Predicting who will not respond to therapy is one of the “holy grails” of psychotherapy research. This is because up to a third of patients who enter treatments do not respond. If we could identify what factors predict non-response, special care could be given to the patients who are at risk for not responding. Despite the fact that researchers have attempted to explore who will or will not respond to psychotherapy, consistent predictors of non-response have yet to emerge. Reuter and colleagues (2015) recently analyzed data from patients undergoing inpatient psychotherapy in two German hospitals to try to identify predictors of non-response. Their sample consistent of 546 patients who were treated with a varied therapeutic program including single and group psychotherapy sessions grounded in psychodynamic therapy, as well as art and music therapy, psychoeducation, and concentrative movement therapy. The author measured intake severity, early change at week 4, and symptoms at treatment termination. Non-response to this treatment was defined as the lack of a reliable change or deterioration. To determine the sustained rate of response or future non-response, they also re-interviewed patients in a 3 month follow-up and a 12-month follow-up. Like in other studies, in this study, the strongest and most consistent predictor of who was going to stay well was who responded by week 4 of treatment –34% of the sample— or who had responded by treatment termination, around 60% of the sample including early responders. Patients who had not responded by week 4 had nine times the likelihood of experiencing non-response past that point when compared to patients who had responded very early. The authors also found that patients were also more likely to experience non-response if they entered the trial higher on symptom severity, were less educated, had a personality disorder, or had hostile personalities. Underscoring the importance of early change, the study authors quote Lambert in arguing that potential non-responders “must be identified before termination from treatment… ideally as early as possible.” The authors highlight the need to develop strong therapeutic alliances with patients who have hostile personalities or personality disorders and argue also for the need for “longer and more specific treatments“ for patients who do not respond early on. These findings highlight the importance of measuring symptoms early in the course of psychotherapy and of identifying specific patients groups who are at risk for treatment non-response.
Society for Psychotherapy Research (SPR)
Marna S. Barrett, Ph.D.
Mood & Anxiety Disorders Treatment Research Unit
University of Pennsylvania Perelman School of Medicine
3535 Market St., Suite 670
Philadelphia, PA 19104