Who drops-out? Do measures of risk to self and to others predict unplanned endings in primary care counselling?

Aims: Unplanned endings, where clients unilaterally end therapy, are of concern for psychological therapy services generally as they raise questions about the appropriateness of the treatment and it's delivery for some clients. Limited available data indicates that those who drop-out often have more severe symptoms at entry, and have poorer clinical outcomes. This raises further questions about risk to self and others for those clients who leave therapy prematurely and how these clients might be identified and kept engaged. Method: This paper uses a large dataset of CORE data collected routinely in a primary care counselling service between 2000 and 2003. Logistic regression was utilised to consider different measures of risk and other client characteristics recorded at assessment to predict drop-out from the service. Results: These indicate that younger age, greater psychological distress at assessment, an addiction problem and greater risk to others, are associated with an unplanned ending. However, no reliable logistic regression model could be produced. This may be partly due to data quality issues or important characteristics not being available in the data. Implications for practice: The paper concludes that counsellors should actively seek to minimise unplanned endings, as amongst them may be represented the more distressed and risky clients referred to primary care counselling.     

Problem‐Focused Content in the Job Search: Two Tests of the Cognitive‐Emotional Theory of Esteem Support Messages

The Cognitive‐Emotional Theory of Esteem Support Messages posits that messages intended to enhance recipients' state self‐esteem focus on cognitions and/or behaviors. In the current studies, problem‐focused message content (i.e., content focused on enacting behavior to alleviate the esteem threat) was of particular interest. College students (Study 1, n= 227) applying for postgraduation jobs and unemployed, underemployed, and/or displaced workers recruited from a government one‐stop career center (Study 2, n = 292) rated esteem support messages varying in degree of focus on behaviors vs. cognitions relevant to the job search process. Messages focused on behavior were rated as less effective than those focusing on cognitions relevant to the esteem threat, although support for this result was stronger in Study 2.