Premature termination in therapy occurs when a client discontinues therapy prior to recovering from his or her presenting concern and against clinician recommendation. Although research indicates that premature termination has decreased in recent years from 47% (Wierzbicki & Pakarik, 1993) to 20% (Swift & Greenberg, 2012), it still presents a major problem.

The effectiveness of treatment is dependent on the client’s participation in the appropriate treatment dosage and adherence to treatment procedures (e.g., homework assignments in cognitive behavioral therapy). Premature termination and treatment nonadherence negatively impact the client through poor patient outcomes. Further, they also negatively impact service providers through possible feelings of failure and loss of revenue, and society as a whole through the burden of mental illness. Thus, motivating clients to actively participate in and complete treatment are of key importance.

Using Financial Incentives as Motivation in Therapy

In a recently published study, Stanley, Chu, Brown, Sawyer, and Joiner (2016) examined financial incentives as a possible motivation tool in improving therapy adherence and attendance. Clients (N = 110) from a university psychology training clinic participated in the study; approximately 50% were assigned to a financial incentive condition and 50% were assigned to a control condition.

In the financial incentive condition, clients received a 5% fee discount each session if three criteria were met: the client arrived on time and attended the session (or cancelled at least 24 hours in advance and rescheduled for the same week), the client paid at the time of service, and the client completed the assigned homework from the previous week. Participants in the financial incentive condition and control condition were then compared in respect to four metrics of treatment engagement (number of sessions attended, therapy duration in months, number of cancellations, and number of no-shows) and Global Assessment of Functioning (GAF) scores at intake and termination.

Higher Global Functioning Ratings at Termination for Those in Financial Incentive Group

Although Stanley and colleagues (2016) found that clients in the financial incentive condition on average attended approximately three more sessions, remained in therapy about two more weeks, and had 0.4 fewer no-shows as compared to clients in the control condition, these differences did not reach statistical significance.

However, controlling for GAF at intake, authors found that clients in the financial incentive condition had significantly higher GAF ratings at termination as compared to the control condition.

Summary and Conclusions

The study suggests that an incentive program in which attendance and adherence to therapy are financially rewarded with discounted session fees is associated with improvements in clinical functioning.

The study provides compelling evidence that rewarding clients for active engagement in treatment is a powerful tool in improving clinical outcomes and should be considered by therapists.

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