What Are the Best Ways to Increase Therapy Attendance?

According to a new study conducted by Mary Oldham of the Department of Psychology at the University of Sheffield in the United Kingdom, offering clients their choice of appointment time and providing simple reminders are two easy yet effective ways of increasing therapy attendance. Treatment refusal (TR) and premature termination (PT) are two events that can cause harm to a client and therapist. Clients who end their treatment early or refuse treatment never receive the full benefits of therapy and often continue to struggle with persistent emotional and psychological problems. Therapists who experience high rates of PT and TR may lose confidence in their abilities to provide meaningful services to their clinical population. Both of these scenarios result in negative outcomes for the clients, providers, and the community at large. Individuals who need help but do not receive it are less productive citizens and may need to rely on social services for financial aid.

Oldham examined the most effective ways to increase treatment adherence by studying 31 trials dedicated to that very topic. The trials provided data from 4,422 individuals who had a history of TR or PT. She found that interventions designed to address PT worked as well as interventions targeted at TR. The most effective strategies were the simplest. Offering clients their choice of appointment date and time and their choice of therapist reduced TR and PT. Additionally, interventions that educated and motivated clients resulted in lower rates of PT and TR. Another factor that reduced negative treatment adherence was being diagnosed with only one problem. Individuals with multiple diagnoses tended to have lower rates of treatment adherence than those with a single diagnosis. Finally, Oldham found that reminding the clients of upcoming appointments was the easiest and the most effective method for reducing PT and TR. She hopes that her results motivate clinicians and their staff members to adopt these tactics to increase treatment retention. She added, “This review indicates that attendance is a more tractable problem than previous reviews have suggested.”

Oldham, M., Kellett, S., Miles, E., Sheeran, P. (2012). Interventions to increase attendance at psychotherapy: A meta-analysis of randomized controlled trials. Journal of Consulting and Clinical Psychology. Advance online publication. doi: 10.1037/a0029630

Related articles:
The Healing Power of the Therapeutic Relationship
The Secret That All Clients Should Know but Few Therapists Share
Why See a Therapist When You Can Just Talk to Your Friends?

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  • P. Russel

    August 22nd, 2012 at 7:51 PM

    I tell people that ending therapy sessions early is akin to stopping antibiotics before the doctor says to. Both can be more destructive then not seeking treatment at all. This is because clients that don’t finish treatment may form the misconception that their disorder isn’t treatable. It kills me to see people terminate treatment after seeing some decent progress, just because they don’t have time to continue the sessions. Either therapists need to realize that their strict schedule leads to termination or patients need to understand that their mental health is the most important thing to invest time into.

  • @drsusannah

    August 23rd, 2012 at 2:04 AM

    In the Middle East, biggest problem is no shows. We’ve worked on this issue in a variety of ways with varying degrees of success, however as long as seeking mental health care is still widely stigmatized, it is likely to remain a therapeutic issue. It has helped significantly to offer a 30 minute free consultation because there is so much misinformation and ignorance regarding mental health and therapy. TR is common for the same reason, but we’ve lowered PT rates by strongly emphasizing relationship building, clearly explaining the benefits and process of therapy, and working in six-session “blocks” – no matter what modality is utilized by the individual therapist. It’s slow going, but it’s a privilege to be a part of positively impacting cultural and social perceptions about therapy.

  • E.P.

    August 23rd, 2012 at 3:10 AM

    I can understand why people don’t want to begin the process, it’s painful. And to have the motivation to get out of bed in the morning could be a struggle. It’s also the case of finding the right therapy for the right person.

  • Leighton

    August 23rd, 2012 at 3:59 AM

    You would be amazed at just how effective a simple phone call to remind someone of an appointment can be! I work for a doctor and we have tried it both ways, calling to remind and not, and unfailingly, patients always show up for more appointments when we have made a simple reminder call an day or two ahead of time. I think that this not only reminds people of appointments that they may have scheduled and forgotten about, but it also holds them a little more accountable to someone that a card that you gave them six weeks ago for a follow up. This is just one little gentle and non intrusive way that I think this could help attandance at follow up therapy sessions too.

  • kayla s

    August 23rd, 2012 at 2:59 PM

    How about just a good therapist who cares about the patients and gets them engaged in their own healing? Makes them care about making progress? Helps them to see how much better life can really be? That in and of itself would be a huge motivational tool for me.

  • kel

    August 23rd, 2012 at 8:54 PM

    I think this makes complete sense.at a time when all kinds of businesses focus on making things easier for their customers and try and make the experience a pleasant one,even going out of the way to achieve the same,it makes sense for the medical community to try and do the same to clients-offer them their choice of therapist and an appointment on their chosen day and time.it can help a lot and make them feel good about attending therapy and not letting it be relegated to a boring thing that they HAVE to attend at an inconvenient time.

  • shane

    August 24th, 2012 at 12:06 AM

    people need promoting for somethin that benefits them?!if they need spoon feeding even to keep appointment, do such clients really have a chance with recovery and therapy??

