Attrition is a common problem in psychotherapy and can be defined as clients ending treatment before achieving an optimal response.

This longitudinal, archival study utilized data for 3,728 clients, using the Outcome Questionnaire 45.2. A Cox regression proportional hazards (hazard ratios) model was used in order to better understand who is likely to attrit when considering (1) demographics, (2) diagnostic categories, and (3) process variables (e.g., recent symptom change).

A pattern emerged, with younger clients and those reporting less education and lower incomes being more likely to end. Clients who demonstrated a recent status change were more likely to remain in treatment.

Consistent with the large-scale STAR*D study, clients with more social and economic challenges demonstrated more risk. Adults diagnosed with a substance or obsessive compulsive disorder–related disorder showed the most elevated risk. Engagement strategies are discussed, with the goal of better supporting recovery.