23 thoughts on “Therapy Dropouts: What We Don’t Know, Why We Should

  • May 20, 2011 at 5:13 pm

    The reason people drop out of therapy has to do with only one reason that comes in a myriad of disguises and that one thing is simply: the therapist.

    Whether it is a bad fit, a bad attitude, bad training, too much belief in good training, etc etc. what therapy doesn’t address, like the medical world, is that the bedside manner of a practitioner can make all the difference in the world to whether or not a client can receive the treatment needed.

    If you are scared of your therapist, judgmental of them, questioning of their training, or just don’t like them, one is told that it is the treatment, not the treator, that works effectively shutting down and/or denying clients’ concerned–even if unintended.

    It REALLY IS the other way around and no one in medical really seems to be able to wrap their heads around that because that calls into question their own talent, rather than the pieces of paper they traveled enough mazes and regurgitated enough facts to “earn”.

    You can be a talented surgeon without a bedside manner if you know enough to leave personal patient care to a talented house doctor. Therapy has no such safety net. And, unlike doctors, have a degree of salesmanship necessary to earning a living which requires an acquisition also not necessary in the biological field…which is why pharmacology has become such a monster. It is a symptom of psychotherapy denial.

  • May 20, 2011 at 8:29 pm

    It’s not the qualifications so much as the chemistry between two people that is the healing factor. Validation, warmth, empathy and innate insight can heal people. There has to be genuine connection. Connecting thought processes and illogical patterns to feelings and behaviours is important as well and sometimes an unempathic health professional can deliver the truth but it will be rejected because the patient thinks the psychiatrist delivering the message is a complete arsehole due to his arrogant narcissistic manner.

  • May 20, 2011 at 8:55 pm

    Therapy done right can be quite useful and I continue to recommend it. It can be hard to find. Therapists may bring their own baggage to the table. They may be too parental and unwilling to accept the person’s autonomy. They may be too busy or be burning out.

    Since you ask if we’ve left therapists, I left one of my first therapists when he insisted that I had not been molested because “women don’t molest.” If he had not insisted that he was correct, if he had been willing to say why do you think you were and how does that make you feel, I might have stayed. And, no, I didn’t tell him. I was too damaged at that point to speak up to authority. I just fled.

  • May 20, 2011 at 11:00 pm

    I think there is a terrible culture of silence and isolation surrounding the mental health care field that is perpetuated by many of its professionals. This perspective comes from a recent experience of going through the process of having someone escorted to a mental health facility by the police. It was a traumatic experience for all involved that was NOT eased by the mental health professionals at the facility. They made no attempt to communicate with the family about the status of the patient, their findings, the treatment, even though we were put of the release of medical information by the patient. The attending nurse practitioner went on vacation, and refused to sit down and discuss the patients case with the family because she was “busy”. I visited the patient 3 times before I was even given a list of protocol regarding patients and their visitors. In the final family meeting, the social worker scheduled it at her convenience without discussing it with the family, and then refused to move it to another floor to accommodate all members of the family. I realize this wasn’t “therapy”, but it definitely made me less trusting of mental health professionals in general, and I feel it was a definite reflection of the field.

  • May 21, 2011 at 1:15 am

    Since Vicki’s comment reminded me–so sorry Vicki had that experience…it’s such a fine line. Therapy can be so very rewarding and so very damaging at the same time.

    Yes, I ‘fired’ my first therapist (actually a white coated psychiatrist) in third grade. The parent chickens had been slipped a duck egg, and took the fact that their chick quacked as a bad sign.

    The man looked at me, talked about me over my head, and treated me like the science teacher treated the classroom hamsters. I told my parents if he couldn’t see me as a person, I wouldn’t see him; being sent anyway, I told him the same and he told my parents that he refused the case because I couldn’t be “helped”. Which was true but not how he meant it, nor how my parents took it.

    After several fits and starts, they eventually settled me down around 7th grade with a colleague’s wife (educational system), a locally respected psychologist, whom I didn’t trust one bit but couldn’t put my finger on why. She just didn’t look, act, react, smell right but the adults loved her. (If I ever met a textbook narcissist, she would be it.)

    So I refused to speak about anything but the weather, in session. Then I realized after a few months that she was still charging my parents even though I had explained to all concerned what I was doing and that I wasn’t going to play the game. According to my parents’ report, I was “making progress.”

