Adherence or Drop Out of Adolescents in Psychotherapy Due to Sexual Abuse: their Therapist’s Perspective

Authors

  • Lucia Beatriz Nuñez Hidalgo Pontificia Universidad Católica de Chile https://orcid.org/0000-0002-5929-3499
  • Claudia Capella Universidad de Chile
  • Vania Vásquez Universidad de Chile
  • Sofía Fuentes Universidad de Chile

DOI:

https://doi.org/10.21615/cesp.13.3.8

Keywords:

Psychotherapy Drop Out, Adherence, Adolescents, Sexual Abuse, Psychotherapists

Abstract

A high percentage of adolescents who attend psychotherapy due to sexual abuse drop out of treatment, affecting the overcoming. There is little research on what precipitates desertion or promotes adherence in these cases. Aim: describe features of the consulting system and the psychotherapeutic process of adolescents who have been sexually abused who adhere and drop out of psychotherapy, in order to explore similarities and differences from the perspective of their psychotherapists. Methods: Semi-structured interviews were conducted with psychotherapists who attended 16 cases of adolescent victims of sexual abuse, 8 who deserted from psychotherapy and 8 who continued until discharge. Thematic narrative analysis of the interviews was developed. Results: the main similarities described were multi-problematic social and family contexts, personal resources in the adolescents and a positive psychotherapeutic relationship. Differences were focused on caretakers, who in the drop out cases showed low support and a more conflictive relationship with the adolescent, little involvement in psychotherapy and a poor relationship with the psychotherapist. Adolescents who deserted had consultation purposes not related with sexual abuse and low social integration, unlike those who adhered. Conclusion and discussion: the phenomena of adherence and dropout of psychotherapy are complex and multifactorial. Along with factors associated with the consulting system, elements of the psychotherapeutic process that support adherence stand out, which can be addressed early in the process.

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Author Biographies

Lucia Beatriz Nuñez Hidalgo, Pontificia Universidad Católica de Chile

Doctora (c) en Psicoterapia, Pontificia Universidad Católica de Chile/Universidad de Chile. Miembro del Instituto Milenio para la Investigación en Depresión y Personalidad (MIDAP).

Claudia Capella, Universidad de Chile

Doctora en Psicología. Académica Departamento de Psicología Universidad de Chile. Investigadora Adjunta del Instituto Milenio para la Investigación en Depresión y Personalidad (MIDAP).

Vania Vásquez, Universidad de Chile

Psicóloga,  Universidad de Chile.

Sofía Fuentes, Universidad de Chile

Psicóloga, Universidad de Chile.

References

Adam, J., Mrug, S., & Knight, D. (2018). Characteristics of child physical and sexual abuse as predictors of psychopathology. Child abuse & neglect, 86, 167-177.

Águila, D., Lama, X., Capella, C., Rodríguez, L., Dussert, D., Gutiérrez, C., & Beiza, G. (2016). Narrativas de terapeutas sobre el proceso de cambio psicoterapéutico en niños, niñas y adolescentes que han sido víctimas de agresiones sexuales. Estudios de Psicología, 37(2-3), 344-364. https://doi.org/10.1080/02109395.2016.1204780

Altimir, C., Krause, M., De la Parra, G., Dagnino, P., Tomicic, A., Valdés, N., … Vilches, O. (2010) Clients', therapists', and observers' agreement on the amount, temporal location, and content of psychotherapeutic change and its relation to outcome. Psychotherapy Research, 20(4), 472-487.

Armbruster, P., & Schwab-Stone, M. E. (1994). Sociodemographic characteristics of dropouts from child guidance clinic. Psychiatric Services, 45(8), 804-808. http://ps.psychiatryonline.org/doi/abs/10.1176/ps.45.8.804

Baruch, G., Vrouva, I., & Fearon, P. (2009). A Follow‐up Study of Characteristics of Young People that Dropout and Continue Psychotherapy: Service Implications for a Clinic in the Community. Child and Adolescent Mental Health, 14(2), 69-75. https://doi.org/10.1111/j.1475-3588.2008.00492.x

Bueno, A., Córdoba, J.A., Escolar, A., Carmona, J., & Rodriguez, C (2001). El abandono terapéutico. Actas Esp Psiquiatría, 29(1), 33-40

Capella, C. (2017). Disequilibrium and Loss of Narrative Coherence in Identity Construction: A Piagetian Perspective on Trauma in Adolescent Victims of Sexual Abuse. Journal of Constructivist Psychology, 30(4), 323-338. https://doi.org/10.1080/10720537.2016.1227737

Capella, C., Lama, X., Rodríguez, L., Águila, D., Beiza, G., Dussert, D., & Gutierrez, C. (2016). Winning a race: narratives of healing and psychotherapy in children and adolescents who have been sexually abused. Journal of child sexual abuse, 25(1), 73-92. https://doi.org/10.1080/10538712.2015.1088915

Centro de Asistencia a Víctimas de Atentados Sexuales [CAVAS]. (2011). Centro de Asistencia a Víctimas de Atentados Sexuales: “Una Revisión de la experiencia”. Instituto de Criminología (INSCRIM), Santiago, Chile.

