Terminación Prematura en Psicoterapia

Una revisión narrativa




Palabras clave:

terminación prematura, deserción, psicoterapia, abandono


La psicoterapia es un recurso efectivo y eficaz, pero no lo es para todas las personas. Uno de los problemas clínicos con el que nos encontramos en este campo es la terminación prematura por parte del paciente sin acuerdo con el psicoterapeuta. El problema mencionado deriva en dos problemas, uno conceptual y otro operacional, existiendo distintas definiciones del término como así diferentes maneras de medirlo. El objetivo general de este trabajo es realizar una revisión no sistemática sobre el tema, teniendo como ejes las distintas maneras en que se ha definido el concepto, las diversas formas de medirla, los resultados de meta-análisis realizados sobre la temática y las variables que pueden modularla.


Aubuchon-Endsley, N. L. y Callahan, J. L. (2009). The hour of departure: Predicting attrition in the training clinic from role expectancies. Training and Education in Professional Psychology, 3(2), 120-126. https://doi.org/10.1037/a0014455

Baekeland, F. y Lundwall, L. (1975). Dropping out of treatment: a critical review. Psychological bulletin, 82(5), 738. https://doi.org/10.1037/h0077132

Barrett, M. S., Chua, W. J., Crits-Christoph, P., Gibbons, M. B. y Thompson, D. (2008). Early with drawal from mental health treatment: Implications for psychotherapy practice. Psychotherapy: Theory, Research, Practice, Training, 45(2), 247-267. https://doi.org/10.1037/0033-3204.45.2.247

Bloom, B. L. (2001). Focused single-session psychotherapy: A review of the clinical and research literature. Brief Treatment and Crisis Intervention, 1(1), 75-86. http://dx.doi.org/10.1093/brief-treatment/1.1.75

Brogan, M. M., Prochaska, J. O. y Prochaska, J. M. (1999). Predicting termination and continuation status in psychotherapy using the transtheoretical model. Psychotherapy: Theory, Research, Practice, Training, 36(2), 105-113. https://doi.org/10.1037/h0087773

Chisholm, S. M., Crowther, J. H. y Ben-Porath, Y. S. (1997). Selected MMPI-2 scales ability to predict premature termination and outcome from psychotherapy. Journal of Personality Assessment, 69(1), 127–144. https://doi.org/10.1207/s15327752jpa6901_7

Cooper, A. A. y Conklin, L. R. (2015). Dropout from individual psychotherapy for major depression: a meta-analysis of randomized clinical trials. Clinical Psychology Review, 40, 57-65. https://doi.org/10.1016/j.cpr.2015.05.001

Cooper, A. A., Kline, A. C., Baier, A. L. y Feeny, N. C. (2018). Rethinking Research on Prediction and Prevention of Psychotherapy Dropout: A Mechanism-Oriented Approach. Behavior modification. https://doi.org/10.1177%2F0145445518792251

Crits-Christoph, P., Connolly, M. B., Gallop, R., Barber, J. P., Tu, X., Gladis, M. y Siqueland, L. (2001). Early improvement during manual-guided cognitive and dynamic psychotherapies predicts 16-week remission status. Journal of Psychotherapy Practice and Research, 10(3), 145-154. PMID:11402077

De Haan, A. M., Boon, A. E., Vermeiren, R. R., Hoeve, M. y de Jong, J. T. (2015). Ethnic background, socioeconomic status, and problem severity as dropout risk factors in psychotherapy with youth. Child & youth care forum, 44(1), 1-16. https://doi.org/10.1007/s10566-014-9266-x

Fernandez, E., Salem, D., Swift, J. K. y Ramtahal, N. (2015). Meta-analysis of dropout from cognitive behavioral therapy: Magnitude, timing, and moderators. Journal of Consulting and Clinical Psychology, 83(6), 1108-1122.

Garb, H. N. (2005). Clinical judgment and decision making. Annual Review of Clinical Psychology, 1, 67–89. https://doi.org/10.1146/annurev.clinpsy.1.102803.143810

Garfield, S. L. (1994). Research on client variables in psychotherapy. En A. E. Bergin y S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change (pp. 190–228). Nueva York, NY: Wiley.