    Then I started refusing to get out of the car. No tantrums; very matter of fact. After two sessions with her at the car window chatting pleasantly about the weather, the adults gave up.

    Years later she was exposed in quite a local scandal hurting many people professionally and personally although at the time I was blamed by all parties for stubbornly refusing help, and my parents worried about damaged professional contacts. They were right about one thing: I’m nothing if not stubborn.

    Since my parents insisted on outside help in raising me, I started hiring my own psychologists in 10th grade. The one I saw the longest and liked the most actually saw me for several weeks before realizing that my parents were not involved and although I paid my own way, he felt professionally he had to inform them of our sessions since I was underage. He was then surprised how nonchalant my parents were about it “as long as that crazy kid was seeing ‘someone'”.

    I mostly tilted at windmills and vented about emperors that had no clothes and he always said the only crazy thing about the teenage me was that peer pressure had little to no affect on me, and thank god for it–which was true and still is.

    It certainly helped me to avoid some of the usual teenage pitfalls but one of my college counselors thought the same was a major sign of maladjustment and anti-social behavior. That was the only one I was slightly dishonest with as I ended the sessions for the reason that I couldn’t afford both him and college…when the real reason was simply that I wasn’t sufficiently interested in seeing him to make a way to do so. I’ll occasionally stay a while with those who think I’m mental just to see what they have to say (and how they say it), but not that one.

    I have had several successful therapeutic relationships along all walks of the degree’d and certificated spectrum, both genders, religious and secular, long and short, begun and ended in mutually respectful ways and thoroughly open and honest on my part. Some have thought I was nuts-in-denial about letting my freak flag fly and some have felt badly about taking money from someone not needing help–one even told me “from someone more grounded than I am”.

    I’ve never used insurance to pay for therapy as, after my parents, I never wanted to have to defer to someone against my better judgment. But I don’t go around hiring only those that tell me what I want to hear either. I respect the process even if I judge it’s practitioners on a case-by-case basis.

    Why have I hired the same general counselor (a retired protestant reverend with formal, university level therapy training) for the last six years? Because I like him. And because session is my karma-free, Faraday cage…like the old “Get Smart” Cone of Silence, and he gets that.

    I can say what I like about whom I like without worrying about karma kicking me in my arse or permanently damaging anyone’s feelings–the whole confidentiality, confessor, thing. Besides, when one can speak without thinking one can poke a lot of fun and laugh at self in a whole different way. Sometimes a session is a running monologue and I leave HIM in tears…from laughing.

    I like him because he is not threatened by, and puts up with, my amateur social-psychology hobby that I’ve studied since 3rd grade (tip o’hat to Freud). I can understand how annoying it may be to be greeted with “hey, did you see the study that just came out in …” especially if you haven’t and don’t expect to. I have to hire someone with whom to talk shop ~grins~.

    My guy, I reckon at least, enjoys an hour of a different sort and a client that doesn’t necessarily expect to be fixed. I know I’m a slightly different type than his normal demographic and specialty and we hooked up quite by chance.

    I know for a fact that he uses my flexibility to help cater to more needy clients when necessary. I trust his judgment to help who needs help when, and he doesn’t take advantage. I don’t care a thing about the security of having “my” timeslot–and I made that clear to him after reading a Psyche Central (or maybe PsycheToday, can’t remember) article on the subject. I work with him; he works with me; it’s a lovely relationship.

    Oh, and I still mostly tilt windmills and rage about emperors that have no clothes.

  • May 21, 2011 at 9:48 am

    Thank you all for your interesting comments.

    As far as I can tell from personal experience, from talking to psychologists, from reading research, and from the comments here, nothing is more important than how you feel about your therapist and whether he or she passes “the smell test” as one psychologist I spoke to called it. The therapeutic relationship is paramount. If a therapist feels wrong to you, that person is wrong for you.

    As in any other field, there are lots of good, qualified, honest, empathetic, wise practitioners, and lots of idiots. The idiots don’t make the good ones any less good and vice versa.

  • May 21, 2011 at 3:35 pm

    Dear Bareheadedwoman,
    I have a son just like you, articulate, creative, sensitive and pure gold. His teachers did not “get” him, his peers did not “get” him, but I, his mother did and I nurtured every single quirk in him and told him he was different, special and would grow up to be someone who made a difference in this world. Currently as it stands he has spent last year volunteering for Riding for the Disabled and this year working at “Subway” in order to finance his trip to Thailand with World Challenge where he will work with others building roads, mud huts, teaching English and building community.

