Therapy Dropouts: What We Don’t Know, Why We Should
In the course of looking for research to back up my blind faith in psychotherapy, I came across all sorts of interesting this and that, not all of which put the field of psychotherapy in the best light.
For example, an article titled Negative Effects from Psychological Treatment: A Perspective addresses the fact that while positive effects of therapy have been thoroughly studied:
The study of negative effects—whether due to techniques, client variables, therapist variables, or some combination of these—has not been accorded the same degree of attention. Indeed, methodologies suitable for ascertaining positive effects often obscure negative effects in the absence of specific strategies for explicating these outcomes.
Hm. So, except for really glaring horrors, like children being smothered in “rebirthing” techniques and problematic techniques related to uncovering past sexual abuse, the field hasn’t really been paying attention to ways therapy can be harmful.
I was also intrigued by an article titled Early Withdrawal From Mental Health Treatment: Implications For Psychotherapy Practice
According to this 2008 literature review:
…obstacles to the delivery and success of treatments remain poorly understood, and effective methods to engage and retain clients in therapy are lacking.
While data is hard to pin down (studies are often based on differing ideas of how few sessions qualify as dropping out), the authors point out that attrition rates don’t appear to have changed in 50 years—about 50 percent of people drop out after three sessions, approximately 35 percent drop out after the first. And, the authors say, research indicates that for therapy to be effective, you need at least 11 to 13 sessions of “evidence-based interventions.”
Why are people starting but stopping? Of course, money and ease of access have something to do with it. So do attitudes towards mental health and how comfortable people are with personal disclosure. Sometimes it’s about simple things—in clinics, a nice waiting room and responsive staff can help. Some sort of orientation about what to expect of and in therapy can also help. (Hint: It’s nothing like sitting across from Dr. Phil and being bellowed at.)
It’s also about expectations: Clients often expect fewer sessions than therapists. They also may leave therapy when they feel better enough, whether or not they have reached clinical criteria for “better.”
Therapists often don’t correctly identify the reason clients withdraw from therapy if the reason is negative—and clients often don’t tell them.
Disturbingly, though, one study found that even when clients do provide feedback:
…therapists are frequently so confident in their own clinical judgment that even evidence to the contrary (via client-report feedback) is dismissed.
While dropping out of therapy early isn’t as bad as, say, not completing a course of antibiotics, it’s not something to shrug off. There are economic issues involved, especially in clinics, where no-shows not only waste staff resources, but also deprive other people who might have benefited from the appointment.
In addition, when therapy dropouts miss out on the full benefit of treatment, they may then go on to perpetuate the idea that therapy is not helpful.
I have “broken up” with a therapist who was not a good fit for me. I did it to her face, cautiously explaining my reasons. To my utter amazement, she thanked me for telling her. She said most people would just stop showing up.
I guess not every therapist would be so gracious. Another might have gotten defensive, or blown me off. But this article makes clear how important it is that clients let therapists know when they’re ready to give up and why–and that therapists pay attention. They may learn something they need to know.
Have you ever dropped out of therapy? Did you explain to your decision to your therapist?
Dembling, S. (2011). Therapy Dropouts: What We Don’t Know, Why We Should. Psych Central. Retrieved on April 26, 2015, from http://blogs.psychcentral.com/research/2011/therapy-dropouts-what-we-dont-know-why-we-should/