Treatment Compliance in Group Therapy: Issues and Interventions.

Treatment Compliance in Group Therapy Treatment compliance has consistently been an issue in mental health treatment, and it can have very specific implications for group treatment. Premature loss of group members can result in lack of group cohesion, reduced client outcomes, disillusionment of the therapist, and other client dropouts (Rice, 1996; Joyce, Piper, Ogrodniczuk, & Klein, 2007; Roth, 1990). This problem is extremely wide in scope, and therefore it is difficult to narrow down statistics on the frequency of its occurrence. Further, level of compliance varies based on the type of treatment offered and clients' specific characteristics. Though there are no general statistics regarding treatment non-compliance in mental health treatment as a whole, Wierzbicki and Pekarik (1993) conducted a metaanalysis of research studies throughout various types of treatment and found an overall dropout rate of 47%. Other studies support this dropout rate specifically in group treatment settings (Klein & Carroll, 1986). In a study of increasing compliance in group therapy, researchers found a 30% dropout rate even after extensive screening and preparing clients for treatment (Lothstein, 1978). Regardless, dropout is a significant problem that clinicians and researchers alike have been working to address for several decades. The definitions of "treatment compliance" and "treatment dropout" in group treatment vary, as different programs and theoretical approaches may have a different conceptualization of what these terms mean (Joyce et al., 2007). Treatment compliance can include finishing a prescribed course of group treatment, completing homework assignments or objectives to meet treatment goals, or simply following through with treatment until both the client and therapist agree that the treatment goals have been fulfilled (Stone & Rutan, 1984). Conversely, Rice (1996) defines treatment dropout as "someone who chooses not to, or is unable to, make a commitment to the group and will most likely leave within 6 months of joining the group" (p. 10). However, these definitions can change with modalities as other researchers have specific time restrictions that define when a client has officially dropped out (McMurran, Huband, & Overton, 2010). When clients drop out of therapy, they are less likely to experience improvement in mental health symptoms, and this can lead to further mental health problems down the road (Davis and Addis, 2002). Some research suggests that non-compliance is related to the value our society places on mental health treatment. Clients seem to under value mental health treatment, and are less likely to be compliant and maintain mental health appointments in comparison with medical appointments (Carter, Turovsky, Sbrocco, Meadows, & Barlow, 1995). This creates a problem for mental health providers. How do we deliver quality care and treatment to clients when they refuse to comply with treatment, or terminate early? Evidence shows that there are characteristics of clients as well as characteristics of treatment that are correlated with group treatment non-compliance. Knowledge of these variables can help counselors and administrators prevent treatment drop-out and increase positive outcomes. Client Characteristics Demographics The demographics found to be correlated with treatment compliance in group treatment include age, race, socioeconomic status, and education level. These findings have been consistent through several studies and literature reviews on the topic (Berrigan & Garfield, 1981; Baekland & Lundwall, 1975; Wierzbicki & Pekarik, 1993). Age. Research suggests that the younger the client, the more likely he or she is to be non-compliant with group treatment. We may even be more specific in terms of age. In a study of alcohol-dependent patients, dropout rates were higher for patients who were 35 years old or younger, and a similar study found that clients aged 34 and younger were more likely to drop out (Hird, Williams, & Markham, 1997; Monras & Gaul, 2000). …