Studies show that 20-57% of individuals do not return to therapy after their initial appointment. There are various reasons for this, and for premature dropout rate in general. Sometimes dropping out of therapy is a reflection of the therapist, other times it is due to the individual receiving therapy, and sometimes it is a combination of factors from both parties.
Generally speaking, one is not eager to seek out a therapist and initiate the therapeutic process. Prior to engaging in therapy individuals are often in what is termed “contemplation stage;” a stage in which the individual is experiencing a variety of thoughts, feelings and emotions in relation to if they should or shouldn’t attend therapy. “Will this even help me?” “Is this worth my time and effort.” “I think I can just do it by myself or with help from my friends or family.” “I’m hopeless and helpless, what is talking to a therapist going to do?” These are some common thoughts people have prior to engaging in therapy.
Once an individual does finally take the big step to set up an appointment with a therapist and attend their first session, they have crossed over from the “contemplation stage” into the “action stage,” a stage in which the individual has made the decision and taken actionable steps to start their healing process. After attending their first session, or during any point of their therapeutic process, individuals can revert backwards. This is one reason why individuals drop out of therapy early. They may have gone back into contemplation stage and resumed negative thoughts about the helping process, or even “pre-contemplation stage,” a stage in which an individual is resistant to help or is in denial that they have a problem.
Another issue is that individuals often have unrealistic expectations and assumptions about therapy and the therapeutic process in general. Individuals often want a quick fix, and after attending their first therapy appointment they may have come to the realization that healing is a process that will take work. They may not be ready for the emotional pain, insight, or depth that is often required for healing. They may have thought they were ready, but after an initial therapy session they may have come to the realization that they’re not, resulting in premature dropout.
Another reason for premature dropout is the therapeutic relationship. The therapeutic relationship is the relationship between the mental health professional and the patient. This relationship is extremely important and is considered to be the most fundamental component of successful outcome in therapy by many experts. Therapists have varying therapeutic styles, and like people, have varying personalities. If the patient does not feel comfortable with the therapist for any reason, this may result in the individual not returning to therapy, or at least to that particular therapist. Therapy is a place where individuals must feel comfortable and have the ability to be vulnerable. If the patient feels they cannot be open with the person sitting across from then they may drop out and try to seek out another professional. Furthermore, the individual may find that they struggle with vulnerability in general, which is another reason people stop attending therapy all-together. Additionally, just like any other human relationship, it is important that the patient be able to relate to their therapist in some way, have good chemistry, and feel comfortable.
Another reason an individual may drop out of therapy is because they did not do their homework prior to engaging in therapy. Finding the right therapist is more of an art than a science. It is important to thoroughly review various therapist’s websites and reviews. Furthermore, most therapists will offer a free brief consultation or discovery call. These are generally 10 to 15-minute phone calls which will briefly give the therapist a chance to see if they can help you, and also a time for the individual to ask questions. Keep in mind that therapists are trained in different schools of thought, use different approaches, and specialize in different areas. Ask specific questions of your therapist during your consultation call to avoid a bad therapy session and a premature dropout. For example, ask if the therapist specializes in the issues you are seeking help with, what types of techniques they use, how long their patients typically stop seeking help and feel better, and other questions that you feel are important and might save you wasted time, money and effort. Also, keep in mind that therapists are just like any other humans with imperfections and biases. As such, finding a culturally competent professional is crucial to your process - especially if you are religious, a minority, secular, or LGBTQ.
Other common reasons people drop out of therapy early is due to cost or time. These are often excuses, as individuals often find money and time for other things that are not important and do not prioritize their mental health, despite it being the most important thing they have in addition to their physical health. Cost and time are often ways people try to rationalize their inability to attend therapy, but there are often underlying reasons that are much deeper.
It is absolutely critical that therapists be knowledgeable about the various reasons why one might drop out of therapy early. Mental health professionals can use this knowledge and try to mitigate drop out through continued growth as a clinician and as an individual, and through their own self-awareness and mindfulness. Furthermore, clinicians must follow ethical guidelines and ensure that they are only working with mental health disorders they are knowledgeable about, implementing interventions and techniques that are effective, and working with individuals they can truly help. Therapy should not be something that patients come to depend on, but rather should be a practice that affords patients with the skills, knowledge and tools to live a healthy, productive, and successful life on their own.
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