Poor suitability for psychotherapy – a risk factor for treatment non-attendance?

•Non-attendance, i.e., refusal to engage in psychotherapy or premature termination, is common.•Treatment refusal was predicted by poor suitability in long-term psychodynamic psychotherapy.•Poor suitability predicted premature termination in solution-focused but not in short-term psychodynamic psychotherapy.•Pre-treatment assessment of patient's suitability for psychotherapy can reduce non-attendance. Patient suitability has been suggested to predict treatment non-attendance but information on its effect is limited. To study the prediction of the Suitability for Psychotherapy Scale (SPS), on occurrence of treatment non-attendance. Altogether 326 outpatients, with depressive or anxiety disorder, were randomized to short-term psychodynamic psychotherapy (SPP), long-term psychodynamic psychotherapy (LPP), and solution-focused therapy (SFT). SPS was based on seven components from three suitability domains: nature of problems, ego strength, and self-observing capacity. Treatment non-attendance was defined as refusal of engaging therapy and of premature termination. The Cox model and logistic regression were used. Treatment non-attendance was significantly more common in LPP patients with poor SPS (RR = 2.76, 95% CI = 1.45-5.26). This was mainly due to poor flexibility of interaction, poor self-concept, and poor reflective ability. Premature termination in SFT showed a similar trend but due to other SPS components: absence of a circumscribed problem, poor modulation of affects, and poor response to trial interpretation. On the contrary, individuals with good values of SPS were more prone to premature termination in SPP. The prediction of suitability on refusal could only be studied in the LPP group due to few refusals in the short-term therapy groups. The sample consisted of patients who participated in a trial. Thus the findings may not be directly generalized to unselected patients in the public mental health setting. Poor suitability, apparently, predicts non-attendance in LPP and SFT, but not in SPP. More studies on large cohorts are needed.