceptanceof psychotherapy.Journal of Clinical Psychology, i956 , I2, 341-344.
Sol L. Garfield
75
Kurland, S. H. Length of treatment in a mental hygiene clinic. Psychology Quarterly Supplement, x956, 3o, 83-9o. Lief, H. I., Leif, V. F., Warren, C. O., & Heath, R. G. Low dropout rate in a psychiatric clinic. Archives of General Psychiatry, 196x, 5, 2oo-2II. Lorr, M., Katz, M. M., & Rubenstein, E. A. The prediction of length of stay in psychotherapy. Journal of Consulting Psychology, x958, 22, 32x-327. Riess, B. F., & Brandt, L. W. What happens to applicants for psychotherapy. Community Mental Health Journal, 1965, z, 175-x8o. Rogers, L. S. Dropout rates and results of psychotherapy in government aided mental hygiene clinics. Journal of Clinical Psychology, x96o, I6, 89-9z. Rosenthal, D., & Frank, J. D. The fate of psychiatric clinic outpatients assigned to psychotherapy. Journal of Nervous and Mental Disease, i958, I27, 33o-343. Rubenstein, E. A., & Lorr, M. A comparison of terminators and remainers in outpatient psychotherapy. Journal of Clinical Psychology, i956, 12, 345-349. Schaffer, L., & Myers, J. K. Psychotherapy and social stratification: an empirical study of practice in a psychiatric outpatient clinic. Psychiatry, i954, 27, 83-93.
Interdisciplinary Meeting in Mental Health Area The A m e r i c a n Orthopsychiatric Association will meet in N e w York, March 3o-April 2. Current research, treatment, and c o m m u n i t y p r o g r a m s in mental health will be reviewed in terms of medical, behavioral, and social science. I n f o r m a t i o n is available at the A m e r i c a n Orthopsychiatric Association, 179o Broadway, N e w York, N. Y. ~oox 9
![[Premature termination of inpatient psychotherapy].](/assets/img/hold.png)
