Who Is Most Likely to Drop Out of Therapy and Why?

A client that drops out of therapy is one who does not complete the recommended course of treatment. Many therapeutic approaches, such as cognitive behavioral therapy, do not have a specific treatment deadline, and clients are considered dropouts when they have voluntarily stopped therapy prior to resolving the issues and symptoms that brought them there to begin with. Dropout is a serious concern for the medical community and the general population. Individuals who drop out of therapy are more likely to have future psychological complications and seek services multiple times, which places an economic burden on society. Because they do not learn adaptive coping strategies and fail to address the issues that plague them most seriously, they are likely to be less than productive in their careers, families, and communities. Additionally, therapists who experience client dropout may begin to question their ability to help clients and their own adequacy.

Understanding the factors that contribute to dropout can provide clinicians with the information they need to address the problem. Joshua K. Swift of the Department of Psychology at the University of Alaska in Anchorage wanted to explore this problem further and made it the focus of his most recent study. Swift analyzed over 650 studies that included more than 83,000 clients and looked at factors such as client age, therapy setting, therapist experience, type of therapy, issues addressed in therapy, and clinician definition of dropout.

Swift found that nearly 20% of all the clients in the studies ended their treatment early. He found that some variables, such as therapy setting, influenced the rates of dropout. He also discovered that rates of dropout were highest among the youngest participants and those seeking treatment for personality or eating problems. Swift believes that more work is needed to determine specific nuances that effect retention. He hopes efforts will be aimed at isolating psychological issues, such as anxiety or depression, and approaches, such as psychodynamic or behavioral therapy, in order to get a clearer idea of the different dimensions affecting treatment completion. Swift said, “By paying attention to these variables and making adaptations where needed, clinicians may be able to reduce rates of premature discontinuation in their work with clients.”

Swift, J. K., Greenberg, R. P. (2012). Premature discontinuation in adult psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology80.4: 547-559.

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  • ian

    August 9th, 2012 at 6:52 PM

    but how exactly is ‘complete cure’ defined in therapy?that may be one reason for the high dropout,you know.suppose i have a physical injury and end up in the hospital,there are definitive signs of cure and i move out of the facility once the wounds have healed and i have regained strength.but how is this defined for therapy?

  • Mindy

    September 24th, 2017 at 1:47 AM

    That is why it’s so important to come in with a very specific goal. When you feel that you have accomplished what you came for, it’s time to discuss termination with your therapist. The journey may take you down different paths, with surprising discoveries, but ultimately everything that comes up should be a stepping stone to accomplishing what you came for. It’s about staying focused about why you came, and being open to facing painful realities about how got to where you are in the first place.

  • Lou

    August 10th, 2012 at 4:17 AM

    What I think that you will see out of clients who do not complete the recommended course of therapy is that these are the same people who have in essence always had a hard time committing to anything in life. These are the people who never follow through with assignments or projects, and have always just kind of coasted through life on the backs of others. Maybe all of this is the result of whatever they are actually seeking treatment for to begin with, but it just always seems to follow them around, and has become a pattern of predictable behavior throughout their lives.

  • willow

    August 10th, 2012 at 11:01 AM

    Perhaps more counselors should look at their own selves when they are trying to figure out who’s dropping out of therapy and why.

    Suppose that it is something that they are or are not doing that is causing patients to leave before they have gone through the treatment plan.

    Sometimes it is about more than just the patient you know. Maybe the professionals in that picture could be doing a little more which would encourage their clients to stay with the program.

  • BRAD

    August 10th, 2012 at 12:59 PM

    I have dropped out of therapy before.And it was only because I did not feel the connection with my therapist.But I did find a better therapist late on and went through therapy.So if someone quits it does not mean they will not see another therapist.So this 20% figure could be a lot more than what is in reality.

  • shelley hall

    August 10th, 2012 at 3:18 PM

    If this is a big problem with younger adults, then why not more of an effort to get parents involved to keep them enrolled?

  • R.M

    August 10th, 2012 at 6:21 PM

    How bout a program wherein clients can leave messages or something that lets them express why they r discontinuing.this could be protected and confidential information but will give a chance to help them n also doesnt leave d therapist askin themselves y.

