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Impact of Treatment Accessibility on Clinical Course of Parasuicidal Patients-Reply

Marsha M. Linehan, PhD; Heidi L. Heard
Arch Gen Psychiatry. 1993;50(2):157-158. doi:10.1001/archpsyc.1993.01820140083011.
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In Reply.—  Hoffman poses a number of alternate interpretations of data presented by Linehan et al that we will address in turn.Did patients pay for DBT? No. Can we attribute the superior retention rate of DBT (83.6% vs 50%) to this fact? We cannot summarily rule out this interpretation. We could not, however, find any discernible difference in cost of therapy or payment method between Treatment as Usual (TAU) subjects remaining in individual therapy and those who dropped out. High BPD dropout rates (35% to 50%) are reported by others, even when sliding fee scales are used (J. F. Clarkin, PhD, personal communication, January 1992). In three additional studies examining early discontinuance of borderline patients from treatment, no patient reported cost of therapy as the reason for dropping out.1-3 The majority reported difficulties with the therapist as the reason. A more plausible interpretation of our data is that therapy

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