Validation predicting premature drop-out from treatment provided in training clinics

Abstract

Therapist validation in treatment is theorized to be related to positive outcomes (Linehan, 1993), including keeping patients in therapy longer. We sought to evaluate the role of therapist validation from both therapists' and clients' perspectives as a predictor of drop-out from psychotherapy in three cognitive behavioural training clinics. Clients in psychotherapy (n = 50; 80% female; 82% Caucasian) and their trainee therapists (n = 22; 68% female; 86% Caucasian) rated validation by the therapist at each of four early sessions of therapy. After accounting for symptom severity, clients who reported greater therapist validation were less likely to drop out of treatment. Therapist ratings of their own validating behaviours were unrelated to client drop-out. Therapist experience moderated the relation between client-rated validation and drop-out, such that validation was unrelated to drop-out for more experienced therapists. Assessing and attending to client perceptions of validation by the therapist early in treatment, with brief self-report inventories, can alert therapists to clients at greater risk of drop-out.