The vast majority of psychotherapy drop-out happens between session 1 and 2. You’d expect people to give it at least two sessions before concluding their symptoms aren’t reducing fast enough. I think you’re attributing far too larger proportion of drop-out to ineffectiveness.
This is fair, we don’t know why people drop out. But it seems much more plausible to me that looking at only the completers with no control is heavily biased in favor of the intervention.
I could spin the opposite story of course, it works so well that people drop out early because they are cured, and we never hear from them. My gut feeling is that this is unlikely to balance out, but again, we don’t know, and I contend this is a big problem. And I don’t think it’s the kind of issue you kan hand-wave away and proceed to casually presenting the results for completers like it represents the effect of the program as a whole. (To be clear, this post does not claim this, but I think it might easily be read like this by a naive reader).
There are all sort of other stories you could spin as well. For example, have the completers recently solved some other issue, e.g. gotten a job or resolved a health issue? Are they at the tail-end of the typical depression peak? Are the completers in general higher conscientiousness and thus more likely to resolve their issues on their own regardless of the programme? Given the information presented here, we just don’t know.
Qualitative interview with the completers only gets you so far, people are terrible at attributing cause and effect, and thats before factoring in the social pressure to report positive results in an interview. It’s not no evidence, but it is again biased in favor of the intervention.
Completers are a highly selected subset of the participants, and while I appreciate that in these sort of programmes you have to make some judgement-calls given the very high drop-out rate, I still think it is a big problem.
The vast majority of psychotherapy drop-out happens between session 1 and 2. You’d expect people to give it at least two sessions before concluding their symptoms aren’t reducing fast enough. I think you’re attributing far too larger proportion of drop-out to ineffectiveness.
This is fair, we don’t know why people drop out. But it seems much more plausible to me that looking at only the completers with no control is heavily biased in favor of the intervention.
I could spin the opposite story of course, it works so well that people drop out early because they are cured, and we never hear from them. My gut feeling is that this is unlikely to balance out, but again, we don’t know, and I contend this is a big problem. And I don’t think it’s the kind of issue you kan hand-wave away and proceed to casually presenting the results for completers like it represents the effect of the program as a whole. (To be clear, this post does not claim this, but I think it might easily be read like this by a naive reader).
There are all sort of other stories you could spin as well. For example, have the completers recently solved some other issue, e.g. gotten a job or resolved a health issue? Are they at the tail-end of the typical depression peak? Are the completers in general higher conscientiousness and thus more likely to resolve their issues on their own regardless of the programme? Given the information presented here, we just don’t know.
Qualitative interview with the completers only gets you so far, people are terrible at attributing cause and effect, and thats before factoring in the social pressure to report positive results in an interview. It’s not no evidence, but it is again biased in favor of the intervention.
Completers are a highly selected subset of the participants, and while I appreciate that in these sort of programmes you have to make some judgement-calls given the very high drop-out rate, I still think it is a big problem.