Psychotherapy engagers versus non-engagers: differences in alliance, therapist verbal response modes, and client attachment.

For each of four therapists, we studied two clients who did not return after intake (non-engagers) and two clients who continued for at least eight sessions of psychodynamic psychotherapy (engagers), for a total of 16 cases yielding 3877 therapist verbal response units. Engagers and non-engagers did not differ in terms of working alliance measured after the intake session. In terms of therapist verbal response modes for non-engagers compared to engagers, therapists used more approval-reassurance in the beginning third of intake sessions, and more reflections of feeling but less information about the helping process in the last third of intake sessions. Non-engagers had higher pre-intake attachment anxiety than engagers. Implications for practice and research are discussed.