Interventions to increase attendance at psychotherapy: a meta-analysis of randomized controlled trials

Rates of nonattendance for psychotherapy hinder the effective delivery of evidence-based treatments. Although many strategies have been developed to increase attendance, the effectiveness of these strategies has not been quantified. Our aim in the present study was to undertake a meta-analysis of rigorously controlled studies to quantify the effects of interventions to promote psychotherapy attendance.

The inclusion criteria were that studies (a) concerned attendance at individual or group psychotherapy by adults, (b) used a randomized controlled trial design to test an attendance strategy, and (c) used an objective measure of attendance. Computerized literature searches and hand searching resulted in a total of 31 randomized controlled trials that involved 33 independent tests of strategies for reducing treatment refusal and premature termination (N = 4,422). Effect sizes from individual studies were meta-analyzed, and moderator analyses were conducted.

Interventions had a small-to-medium effect on attendance across studies (d+= .38). Interventions to reduce treatment refusal and premature termination were similarly effective (d+= .37 and .39, respectively). Choice of appointment time or therapist, motivational interventions, preparation for psychotherapy, informational interventions, attendance reminders, and case management were the most effective strategies. Diagnosis also moderated effect sizes; samples with a single diagnosis benefited more from attendance interventions compared to samples with a variety of diagnoses.

Interventions to increase attendance at adult psychotherapy are moderately effective. However, relatively few studies met the strict study inclusion criteria. Further methodologically sound and theoretically informed interventions geared at increasing attendance are required.