    All this as well as being a high achieving academic 15 year old student who just scored 100% in a chemistry exam. When he was 13 I got a phone call from his science teacher because he would not put pond water under the electron microscope because small creatures in it would die. I told the teacher I supported him in his values and ethics. When teachers and others said he was strange and different I told them he was gifted and simply felt over-responsible for the world and its problems.

    The world needs more people who are sensitive and different and the world need to accept that people who are different MAKE a difference.

  • May 21, 2011 at 9:14 pm

    I dropped out of therapy, but after three years! I wish I had been one of the ones smart enough to drop out after three sessions. Could have saved myself 10 to 15k of wasted money and further degradation of my already limited trust in humans. And yes, I told my therapist why. (Therapy wasn’t effective, wasn’t getting any help or improvement with the things I had gone in for which were and still are severely debilitating my life). Big mistake. He blew up at me, used all the secret things I’d told him about myself against me even though he promised he never would, called me names, and told me I wasn’t getting better because I didn’t want to. So long story short, I think therapy is a big waste of time, a sham, and am trying to keep from generalizing all therapists as akin to snake oil salesmen. I still reel from the experience which reeks of being used and abused, lied to and betrayed. I wish I had never gone, and most of all, I wish I could get a refund and use that ill-spent money on something more useful to try to help myself instead.

    P.S. Vicki, not sure if you’ll see this but I was told the same thing by an idiot psychiatrist. That he’d seen and heard worse things, and that since it wasn’t a man, it wasn’t that bad. If you try to tell a psychiatrist or therapist that a woman did bad and gross things to you, especially if it’s a relative, they don’t take you seriously. The only thing that kept me from thinking I’m totally crazy was finding out from my brother she did weird things to him too, but fortunately in his case they were hands off unlike my experiences. The so-called professionals will make you think you’re reacting over nothing. They don’t believe women or female relatives will do those sorts of things to kids… as if we don’t have enough trouble believing it ourselves.

  • May 22, 2011 at 12:46 pm

    The problem is that, if it’s your first time entering therapy, you don’t know what to expect. You don’t know about the relationship, what can go wrong, and maybe you’re not assertive anyway. I was required to sign a *LENGTHY* document when I started therapy, but it was designed less to educate me than to cover the therapist’s rear end. If I’d known what I was getting into, and the damage it would cause, I would have run out the door instead of staying for years.

  • May 22, 2011 at 11:54 pm

    I broke up with my therapist of two years when he had a meltdown and accused me of bullying him because I objected to a mean joke he made about me. He yelled that I didn’t know anything about him and stood over the couch where I was lying saying, “YOU aren’t so perfect!” He went on screaming for 15 minutes. Now he wants to have a termination session. No thanks!!!

  • May 25, 2011 at 5:02 pm

    I broke up with two therapists. The first one was after about a year. There were two issues that I had. She didn’t seem to have any understanding of office politics, which was something I was having trouble with. Second, I asked her where we were going and how much longer I would need to continue, and she said that it was up to me, and I said, well, then, I guess we’re done. I was expecting a discussion of my progress and goals, but I didn’t get that.

    The second time, with a different therapist, was after four sessions, and it was for a similar reason: I couldn’t figure out what the plan was. When I asked, I got a circular discussion, and I wasn’t sure what was going on or if she would be able to help me.

    I really don’t have the time and the money to spend on therapy without a plan. I’m left with no real understanding of how therapy is supposed to work or even if it works, despite having spent some time in it.

    • May 26, 2011 at 12:02 pm

      That’s very interesting AC. In the section “Implications and Recommendations for Practice” in the the Early Withdrawal paper I reference in this post, the authors write.

      “In fact, one might consider setting a specific time with the client for regular review of treatment goals and progress such that goals and the steps necessary to reach the goals can be renegotiated.”

  • May 27, 2011 at 12:48 pm

    Therapists, even when one has removed the monetary obstacles, tend to be LITERALLY unavailable. The number of practicing therapists who actually have a method of contact that they actually use regularly and effectively is near nil. And I live in a big city.

