Provider Perceptions of Their Patients' Dropout From Trauma-Focused Therapy for PTSD in the US Veterans Health Administration

Objective: Many patients who initiate prolonged exposure (PE) and cognitive processing therapy (CPT) do not complete a full course, although little is known about how providers view PE and CPT dropout among their own patients. Method: Semistructured interviews were conducted with providers (n = 29) in the Veterans Health Administration to understand each provider's experience of dropout by a specific patient whom they treated using PE or CPT. Content analysis was used to categorize perceptions of dropout as negative, somewhat negative, or not negative. Themes associated with somewhat or not negative views of dropout were identified via inductive coding. Results: Fourteen percent of providers viewed their patient's dropout from PE or CPT as wholly negative, 38% as somewhat negative, and 48% as not a negative outcome. Themes associated with viewing dropout as something other than wholly negative included belief that the patient would not benefit from treatment if they were not ready, the importance of maintaining the therapeutic relationship, the view that trauma-focused therapy was not what the patient needed or that the patient could benefit from other approaches, the impression that the patient had made some gains, and that patients are responsible for treatment engagement and have the right to disengage. Conclusions: Providers' perceptions of dropout from PE or CPT for individual patients were rarely viewed as entirely negative. Research is needed to help providers determine when patient dropout is an undesirable outcome and when efforts to reengage patients in trauma-focused treatment are warranted. Clinical Impact Statement Treatment dropout is viewed as a shortcoming of trauma-focused therapy in the aggregate; however, this study suggests few providers view the dropout of a veteran they treated using trauma-focused therapy as an entirely negative outcome. Although these findings need to be further examined in future studies, identifying veterans who are likely to benefit from continued engagement and developing engagement strategies that encourage continuation while maintaining the therapeutic relationship may improve clinical outcomes.