The roles of epistemic mistrust and alliance rupture in dissatisfied dropouts from psychotherapy

Approximately 45% of adolescents drop out of psychotherapy (de Haan, Boon, de Jong, Hoeve, & Vermeiren, 2013). Adolescents who drop out of psychotherapy due to dissatisfaction with treatment (‘dissatisfied dropouts’) are a priority group for psychotherapy research, as their needs?are unlikely to be met (O'Keeffe, Martin, Target, & Midgley, 2019). Previous studies have shown that ‘dissatisfied dropouts’ have more unresolved ruptures and poorer clinical outcomes than adolescents who complete psychotherapy, and dissatisfaction with treatment may discourage future help-seeking (O’Keeffe, Martin & Midgley, 2020). Research is needed to understand how?psychotherapy can be tailored to the needs of these adolescents. This aligns with the NHS's aim to?tailor support to the individual needs of young people accessing services (Dutton, Humphrey, &?Qualter, 2023).?Those who display epistemic mistrust in psychotherapy – often as a result of early experiences of maltreatment – tend to find psychotherapy unhelpful and may be at risk of dropping out. To date, no study has investigated how epistemic mistrust relates to alliance ruptures. By better understanding how ruptures can be negotiated in the context of epistemic mistrust, we plan to?identify how to improve engagement in psychotherapy, thus reducing the risk of dissatisfied dropout.?This study aims to: i) develop a coding system of epistemic mistrust; ii) assess the relationship?between adolescents’ epistemic mistrust and alliance rupture-repair; and iii) understand how therapists can repair ruptures with adolescents with epistemic mistrust. Secondary analysis of?psychotherapy recordings from the IMPACT study – a randomised controlled trial of therapies for?adolescent depression – will be conducted. Fourteen dissatisfied dropout and fourteen completer cases will be included.?Results will show whether positive resolution of ruptures can help reduce epistemic mistrust, and?how therapists can repair ruptures with adolescents with epistemic mistrust. The findings will support therapists working with adolescents at risk of dissatisfied dropout.