UCLA

Despite the availability of effective psychotherapeutic interventions for mental health concerns, many individuals who seek mental health services experience substantial barriers to accessing and remaining engaged in care (Andrade et al., 2014; SAMHSA, 2023). Although psychotherapy engagement has often been examined through discrete indicators such as attendance, missed appointments, or premature termination, engagement can be conceptualized as a dynamic, multi-phase process unfolding across the transition from help-seeking to treatment access, initiation, ongoing participation, and termination (Dixon et al., 2016; Holdsworth et al., 2014). This dissertation examined psychotherapy engagement processes within a university-based training clinic providing evidence-based psychotherapy services to the general community. Study 1 used archival electronic health record data from adult psychotherapy clients to examine associations among client demographic factors, wait times, psychotherapy attendance behaviors, and engagement outcomes. Results indicate that demographics and wait times were not associated with engagement following treatment initiation, while missed appointment rates during active treatment were associated with increased likelihood of premature treatment termination. Building upon these findings, Study 2 employed a mixed-methods quasi-experimental pilot design to develop and conduct a preliminary evaluation of the Pre-treatment Engagement Program adapted from the Unified Protocol (PREP-UP), a brief pre-treatment engagement preparation intervention designed to support psychotherapy engagement during the transition from waitlist to care. Preliminary findings supported the acceptability, appropriateness, and feasibility of PREP-UP. Qualitative findings further suggested that participants perceived PREP-UP as helpful for increasing readiness for therapy and clarifying treatment goals, while exploratory quantitative findings indicated promising trends in psychotherapy attendance outcomes among PREP-UP participants. Collectively, findings from this dissertation highlight the importance of conceptualizing psychotherapy engagement as a multi-phase process and suggest that the pre-treatment period may represent a clinically meaningful opportunity for engagement-focused intervention.