Why Do People Leave Therapy Prematurely?

woman in therapy is feeling uneasyPremature termination with people in therapy happens with both seasoned and newly licensed therapists. In a study that talked about the therapeutic relationship and psychotherapy outcome, it shows that 20 to 57 percent of people in therapy do not return after the initial session (Lambert). Another 37 to 45 percent only attend therapy a total of two times (Schwartz). Sometimes these people leave without warning, but sometimes they do give some signs they won’t be returning, even if they do not directly explain them. Some will contact the therapists by email, will leave phone messages, or simply will not show up for their appointments. These people may come back much later, or not all. Many will also find a new therapist when they want to resume their therapy work.

There can be many reasons for this. I have had some people and personal contacts share some of their reasons with me. Here are some common reasons I’ve heard:

The ‘Can of Worms’

People realize therapy opened a bigger “can of worms” than they were prepared to handle. They say hindsight vision is 20/20. I wrote in my previous article, Helpful Tips to Make Therapy Most Effective for You, that one of the things to keep in mind during therapy is what you want to achieve or gain in therapy. Sometimes we don’t always know, even when we are posed that question. We can identify that we are struggling in some area of our life, or we are in some pain either emotionally or mentally, and we want some relief. We find the therapist we have a good connection with, make the appointment, and go in for our sessions.

Sometimes, we never know what to expect. Some have really good results; others have light-bulb moments with increased insight. Some, however, are taken aback by the depth of therapy, and they realized they didn’t want to go further at that time. One particularly candid response I heard from someone in this position was, “it was just too hard and painful at the time, and I just didn’t want to see what else was there.”

Subconscious Resistance

I don’t often hear people in therapy say, “I don’t think I’m ready to continue with this issue.” Sometimes other reasons come up, which is known as resistance. Therapy can provide wonderful possibilities, benefits, and outcomes, but occasionally we still resist the experience. This may be because of fear of success, failure, feeling overwhelmed by truth, fear of the unknown, or simply overwhelming emotions.

Therapeutic Breach

Misunderstandings, miscommunications, and impasses can often happen between therapists and people in therapy during the treatment duration. In the study mentioned earlier, the top reason people dropped out of therapy after the initial session was dissatisfaction with the therapist, or the feeling that the therapist didn’t really “get” them. There can be both competent and unprofessional behaviors found in all professions, and this is holds true in the therapy world. Further, even with the best training and the heart to serve people, the best therapists are not omnipotent, nor will they be perfect in their approach.

Many interventions are chosen according to what the person in therapy presents. Some will make unintentional mistakes or misunderstand what people meant. Therapy is not like getting a medical exam. There is no therapeutic equivalent to getting blood drawn, waiting for it to be studied, then receiving a detailed evaluation and report. The journey of healing through therapy must be a collaborative effort to be effective. If or when a therapeutic breach happens, a person may choose to drop out prematurely, or avoid the elephant in the room—the elephant being that there’s something hindering your therapeutic growth; you can feel it’s there but you are not able to talk about it. Alternatively, the person in treatment and therapist could have a dialogue, which can offer the most constructive growth for both parties. Often, however, it’s difficult to initiate that dialogue.

Giving Feedback

Healing in therapy is not just about getting results and meeting goals; it is also about the process of the therapeutic relationship. It is about how things unfold as you are exploring issues with your therapist. Therefore, sometimes constructive feedback is needed from people in therapy to minimize impasses and misunderstandings. This proactive approach can itself be a reflection of significant growth. For example, let’s say this person has relational difficulties, such as discussing vulnerable feelings. This is a wonderful opportunity to practice giving constructive feedback, which the person can then apply to other relationships. A competent therapist will often be very receptive to constructive feedback at any time during the sessions.

Readiness for therapy often comes at a point where people experience greater pain and discomfort by remaining personally stagnant than by initiating small adjustments in life to feel better in the long run. While there is no exact time frame for those lasting changes to occur, that readiness provides that platform for real growth to occur. The key is consistency. Premature termination sometimes cuts that opportunity short, despite improvements thus far in therapy sessions. Therapy, no matter the duration, is not a pass-or-fail experience, but rather an opportunity for positive growth with the right therapist.

References:

  1. Lambert, M., J. & Barley, D., E. (2001). Research Summary on the therapeutic relationship and psychotherapy outcome. Psychotherapy, 38, 4, 357-361.
  2. Schwartz, Bernard, PhD and Flowers, John, PhD. (2010). How therapists fail: Why too many clients drop out of therapy prematurely. Impact Publishers.

© Copyright 2013 GoodTherapy.org. All rights reserved. Permission to publish granted by Gracie C. Lu, LCSW, therapist in Irvine, California

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • selena

    selena

    June 28th, 2013 at 4:01 AM

    I think that with leaving therapy early it is just like anything else. There are people who are afraid of doing the hard work that going to therapy and doing it right demands. I think that there are a lot of people who think that therapy will be a little cake walk, that you get to sit down and chat with someone and that’s that, everything is cured. I think that any of us who have done it ourselves though know that there is so much more to it than that. This is a lot of digging deep and soul searching required and if you aren’t ready to face those things that cause you pain then you aren’t ready for the commitment that therapy is going to require from you.

  • Gracie

    Gracie

    June 28th, 2013 at 11:29 AM

    Hi Selena,

    You are absolutely right about this. Some clients want their symptoms alleviated, but not know the cause to the symptoms. Felt a conviction to write this as a result. Lasting changes DO take effort on our parts.

  • Jacob M

    Jacob M

    June 29th, 2013 at 1:03 AM

    Have two friends who have been to therapists and their complaint is that they are not able to open up even if they want to.Maybe it makes them feel vulnerable,or maybe it is the fear of an unknown experience.But I think communicating these fears or doubts to the therapist would be a good thing.The therapist could then come back with a solution,and the therapy does not have to end.Hiccups will be there but that does not mean therapy should end.

