It takes two to tango: a qualitative meta-synthesis on processes of psychotherapy dropout from the Single Case Archive

Premature termination of psychotherapy is a challenging reality for both research and practice. This study aimed to contribute to a more comprehensive understanding of psychotherapy dropout by aggregating and synthesizing findings across dropout cases. A qualitative meta-synthesis was conducted on case studies from the Single Case Archive (SCA), a representative sample of published, peer-reviewed single-case psychotherapy studies. This meta-synthesis aggregated and synthesized the 11 case studies in the SCA published in English that described dropout substantively. The meta-synthesis identified 7 themes that influenced dropout: misattunement, inert therapeutic relationships, unmanaged therapist responses, unmanaged therapist interventions, rigid protocol adherence, readiness for change, and repeating interpersonal dynamics. These themes were arranged into the interrelated patient, therapist, and interactional clusters. The findings of the meta-synthesis were comprehensively represented by the metaphor of tango dancing, in which both partners co-create the dynamic that produces a (un)successful dance. One additional theme not fitting this structure includes instances in which dropout was a positive act on the part of the patient. The meta-synthesis revealed the complex and multifarious nature of psychotherapy dropout, a phenomenon that requires a sufficiently multifaceted conceptual framework for adequate comprehension. It was found that patients, therapists, and their dynamic interaction must be incorporated to account for the complex processes underlying psychotherapy dropout.