The hour of departure: Predicting attrition in the training clinic from role expectancies.

In addition to having potentially deleterious effects on clients in distress, client attrition also thwarts efforts by trainee clinicians to develop psychotherapy competencies that are uniquely associated with providing middle- or late-stage treatment. Within the established literature, one well-replicated correlate of attrition is client expectations. Thus, the following study investigated whether client attrition within a training clinic could be prospectively predicted from pretreatment expectancies. To that end, all adult clients presenting for an intake at a training clinic completed the Psychotherapy Expectancy Inventory—Revised (PEI–R). First, normative reference ranges for the PEI–R total and factor scores were developed. Next, analyses revealed that these reference ranges had good specificity in prospectively identifying clients that subsequently prematurely terminated treatment. Moreover, the computed positive likelihood ratios revealed that an individual who obtains a total score outside of the reference range is 7 times more likely to prematurely terminate therapy in comparison with individuals obtaining scores within the normative reference range. Training clinics are therefore encouraged to routinely administer the PEI–R as a means of identifying individuals at risk for attrition and defining which role expectations may need to be modified. (PsycINFO Database Record (c) 2010 APA, all rights reserved)