A consideration of the factors associated with the engagement of clients in outpatient psychotherapy

Thomas Hall Grant, Fordham University


The study addressed the question of why people either become engaged in psychotherapy or discontinue following the intake session. It extended the literature on the initial engagement of clients by (a) examining a wider array of variables than usually considered in studies of this type, and (b) providing data from outpatient psychotherapy clinics rather than college counseling centers where most engagement studies have been conducted. Three types of influences on engagement were considered: client and therapist characteristics, perceptions of the intake, and the administrative handling of the client. The subjects for the study were 216 individual psychotherapy clients and 14 therapists from 3 outpatient clinics in Connecticut. Therapists and their new clients were asked to fill out separate anonymous questionnaires following intake sessions. The questionnaires requested demographic information and included the following measures from the premature termination literature designed to assess reactions to counseling: the Counselor Rating Form-Short (CRF-S; Corrigan & Schmidt, 1983), the Client Satisfaction Questionnaire-Short (CSQ-S; Larsen, Attkesson, Hargreaves, & Nguyen, 1979), the Client Problem Identification Questionnaire (CPIQ; Kokotovic & Tracey, 1987), and the Therapist Personal Reaction Questionnaire (TPRQ; Davis, Cook, Jennings, & Heck, 1977). The results corroborated previous findings suggesting that the three "social influence variables" measured by the CRF-S are correlated with one another and reflect overall client satisfaction. The latter was found to correlate with engagement, defined as returning for a second scheduled session. Hypotheses predicting that engagement would be associated with higher client SES, client prior therapy experience, client "attractiveness" and likeability (as measured by the TPRQ), client/therapist agreement on client difficulties, and shorter waiting periods before intakes were not supported. A small sample size in the nonengaged group attenuated all correlation coefficients. Statistically adjusting for unequal sample sizes, tentative support was offered for hypotheses predicting that engagement would be associated with therapists' assessments of intake sessions (on the TPRQ), shorter waiting periods between intakes and second sessions, and the assignment to continue therapy with the intake therapist rather than a different therapist. The hypothesis that client/therapist demographic similarity would correlate with engagement was also conditionally supported.

Subject Area


Recommended Citation

Grant, Thomas Hall, "A consideration of the factors associated with the engagement of clients in outpatient psychotherapy" (1992). ETD Collection for Fordham University. AAI9223815.