A meta-analysis was conducted of 125 studies on psychotherapy dropout. Mean dropout rate was 46.86%. Dropout rate was unrelated to most of the variables that were examined but differed significantly as a function of definition of dropout. Lower dropout rates occurred when dropout was defined by termination because of failure to attend a scheduled session than by either therapist judgment or number of sessions attended. Significant effect sizes were observed for 3 client demographic variables: racial status, education, and income. Dropout rates increased for African-American (and other minority), less-educated, and lower income groups. Recommendations for future psychotherapy dropout research are presented.

Premature termination of psychotherapy, or Psychotherapy dropout, is generally recognized as a significant obstacle to the delivery of effective mental health services. For example, reviews of the psychotherapy dropout literature (Baekeland & Lundwall, 1975; Eiduson, 1968; Garfield, 1986) and aggregated U.S. community mental health center data (National Institute of Mental Health [NIMH], 1981) indicate that between 30% and 60% of psychotherapy outpatients terminate prematurely.

Psychotherapy dropouts pose clinical, fiscal, and morale problems for mental health professionals (Pekarik, 1985a), perhaps the most significant of which are reduced treatment efficacy and decreased cost-effectiveness (Garfield, 1986; Pekarik, 1985a). Relatively few studies have investigated treatment outcome for dropouts, typically reporting a pattern of poor outcome (Pekarik, 1986) and low client satisfaction (Lebow, 1982), especially when dropout occurs within the first few sessions. Impaired outcome for early dropouts erodes the overall impact and hence the cost-effectiveness of treatment. Thus, concerns about both the efficacy and cost-effectiveness of treatment have contributed to recent research attention to dropouts (Garfield, 1986).

Two major reviews of psychotherapy dropout research have been published in the past 2 decades. Baekeland and Lundwall (1975) comprehensively reviewed 362 articles from the literatures on medicine, alcohol/drug use, and mental health treatment and reported findings from 74 dropout studies of outpatient psychotherapy (62 on adult individual therapy, 5 on child therapy, and 7 on group therapy). They concluded that dropping out of individual...