  • macgregor

    August 11th, 2012 at 4:22 AM

    Retention is always a difficult obstacle facing therapists and clients alike. We all know how it is when you start taking an antibiotic for example- you probably will start to feel better after a day or two of the medicine, but your doctor says you have to take it for the full ten days to be completely free of the bug. But you don’t want to go the distance, taking the medication is a hassle. So you stop taking it before the meds have run their course. And then guess what? In a few days or weeks there you are all over again at his office admitting that you need more antibiotices because you didn’t finish up the last round.

    Therapy is the same way. You may begin to feel better after just a few visits, especially if you are working with someone who has allowed you to pretty quickly get at the root of your problem and has made you feel improved in just a few sssions. But just like the antibiotic, if you are unwilling to stick this through and complete what has been recommended for you, then there is no doubt that you have only just begun to scratch the surface of your issues and you are bound to be back there sooner or later.

  • DIA

    August 11th, 2012 at 3:56 PM

    This kind of therapy isn’t for everyone
    Not everyone who gets involved in this with a therapist will be a success, and it shouldn’t be expected to be that way
    How about being open to more alternative forms of therapy? Like maybe onlibe sessions or even group sessions that are open to patients dropping in and out at will?
    If someone is getting something out of it, sure it may not be for them every day of the week, but couldn’t they come and go with the meetings as they choose or see necessary, a la AA or groups like that?
    Something and attending sometimes is of more benefit than nothing at all

  • Reese

    August 12th, 2012 at 4:29 AM

    This is not the fault of the therapist, We have to remember that part of therapy is becoming accountable for your own actions

  • Jasonstackhouse

    August 15th, 2012 at 9:12 AM

    “This is not the fault of the therapist, We have to remember that part of therapy is becoming accountable for your own actions”

    …Unless your therapist really just SUCKS

  • Cameron

    August 13th, 2012 at 4:17 AM

    Have we looked at the financial ramifications of being and staying in therapy for a long period of time?
    This is a very expensive undertaking for many people, especially those for whom health insurance coverage is not an option.
    I think that if we find a way to make our healthcare system more fair, equitable, and accessible, then you would see far fewer people dropping out of therapy, especially when they are experiencing improvement from the therapy.

  • delilah oglesby

    August 14th, 2012 at 11:09 AM

    If I thought that a family member of mine needed treatment still but was dropping out of it too early, then I would be that person who would step in make this my business, to see to it that they were not giving up too soon or that they at least sought help form another therapist if that just wasn’t the right fit for them.

  • stacia

    August 15th, 2012 at 4:30 AM

    This is something that you have to commit to and be willing to go the distance with. If you aren’t there, then it is highly unlikely that you will complete all of the therapy that you could need for healing.

  • Maurice

    November 22nd, 2013 at 12:33 AM

    I dropped out because therapy seemed pointless and futile. I didn’t want to be like Woody Allen who spent 13 years in therapy and was the same fucked up person at the end as he was at the beginning.

  • disequilibrium1

    October 19th, 2014 at 3:59 PM

    “This is not the fault of the therapist, We have to remember that part of therapy is becoming accountable for your own actions.”

    Thanks for exquisitely distilling why some of us found psychotherapy such a poor modality.

    We just couldn’t surrender to these scornful, blameless authoritarians, who clairvoyantly believe they understand all human thinking. Hubris seems a pervasive and chronic condition among mental health providers.

    Please see: Bad Therapy? A Disgruntled Ex-Psychotherapy Client Speaks Her Piece.

  • Anonymous

    June 3rd, 2016 at 6:32 PM

    I’m a therapist. I will tell you that the #1 reason I see clients drop out of therapy with me and other therapists is because of some conflict that comes up in the treatment relationship with the therapist. For example, the client has a negative reaction to something the therapist said and the therapist has little or no idea about this. Rather than bring it up with the therapist, the client bolts. If the therapist is attuned enough to the client’s reaction and picks up on it, the client doesn’t want to talk about it, has already made up their mind, and still bolts. The sad thing is that THIS is precisely where the most important work in therapy happens. Look up ‘transference’ on the internet. When clients and therapists work through these issues, and become comfortable talking about them openly and non-defensively, massive insights are gained, the client improves, and the therapy only continues getting better. There is research out there on this as well. Most clients come into therapy because of relationship and social issues, and it is unfortunate that when these issues get activated in therapy they take off. Therapists are not perfect, and the good ones acknowledge their shortcomings and contributions to misunderstandings in therapy. If you have a therapist who is open to examining the therapy relationship without casting blame on you or themselves, you have found a rare and GOOD one. Stick with it. The gains are worth it. Good luck!

