Therapist Characteristics' Effect On Attrition

Purpose:  Children are an underserved population in the mental health field. A national survey reported that almost half (47.9%) of children who had been exposed to maltreatment had clinically significant emotional and behavioral problems (Burns et. al., 2004; Ingoldsby, 2010). Many children do not receive the support and treatment they need, and studies have shown that even when children do enter treatment their retention rates are low.  A variety of factors have previously been found to affect treatment attrition, including; minority status, parent’s education level, and socioeconomic status. Further, studies have shown that long term effects of untreated trauma symptoms can lead to difficulty forming attachments, increased negative behavioral problems, increased difficulty in educational settings, increased drug and alcohol use, and as Craig and Sprang (2007) discussed, the potential for the child to later become the perpetrator. The current study explores possible role of therapist personality as a contribution factor to attrition among children receiving trauma-related mental health services in a community-based setting and a clinic based setting. 

Method:  Data for the analyses came from two sources: records of children receiving trauma-related mental health services from either community-based agencies or a specialized clinic that provides services to traumatized children.  Demographic data and a personality inventory (Big Five Inventory, BFI) was collected from nine therapists, who are primarily female (N=7) and fairly evenly divided between the community based and clinic based treatment sites. The BFI assesses personality along five dimensions: neuroticism, openness, agreeableness, extroversion, and conscientiousness). The therapist’s information was matched with their corresponding client case load and the children (N= 169) whose cases were currently closed were used in the study. The children’s information was obtained from archival data in client records.  The outcome variable, dose of treatment, was coded as follows: none (dropped out after a few sessions, partial, and full. It was hypothesized that the personality characteristics of the treating therapists would have an effect on doses of treatment.  It was further hypothesized that there would be a higher dose of treatment rate at the community based setting when compared to the clinic site.

Results:  Ordinal logistic regression indicated that higher levels of extroversion and agreeableness are associated with higher doses of treatment and higher levels of neuroticism are associated with lower doses of treatment. Additionally, increased client age was associated with lower doses of treatment, while receiving services in the clinic was associated with higher doses of treatment.

Conclusions and Implications: This study offers insight into treatment factors that affect the attrition of children who have experienced a traumatic event. The findings could be used for further discussion surrounding therapist’s personality and location of treatment on client outcomes. Personality is typically believed to be an innate quality that doesn’t change from location to location. Further consideration will need to be given to therapist’s choice in practice location and if attrition rate can be improved by increasing the ability to assign a client to a treatment location or therapist based on personality characteristics.