  • Mary S

    Mary S

    July 5th, 2013 at 7:09 PM

    When I read this blog, I thought it strange that the author used the phrase “premature termination” when a client does not return after one or two sessions. I see the first couple of sessions with a therapist as a job interview, so that if a client does not return after one or two sessions, I would say that the therapist didn’t pass the job interview, rather than that the client terminated prematurely.

    To see if the terminology “premature termination” is used by others in this situation, I looked up the references given. The second one (Schwartz, Bernard and Flowers, John. (2010). How therapists fail: Why too many clients drop out of therapy prematurely) was easy to find on the web. That article does indeed use the phrase “premature termination” as the blog post does, but the article’s title suggests that the authors also see the phenomenon somewhat as I do (i.e., “the therapist flunked the job interview”).

    I definitely recommend the Schwartz and Flowers article to therapists who care about doing a good job – it goes much more in depth into the problem of improving therapist performance than this blog post does. It is an example of the kind of thing I would like to see on a website called Good Therapy. I also recommend the Schartz/Flowers article to therapy clients (or prospective clients), to help evaluate the quality of their therapist (or prospective therapist).

  • Gerald Voigt

    Gerald Voigt

    July 5th, 2013 at 7:16 PM

    Sometimes therapists just don’t listen. I spent 5 valuable hours telling my therapist that because I was physically threatened in her group therapy that I was not going back because she could not guarantee my safety and I wanted to return to one on one therapy with her. I finally had to tell her “You are the worst listener in the world” to make her understand that no means no.

  • Donna-1

    Donna-1

    July 7th, 2013 at 7:35 PM

    It is difficult for me to remember that my therapist is just as vulnerable and prone to error as I am. Yes, she is the professional and I am the nonprofessional. But sometimes I expect her to remember every word I have said and intuit every nuance of meaning behind my words…when in truth, I don’t remember everything I said, either. It has to be teamwork between two people, not me sitting at the feet of an all-knowing fountain of wisdom.

  • Kris Smith

    Kris Smith

    July 24th, 2013 at 1:43 AM

    I even do that to my therapist….but it is only when I feel no improvement deep in me after a couple of sessions done.

  • Me

    Me

    November 22nd, 2013 at 5:22 PM

    You expect improvement deep within you after a couple of sessions?

  • Sue

    Sue

    August 16th, 2013 at 2:37 PM

    Many therapists treat their clients like they’re inferiors, defectives or children. Therapy can label normal human characteristics as disorders or diseases. Therapy often dwells on shortcomings and injuries.

    Maybe some people leave– seeing this as a step backwards toward a happier life.

  • Maurice

    Maurice

    June 27th, 2015 at 5:02 PM

    The reason why people drop out of therapy was best summarized by the singe Morrissey who said “they just nod and doodle”.

  • Johanna

    Johanna

    July 15th, 2015 at 7:36 AM

    People drop out pre-maturely because they don’t get anything out of the first few sessions. I’ve been to several “initial consultations” and they’re all a waste of time. If I’m going to take time off from work to come and see you for an hour, I don’t want to spend all that time filling out paperwork. The first time should be a comprehensive example of what I can expect from the rest of the sessions – it should make a believer in your services, and worth my time and effort. And unfortunately, this just doesn’t happen.

  • Maurice

    Maurice

    January 9th, 2016 at 5:24 PM

    I dropped out of therapy because one way communication seemed pointless, meaningless, futile and absurd.

  • Braden B

    Braden B

    January 11th, 2017 at 7:13 AM

    I think it’s important to stick it out through a therapy. It might be hard at first, but it’s definitely worth it to stick to it. It’s important to see treatment through to the end!

  • anonymous

    anonymous

    January 23rd, 2017 at 3:55 PM

    I had the experience many years ago in therapy where the therapy relationship itself actually seemed to be making me worse. My therapist tried to frame this in about a million different ways that all essentially blamed me or highlighted deficiencies in me or told me things like “it gets worse before it gets better,” but ultimately, I think if I just talked to a friend or someone I already knew in a relationship that was based on mutual vulnerability and trust, I would have been better off in the long term. I do still think a lot about how my life could have been better without therapy, but I am learning to let go of that. The experience was very traumatic though.

  • Iga

    Iga

    March 27th, 2019 at 1:38 AM

    In my opinion, the psychotherapy drop out is a crucial issue for us as specialists. I have been studying this thema for couple years. I agree with the above comments, but I also try to figure out, what can be done by us, psychotherapist, to overcome some difficulties that can higher the drop out rate. I tried to work out, what information, what kind of care do the patients need in the first sessions to stay in therapy. Of course, people differ in needs and circumstances they are in, but I have worked out a method, that significantly lowered the drop out rate in my practice.

  • ElizabethCa

    ElizabethCa

    July 31st, 2019 at 5:11 AM

    I was one of the people who ended up dropping out, multiple times. In retrospect what was happening was I was misdiagnosed, and since the misdiagnosis stuck with me I was not receiving treatment that was appropriate to my condition. (Trauma diagnosed as GAD.)
    As a further issue, my attempts to indicate that I felt treatment was not addressing my issues were treated as resistance. The pathologization of my concerns created an environment where dialogue with the therapist about the treatment was not possible.

    I found that this lack of openness to dialogue or to reconsideration of approach was fairly consistent across multiple therapists. Since I had an incorrect diagnosis, I was repeatedly getting the same unhelpful treatment. However my dropping out after being unable to start genuine dialogue was typically treated as an inexplicable refusal of help, despite multiple attempts to bring up the problem.

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