  • Stephanie

    October 21st, 2019 at 2:02 PM

    Too many times therapists position themselves as not wanting any sort of feedback and discourage it esp if they are a PhD or md. In those cases it matters very little what the counseled has to say or how they feel about the interaction. Not everything can be interpreted as transference. Sometimes therapists are just plain prideful and insensitive and judgmental.

  • Max S.

    February 5th, 2017 at 6:39 AM

    Please learn how to spell, otherwise your inability to use the English language correctly, truly diminishes your credibility. If you’re going to go through the trouble of writing an article, make sure you know your grammar, and spell check. I’ve read other articles here, and have consistently found the same poor use of language. The word used her is effect, when in the correct word should be affect.

  • drop-out

    June 14th, 2017 at 8:52 AM

    actually, you’re wrong. affect or effect are both acceptable here depending on the exact usage the author was going for.
    affect means to change. effect means to bring about.
    Swift believes that more work is needed to determine specific nuances that [change] retention [rates].
    Swift believes that more work is needed to determine specific nuances that [bring about] retention.
    it is often toted that “effect” is a noun and “affect” is a verb when really both can be used as both. they just have different meanings. “affect” as a noun, for instance, is a very popular term used in psychology, as it means outwardly displaying feelings felt. someone with flat affect, such as someone with schizophrenia, will have limited facial expressions, speak in a monotone voice, and seem uninterested in everything.
    also, the word is “here” not “her.” ;-)

  • drop-out

    June 14th, 2017 at 8:42 AM

    i’ve dropped out of therapy… six times. i’m one of the ones that proves its burden economically (although, honestly, i feel that i’m the one burdened).
    my reasons range were: being triggered and feeling unable to respond to a social situation, objecting to certain key ideas behind different therapies, the therapist didn’t like me, i could not afford it, and i moved.
    i think this article’s fatal flaw is assuming that the reason people don’t come back is always related to a client-patient relationship (it’s not). but, i also think it attributes unidentified or targeted psychological issues as such as depression and anxiety, even though directly earlier swift says that people most likely to drop have personality and eating disorders.
    addressing depression or anxiety with people with personality and eating disorders (such as myself, ding ding ding) is not going to work. my major problems, my real reasons for being there, aren’t addressed; my wellbeing is boosted only through the session, if that, and then it’s back to square one the minute i left.
    that said, i’m done with behavioral therapy and on my way to try something new. let’s see how it goes.

  • Jeff

    May 16th, 2021 at 9:15 AM

    Dr. Scott Peck of A Road Less Traveled said the goal of therapy is t o find the core of our neurosis and, further on, to be able to talk about it without pain. Once we know why we are acting out, we can choose to not act that way.

  • Judy

    September 4th, 2021 at 4:11 PM

    I find it both hilarious and deeply sad how casually arrogant several of the therapists here are in so readily laying the blame for clients “bolting” on the clients’ own supposed unwillingness to face their issues. I’ve left therapy twice; once because the therapist was impossibly sexist, and again because the therapist scolded and shamed me for still being upset over a serious medical misdiagnosis and long subsequent diagnosis. She was clearly very annoyed and told me I needed to stop thinking about it. The real diagnosis was two months ago, after 8 years of mistreatment; it is a heart condition that killed my grandmother, and that I will be living with for the rest of my life.
    I am not interested in discussing either of these matters with the perpetrators, as I don’t really see the wonderful opportunities for growth claimed by one of the commenters. I just see a couple of bullies who used their power to put down someone who was in a vulnerable position. Leaving is the only response that allows me to recover my agency. If I stayed, I would always be inferior, never a partner in my care.

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