Gersh, E., Hallford, D. J., Rice, S. M., Kazantzis, N., Gersh, H., Gersh, B. y McCarty, C. A. (2017). Systematic review and meta-analysis of dropout rates in individual psychotherapy for generalized anxiety disorder. Journal of anxiety disorders, 52, 25-33. https://doi.org/10.1016/j.janxdis.2017.10.001

Gonzalez, A., Weersing, V. R., Warnick, E. M., Scahill, L. D. y Woolston, J. L. (2011). Predictors of treatment attrition among an outpatient clinic sample of youths with clinically significant anxiety. Administration and Policy in Mental Health and Mental Health Services Research, 38, 356-367. https://doi.org/10.1007/s10488-010-0323-y

Greenberg, R. P., Constantino, M. J. y Bruce, N. (2006). Are patient expectations still relevant for psychotherapy process and outcome? Clinical psychology review, 26(6), 657-678. https://doi.org/10.1016/j.cpr.2005.03.002

Gutner, C. A., Gallagher, M. W., Baker, A. S., Sloan, D. M. y Resick, P. A. (2016). Time course of treatment dropout in cognitive-behavioral therapies for posttraumatic stress disorder. Psychological Trauma: Theory, Research, Practice, and Policy, 8(1), 115-121. https://doi.org/10.1037/tra0000062

Hatchett, G. T., Han, K. y Cooker, P. G. (2002). Predicting premature termination from counseling using the Butcher Treatment Planning Inventory. Assessment, 9(2), 156–163. https://doi.org/10.1177%2F10791102009002006

Hatchett, G. T., y Park, H. L. (2003). Comparison of four operational definitions of premature termination. Psychotherapy: Theory, Research, Practice, Training, 40(3), 226-231. https://doi.org/10.1037/0033-3204.40.3.226

Kane, A. S. y Tryon, G. S. (1988). Predictors of premature termination from counseling at semester recess. Journal of College Student Development, 29(6), 562-563.

Kehle-Forbes, S. M., Meis, L. A., Spoont, M. R. y Polusny, M. A. (2016). Treatment initiation and dropout from prolonged exposure and cognitive processing therapy in a VA outpatient clinic. Psychological Trauma: Theory, Research, Practice, and Policy, 8(1), 107-114. https://doi.org/10.1037/tra0000065

Lambert M. J., Hansen N. B., Umpress V., Lunnen K., Okiishi J. y Burlingame G.M. (1996). Administration And Scoring Manual for the OQ45.2. Nashville, TN: American Professional Credentialing Services LLC.

Lambert, M. J., Okiishi, J. C., Finch, A. E. y Johnson, L. D. (1998). Outcome assessment: From conceptualization to implementation. Professional Psychology: Research and Practice, 29(1), 63–70.


Linardon, J., Brennan,L. y de la Piedad Garcia, X.(2016).Rapid response to eating disorder treatment: A systematic review and meta-analysis. International Journal of Eating Disorders, 49(10), 905–919.


Linardon, J., Fitzsimmons-Craft, E. E., Brennan, L., Barillaro, M., y Wilfley, D. E. (2018). Dropout from interpersonal psychotherapy for mental health disorders: A systematic review and meta-analysis. Psychotherapy Research, 29(7), 1-12. https://doi.org/10.1080/10503307.2018.1497215

Linardon, J., Hindle, A. y Brennan, L. (2018). Dropout from cognitive‐behavioral therapy for eating disorders: A meta‐analysis of randomized, controlled trials. International Journal of Eating Disorders, 51(5), 381-391. https://doi.org/10.1002/eat.22850

Longo, D. A., Lent, R. W. y Brown, S. D. (1992). Social cognitive variables in the prediction of client motivation and attrition. Journal of Counseling Psychology, 39(4), 447-452. https://doi.org/10.1037/0022-0167.39.4.447

Lutz, W., Hofmann, S. G., Rubel, J., Boswell, J. F., Shear, M. K., Gorman, J. M. y Barlow, D. H. (2014). Patterns of early change and their relationship to outcome and early treatment termination in patients with panic disorder. Journal of Consulting and Clinical Psychology, 82(2), 287-297. https://doi.org/10.1037/a0035535

Maher, M., Huppert, J. D., Chen, H., Duan, N., Foa, E. B., Liebowitz, M. R. y Simpson, H. B. (2010). Moderators and predictors of response to cognitive-behavioral therapy augmentation of pharmacotherapy in obsessive–compulsive disorder. Psychological Medicine, 40(12), 2013–2023. https://dx.doi.org/10.1017%2FS0033291710000620

McAleavey, A. A., Youn, S. J., Xiao, H., Castonguay, L. G., Hayes, J. A. y Locke, B. D. (2017). Effectiveness of routine psychotherapy: Method matters. Psychotherapy Research, 29(2), 139-156. https://doi.org/10.1080/10503307.2017.1395921

McMurran, M., Huband, N. y Overton, E. (2010). Non-completion of personality disorder treatments: A systematic review of correlates, consequences, and interventions. Clinical Psychology Review, 30(3), 277-287. https://doi.org/10.1037/h0087822

Miller, S. D., Duncan, B. L., Brown, J., Sparks, J. A., y Claud, D. A. (2003). The outcome rating scale: A preliminary study of the reliability, validity, and feasibility of a brief visual analog measure. Journal of brief Therapy, 2(2), 91-100.