Cornejo, M., & Salas, N. (2011). Rigor y calidad metodológicos: un reto a la investigación social cualitativa. Psicoperspectivas, 10(2), 12-34. http://dx.doi.org/10.5027/psicoperspectivas-Vol10-Issue2-fulltext-144

Deakin, E., Gastaud, M., & Tiellet, M. L. (2012). Child psychotherapy dropout: an empirical research review. Journal of Child Psychotherapy, 38(2), 199-209. https://doi.org/10.1080/0075417X.2012.684489

De Haan, A. M., Boon, A. E., de Jong, J. T., Hoeve, M., & Vermeiren, R. R. (2013). A meta-analytic review on treatment dropout in child and adolescent outpatient mental health care. Clinical Psychology Review, 33(5), 698-711. Recuperado de http://www.sciencedirect.com/science/article/pii/S0272735813000688

Demarest, K., Heger, A. H., Foy, D. W., & Leskin, G. A. (1996). Factors associated with entry into therapy in children evaluated for sexual abuse. Child abuse & neglect, 20(1), 63-68.

Di Matteo, M. R., & DiNicola, D.D. (1982). Achieving Patient Compliance. The Psychology of the Medical Practitioner’s Role. New York: Pergamon Press.

Dussert, D., Capella, C., Lama, X., Gutiérrez, C., Águila, D., Rodríguez, L., & Beiza, G. (2017). Narrativas de Padres de Niños, Niñas y Adolescentes que Han Finalizado Psicoterapia por Agresiones Sexuales: Un Proceso de Superación Conjunta. Psykhe, 26(1), 1-14.

Edlund, M. J., Wang, P. S., Berglund, P. A., Katz, S. J., Lin, E., & Kessler, R. C. (2002). Dropping out of mental health treatment: patterns and predictors among epidemiological survey respondents in the United States and Ontario. American Journal of Psychiatry, 159(5), 845-851. https://doi.org/10.1176/appi.ajp.159.5.845

Epperson, D. L., Bushway, D. J., & Warman, R. E. (1983). Client self-terminations after one counseling session: Effects of problem recognition, counselor gender, and counselor experience. Journal of Counseling Psychology, 30(3), 307–315. https://doi.org/10.1037/0022-0167.30.3.307

Eslinger, J., Sprang, G., & Otis, M. (2014). Child and Caregiver Dropout in Child Psychotherapy for Trauma. Journal of Loss and Trauma, 19, 121–136. https://doi.org/10.1080/15325024.2012.742720

Fernández, O., Pérez, C., Gloger, S., & Krause, M. (2015). Importancia de los Cambios Iniciales en la Psicoterapia con Adolescentes. Terapia psicológica, 33(3), 247-255.

Fondo de las Naciones Unidas para la Infancia [UNICEF], (2012). Cuarto estudio de maltrato infantil. Santiago: UNICEF. Recuperado de https://www.unicef.org/spanish/publications/index_69639.html

Freire, B. (1990). Estudio comparativo de tres grupos de pacientes con distinta continuidad terapéutica. Rev Asoc Esp Neuropsiquiatría,; 10(33), 221-227.

Fuentes, S., & Vásquez, V. (2017). Deserción Psicoterapéutica de Adolescentes que han sido Víctimas de Agresiones Sexuales: La Mirada de sus Psicoterapeutas. Memoria para optar al título de Psicóloga. Universidad de Chile.

Furnham, A., & Wong, L. (2007). A cross-cultural comparison of British and Chinese beliefs about the causes, behaviour manifestations and treatment of schizophrenia. Psychiatry research, 151(1), 123-138.

