The transtheoretical stages of change as a predictor of premature termination, attendance and alliance in psychotherapy.

OBJECTIVE: The Transtheoretical Model proposes that clients' stage of change will predict their engagement in therapy. This study tested the hypotheses that clients with high Precontemplation scores would prematurely terminate from therapy and that clients with high Action scores would attend a greater number of sessions and establish a more positive therapeutic alliance.
DESIGN: Using a within-subjects design, baseline measures of stage of change were used to predict the number of sessions attended, premature drop-out from therapy, and the therapeutic alliance after sessions one and three.
METHODS: Sixty clients completed the Stages of Change Scales and the Brief Symptom Inventory prior to therapy. The therapeutic alliance was assessed after the first and third therapy session using the Agnew Relationship Measure.
RESULTS: The specific hypotheses were not supported. Premature termination from therapy was predicted by high level of initial symptom severity and low Contemplation scores. Positive therapeutic alliance at session one and session three was predicted by high Contemplation at baseline.
CONCLUSIONS: These results suggest that the Transtheoretical Model, which was developed in the context of interventions for behavioural change, may not be directly generalizable to outpatient psychotherapy populations. However, Contemplation did predict premature termination and engagement. This implies that with adaptation the model may be a useful adjunct to psychotherapy assessment.