Nathan, P. E. y Gorman, J. M. (2015). A guide to treatments that work (4th ed.). Nueva York, NY: Oxford University Press.

Ong, C. W., Lee, E. B. y Twohig, M. P. (2018). A meta-analysis of dropout rates in acceptance and commitment therapy. Behaviour research and therapy, 104, 14-33. https://doi.org/10.1016/j.brat.2018.02.004

Pekarik, G. (1985). The effects of employing different termination classification criteria in dropout research. Psychotherapy, 22(1), 86–91. https://doi.org/10.1037/h0088531

Reis, B. F. y Brown, L. G. (1999). Reducing psychotherapy dropouts: Maximizing perspective convergence in the psychotherapy dyad. Psychotherapy: Theory, Research, Practice, Training, 36(2), 123–136. https://doi.org/10.1037/h0087822

Richmond, R. (1992). Discriminating variables among psychotherapy dropouts from a psychological training clinic. Professional Psychology: Research and Practice, 23(2), 123-130. https://doi.org/10.1037/0735-7028.23.2.123

Sharf, J., Primavera, L. H. y Diener, M. J. (2010). Dropout and therapeutic alliance: A meta-analysis of adult individual psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 47(4), 637-645. https://doi.org/10.1037/a0021175

Saxon, D., Barkham, M., Foster, A. y Parry, G. (2017). The contribution of therapist effects to patient dropout and deterioration in the psychological therapies. Clinical psychology & psychotherapy, 24(3), 575-588. https://doi.org/10.1002/cpp.2028

Saxon, D., Firth, N. y Barkham, M. (2017). The relationship between therapist effects and therapy delivery factors: Therapy modality, dosage, and non-completion. Administration and Policy in Mental Health and Mental Health Services Research, 44, 705-715. https://doi.org/10.1007/s10488-016-0750-5

Schindler, A., Hiller, W. y Witthoft, M. (2013). What predicts outcome, response, and drop-out in CBT of depressive adults? A naturalistic study. Behavioural and Cognitive Psychotherapy, 41(3), 365-370. https://doi.org/10.1017/S1352465812001063

Swift, J. K. y Greenberg, R. P. (2012). Premature discontinuation in adult psychotherapy: A meta-analysis. Journal of consulting and clinical psychology, 80(4), 547-559. https://psycnet.apa.org/doi/10.1037/a0028226

Swift, J. K. y Greenberg, R. P. (2015). Premature termination in psychotherapy: Strategies for engaging clients and improving outcomes. Washintong, DC: American Psychological Association. https://psycnet.apa.org/doi/10.1037/14469-000

Swift, J. K., Greenberg, R. P., Tompkins, K. A. y Parkin, S. R. (2017). Treatment refusal and premature termination in psychotherapy, pharmacotherapy, and their combination: A meta-analysis of head-to-head comparisons. Psychotherapy, 54(1), 47–57. https://psycnet.apa.org/doi/10.1037/pst0000104

Szafranski, D. D., Smith, B. N., Gros, D. F. y Resick, P. A. (2017). High rates of PTSD treatment dropout: A possible red herring? Journal of Anxiety Disorders, 47, 91-98. https://doi.org/10.1016/j.janxdis.2017.01.002

Wierzbicki, M. y Pekarik, G. (1993). A meta-analysis of psychotherapy dropout. Professional Psychology: Research and Practice, 24(2), 190-195. https://doi.org/10.1037/0735-7028.24.2.190

Zieve, G. G., Persons, J. B. y Yu, L. A. D. (2019). The Relationship Between Dropout and Outcome in Naturalistic Cognitive Behavior Therapy. Behavior therapy, 50(1), 189-199. https://doi.org/10.1016/j.beth.2018.05.004

Zimmermann, D., Rubel, J., Page, A. C. y Lutz, W. (2017). Therapist effects on and predictors of non‐consensual dropout in psychotherapy. Clinical psychology & psychotherapy, 24(2), 312-321. https://doi.org/10.1002/cpp.2022



Cómo citar

Santangelo, P. R. (2020). Terminación Prematura en Psicoterapia: Una revisión narrativa. Revista De Psicoterapia, 31(115), 181-195. https://doi.org/10.33898/rdp.v31i115.316



Open Access: Artículos de temática libre