Gearing, R. E., Schwalbe, C. S., & Short, K. D. (2012). Adolescent adherence to psychosocial treatment: mental health clinicians' perspectives on barriers and promoters. Psychotherapy Research, 22(3), 317-326. https://doi.org/10.1080/10503307.2011.653996

Guha, A., Luebbers, S., Papalia, N., & Ogloff, J. (2019). A follow-up study of mental health service utilization in a cohort of 2433 sexually abused Australian children utilizing five years of medical data. Child abuse & neglect, 90, 174-184.

Hamberger, L., Lohr, J., & Gottlieb, M. (2000). Predictors of treatment dropout from a spouse abuse abatement program. Behavior Modification, 24(4), 528-552.

Hernández, J. L., Acosta F.J, & Pereira J. (2009). Adherencia terapéutica. Cuadernos de psiquiatría comunitaria, 9 (1), 15-28.

Hetzel-Riggin, M. D., Brausch, A. M., & Montgomery, B. S. (2007). A meta-analytic investigation of therapy modality outcomes for sexually abused children and adolescents: An exploratory study. Child abuse & neglect, 31(2), 125-141.

Hillis, G., Eagles, A., & Eagles, J. (1993). Premature termination of psychiatric contact. Int J Soc Psychiatry, 39(2), 100-107.

Horne, R., Weinman, J., Barber, N., Elliott, R., Morgan, M., Cribb, A., & Kellar, I. (2005). Concordance, adherence and compliance in medicine taking. London: NCCSDO.

Jo, T., & Almao, S. (2002). Abandono del tratamiento en una consulta externa de psiquiatría y psicología clínica. Revista Electrónica de portales médicos.com. Recuperado de http://www.portlesmedicos.com/monografías/abandono _tratamiento/index.htm

Kazdin, A. E. (1996). Dropping out of child psychotherapy: Issues for research and implications for practice. Clinical Child Psychology and Psychiatry, 1(1), 133-156. https://doi.org/10.1177/1359104596011012

Kazdin, A., Mazurick, J., & Bass, D. (1993). Risk for attrition in treatment of antisocial children and families. Journal of Clinical Child Psychology, 22(1), 2–16. https://doi.org/10.1207/s15374424jccp2201_1

Killaspy, H., Banerjee, S., King, M., & Lloyd, M. (2000). Prospective controlled study of psychiatric out-patient non-attendance. The British Journal of Psychiatry, 176(2), 160-165. https://doi.org/10.1192/bjp.176.2.160

Lippert, T., Favre, T., Alexander, C., & Cross, T. P. (2008). Families who begin versus decline therapy for children who are sexually abused. Child abuse & neglect, 32(9), 859-868.

Luk, E. S., Staiger, P. K., Mathai, J., Wong, L., Birleson, P., & Adler, R. (2001). Children with persistent conduct problems who dropout of treatment. European Child & Adolescent Psychiatry, 10(1), 28-36. https://doi.org/10.1007/s007870170044

Marks, I., Lovell, K., Noshirvani, H., Livanou, M., & Thrasher, S. (1998). Treatment of posttraumatic stress disorder by exposure and/or cognitive restructuring: A controlled study. Archives of General Psychiatry, 55(4), 317-325. https://doi.org/10.1001/archpsyc.55.4.317

Matas, M., Staley, D., & Griffin, W. (1992). A profile of the noncompliant patient: a thirty month review of outpatient psychiatry referrals. Gen Hosp Psychiat, 14(2), 124-130.

McPherson, P., Scribano, P., & Stevens, J. (2012). Barriers to Successful Treatment Completion in Child Sexual Abuse Survivors. Journal of interpersonal violence, 27 (1), 23-39. https://doi.org/10.1177/0886260511416466

Mendoza, M. (2016). Relación terapéutica y cambio psicoterapéutico, desde la experiencia subjetiva de adolescentes y sus terapeutas. (Tesis de Magíster, Departamento de Psicología, Universidad de Chile).

Núñez, L., Fuentes, S., Vásquez, V. & Capella, C. (2016). Adolescentes víctimas de agresión sexual que desertan de la psicoterapia: La mirada de sus terapeutas. Ponencia presentada en el XII Congreso Latinoamericano de Investigación en Psicoterapia. Porto Alegre, Brasil. 20 al 22 de Octubre 2016.