  • selma d

    August 24th, 2012 at 4:02 AM

    Maybe this violates confidentiality rules or something but how about trying to get the family behind you?
    If you get parents, spouses, even kids involved then maybe this would encourage those in therapy to complete their programs and to be more committed to the healing process.
    It is one thing to feel like you are letting down someone who in essence could be little more than a stranger to you playing the role of your therapist.
    But it is another to feel like you are letting your whole family down. How does that make you feel? Even just having them involved on the peripheral could be enough motivation to keep someone in therapy longer than they would have otherwise.

  • @drsusannah

    August 24th, 2012 at 8:14 AM

    Selma d ~ What if the family IS the reason the client is seeking help? Here (Kuwait) I ask if there’s a trusted family member who can support the client’s process, because the more support the better. Usually, if there is a “cookie person” it is someone outside the client’s nuclear family.
    Inducing a client to attend therapy because of the possibility of disappointing someone else or of incurring family disapproval feels like a violation of the client’s autonomy and a recipe for therapeutic disaster. And without the client’s permission (which, granted, isn’t mentioned in your comment) is definitely a violation of confidentiality.

  • selma d

    August 24th, 2012 at 10:58 AM

    @drsusannah- I can see your point that may times the family is the issue why they ould be going to therapy in the first place. So how about this- get someone involved that you know loves and cares for the patient in a healthy way and someone who does not impede the patient’s progress. It’s not that I would wnat to intruse on someones privacy, I just think that if you can find a way to get someone involved whose opinion really matters to the patient then this might encourage better participation.

  • @drsusannah

    August 24th, 2012 at 9:23 PM

    You’re describing a “cookie person,” selma d. :) Someone whom the client trusts to be supportive and helpful, and from whom the client experiences acceptance rather than judgment. I didn’t generally do this while practicing in Canada, with the exception of addiction recovery clients ~ it wasn’t necessary. Here, I always ask about a Cookie Person because just coming to therapy can cause significant conflict for the client within the family (as in the family nearly always strongly opposes seeking mental health services of any kind), or, more likely, the fact the client is in therapy is a secret from /everybody/. Having support increases the likelihood the client will attend regularly, do the homework, and not terminate prematurely. I don’t ever use the Cookie Person as a “stick” (to get the client to engage in therapy) ~ to do so changes that person from a supporter to an authority (accountability). In my experience, not only does this change the nature of that relationship for the client, it can backfire as a therapeutic incentive, especially in this shame-based culture.
    In the end, we as therapists need the skills to build a relationship that allows the client to feel safe in doing the hard work of self-renovation, but even if we do that well, in the end it is always the client who makes the choice whether or not to engage in the therapeutic process. And so it should be. =)

  • selma d

    August 25th, 2012 at 7:55 AM

    I suppose that we will simply have to agree to disagree. While I am not a therapist, I think that I am realistic enough to see that at least in the beginning everyone needs a “stick” to lean on as you say. Why is that wrong? Why is it not okay while I learn the skills myself to have others on who I can depend? I think that the term Cookie person is kind of demeaning and I don’t see it that way at all. I realize that without devekloping the capacity to stand on one’s own will hold clients back, but I think that there is a time and a place when we all have to rely on others for help and I don’t see that as the bad thing that you obviously do.

  • @drsusannah

    August 26th, 2012 at 3:02 AM

    Actually, selma d, I don’t think we do disagree – at least I agree with you in principle. =)
    Clients (who are people like the rest of us) do need someone to lean on at times, as do we all. And far from being a demeaning term, “Cookie person” is that individual who metaphorically serves milk & cookies and listens with an empathic and supportive heart (not unlike many of us experienced with grandma etc) At least I certainly don’t mean the term in a derogatory way.
    The place where we part company is when the support person becomes a source of disapproval or judgement because the individual in therapy has not met his/her expectations with regard to the process. (Quote “But it is another to feel like you are letting your whole family down. How does that make you feel? Even just having them involved on the peripheral could be enough motivation to keep someone in therapy longer than they would have otherwise”) This is actually exactly what the individual doesn’t need – the sense of having (once again) disappointed the expectations of others.
    The therapists I know do everything they can to support the therapeutic process in a variety of different ways, including encouraging as you suggest, leaning on a willing friend or family member through the work of therapy ~ if the client agrees. In the end, however, it is the individual’s internal motivation and commitment to change that carries him/her through the process of self-renovation. And that is the essence of personal responsibility. =)

  • @drsusannah

    August 26th, 2012 at 3:03 AM

    P.S. Thanks for the great discussion, selma d. :)

  • leah

    August 26th, 2012 at 8:46 AM

    um, how about make it relevant and interesting?

  • Ollie j

    August 27th, 2012 at 5:53 PM

    One of the best things that I can think of is for it to be made relevant to the patient. I think that a lot of times patients get kind of turned off when they go and go and go and feel like they are not getting anything out of it for them. It becomes a drag, a waste of their time and therefore they stop going as a result of that. I think that more therapists need to be aware that in their office is not always where someone will necessarily want to be- there will be some who will but for the most part people are looking for a quick fix and when they don’t get that, then they see this as the perfect time to get up and move on.

  • Christina T.

    September 18th, 2016 at 5:12 AM

    I enjoyed reading the article “What Are the Best Ways to Increase Therapy Attendance?”

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