Nock, M. K., & Ferriter, C. (2005). Parent Management of Attendance and Adherence in Child and Adolescent Therapy: A Conceptual and Empirical Review. Clinical Child and Family Psychology Review, 8(2), 149-166. https://doi.org/10.1007/s10567-005-4753-0

O’Keeffe, S., Martin, P., Goodyer, I., Wilkinson, P., Impact Consortium, & Midgley, N. (2018) Predicting dropout in adolescents receiving therapy for depression. Psychotherapy Research, 28(5), 708-721. https://doi.org/10.1080/10503307.2017.1393576

O’Keeffe, S., Martin, P., Target, M., & Midgley, N. (2019). ‘I Just Stopped Going’: A Mixed Methods Investigation into Types of Therapy Dropout in Adolescents with Depression. Frontiers in Psychology, 10(75). https://doi.org/10.3389/fpsyg.2019.00075

Ormhaug, S., & Jensen, T. (2018). Investigating treatment characteristics and first-session relationship variables as predictors of dropout in the treatment of traumatized youth. Psychotherapy Research, 28(2), 235-249, https://doi.org/10.1080/10503307.2016.1189617

Pelkonen, M., Marittunen, M., Laippala, P., & Lönnqvist, J. (2000). Factors associated with early dropout from adolescent psychiatric outpatient treatment. Journal of American Academy of Child and Adolescent Psychiatry, 39(3), 329–36.

Pellerin, K. A., Costa, N. M., Weems, C. F., & Dalton, R. F. (2010). An examination of treatment completers and non-completers at a child and adolescent community mental health clinic. Community mental health journal, 46(3), 273-281. https://doi.org/10.1007/s10597-009-9285-5

Pereda, N., Guilera, G., Forns, M., & Gómez-Benito, J. (2009). The international epidemiology of child sexual abuse: A continuation of Finkelhor (1994). Child abuse & neglect, 33(6), 331-342.

Reich, C., & Berman, J. (2018). Are psychotherapies with more dropouts less effective? Psychotherapy Research, 30(1), 23-40. https://doi.org/10.1080/10503307.2018.1534018

Reis, B. F., & Brown, L. G. (1999). Reducing psychotherapy dropouts: Maximizing perspective convergence in the psychotherapy dyad. Psychotherapy: Theory, Research, Practice, Training, 36(2), 123.

Riessman, C. (2008). Narratives Methods for the human sciences. California: Sage Publications.

Rondón, A.P., Otálora, I.L., & Salamanca, Y. (2009). Factores que influyen en la deserción terapéutica de los consultantes de un centro universitario de atención psicológica. International Journal of Psychological Research, 2(2), 137-147.

Ross, J., & Werbart, A. (2013) Therapist and relationship factors influencing dropout from individual psychotherapy: A literature review. Psychotherapy Research, 23(4), 394-418. https://doi.org/10.1080/10503307.2013.775528

Saxe, G., Ellis, H., Fogler, J., & Navalta, C. (2012). Innovations in Practice: Preliminary evidence for effective family engagement in treatment for child traumatic stress–trauma systems therapy approach to preventing dropout. Child and Adolescent Mental Health, 17(1), 58–61. https://doi.org/10.1111/j.1475-3588.2011.00626.x

Sepúlveda, M.G. (2013). Psicoterapia evolutiva con niños y adolescentes. Santiago, Chile: Mediterráneo.

Servicio Nacional de Menores (SENAME). (2015). Bases técnicas específicas: Programa de protección especializado modalidad maltrato infantil grave y abuso sexual. Recuperado de http://www.sename.cl/wsename/otros/proteccion/BTE.pdf

Swift, J., Spencer, J., & Goode, J. (2018) Improving psychotherapy effectiveness by addressing the problem of premature termination: Introduction to a special section. Psychotherapy Research, 28,(5), 669-671. https://doi.org/10.1080/10503307.2018.1439192

Valles, M. (2003). Técnicas cualitativas de investigación social. Madrid: Ed. Síntesis.

Viale-Val, G., Rosenthal, R. H., Curtiss, G., & Marohn, R. C. (1984). Dropout from adolescent psychotherapy: A preliminary study. Journal of the American Academy of Child Psychiatry, 23(5), 562-568.

Wamser-Nanney, R., & Steinzor, C. (2017). Factors related to attrition from trauma-focused cognitive behavioral therapy. Child Abuse & Neglect, 66, 73–83. http://dx.doi.org/10.1016/j.chiabu.2016.11.031

Wierzbicki, M., & 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

Published

2020-11-24

How to Cite

Nuñez Hidalgo, L. B., Capella, C. ., Vásquez, V. ., & Fuentes, S. (2020). Adherence or Drop Out of Adolescents in Psychotherapy Due to Sexual Abuse: their Therapist’s Perspective. CES Psicología, 13(3), 124–141. https://doi.org/10.21615/cesp.13.3.8

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Section

Investigación con Niños y Adolescentes
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