    I also second the idea that the problem is the therapists. Most of them are uneducated about anything that is not in a book and that is pretty useless when you’re dealing with someone else’s real life. On top of that, they tend to be pushy about their own perception, arrogant, and just generally untrustworthy as far as their opinion about the patient is concerned. And these are things you can sniff out pretty early- way before 11 sessions.I’ve even had one jump out of his skin when I told him information that was on the intake form he was still holding and had skimmed, it was so at odds with his assumptions about me, due to my appearance. For some people, a degree is the last thing to render them subjective, as well as the first thing to render them a psychologist.

    Now I know why smart people RUN from therapy…

  • May 27, 2011 at 12:58 pm

    whoops meant “objective”

  • June 8, 2011 at 2:25 am

    All the above comments are quite a revelation to me.I too am a counselor but i have never came across so much of ire against counselors. However it was very educating to know the other side of the story.If a therapist cannot connect or empathize with the patient then the whole point of a session is lost.

    • June 8, 2011 at 10:06 am

      I was surprised and saddened, too. The worst counselor I ever had was a bit clueless but not harmful and I felt no ill-will towards her. I just needed to break it off and find someone else.

      I think it is good information for professionals, I think, and seems to confirm what the research papers say–that the field is not adequately tuned in to the negative experiences people might have.

      Thanks for your comment.

  • June 28, 2011 at 5:47 pm

    I dropped out of therapy after about 6 months but in fact my motivation to go had been steadily declining for some time, and it was beginning to feel like being in detention at school. my therapist had initially insisted on taping records of sessions which i felt was unethical and put a stop to. He wanted to use them for a current course he was on (in a different city). I do think that therapy can be effective, but it relies upon a rare confluence of client/therapist compatibility and the client being in the ‘right place’.

  • June 28, 2011 at 5:56 pm

    (contd)i do think that the prejudices and attitudes of the therapist are very important and in the end rather than feeling supported by the therapist or having a great sense of relief when i saw him, the sense of relief came when I didn’t go that particular week for whatever spurious reason.

    Didn’t do it for me i’m afraid.

  • July 11, 2011 at 5:27 pm

    I have recently dropped two therapists after only a few months each. Both of them seemed astonishingly ignorant about things therapists should know about, including things that were issues for me. I can see having to explain things to your therapist if you have unusual issues, but mine were fairly common and I had picked these two for their supposed expertise in these areas. The first one was also a total downer – if I reported disappointment in not making a change she told me I should make “baby steps” then when I reported baby steps she told me it wasn’t nearly enough, things like that. If I told her about something difficult in my childhood she said “everybody has issues with their family.” Charming. I finally realized I was being belittled at every session.

    The second one kept talking about himself, and not in a “oh that happened to me too I understand” kind of way. My ah-ha moment was when I said something about my feelings on something and he replied “what does it say about me that I don’t feel that way?” uhhhh I don’t know, I’m not your therapist. I realized I wasn’t being helped because he just kept telling me how he was the opposite from me and couldn’t relate. Between his ignorance and his “enough about you I want to talk about me” interruptions I decided I’d be better off with no therapy at all.

    I don’t call that bad chemistry in either case. Both of these therapists have their own issues and they were letting them interfere with my therapy. Before these two I’d had excellent therapists in the past, so I know it wasn’t just me. I think they are both in the wrong profession.

  • June 7, 2012 at 1:10 am

    Smart-that’s my view of anyone who quits therapy in one to three sessions. He’s smart enough to reject the infantilizing, role play and subordination. He’s smart enough to realize that a few years of graduate school does not teach a counselor life wisdom. He’s smart enough to deduce he’s purchasing an empathy performance that’s as genuine as a plastic plant.

    I had to reread DC’s post to make sure I didn’t write it myself, particularly the part about the therapist’s vindictive fury upon leaving therapy. I departed poorer, not wiser, eventually realizing I too had bought the snake oil.

  • May 16, 2016 at 1:39 pm

    I was in therapy for 2 years and would not recommend it. Although I became more aware of my issues and tried to change, I just could not move forward. I found the process demoralising and expensive.

  • August 5, 2017 at 8:31 pm

    Okay, I’ve read a bunch of comments and now feel a bit demoralized…no, quite demoralized.

    ‘Cuz I’ve seen a number of therapists AND I’ve been a therapist. I’m a graduate student in Clinical Psychology, so that’s somewhat standard. And interestingly, we ARE taught a lot of what you guys object to – that in a sense, good therapeutic techniques cannot be directly taught. It is basically bedside manner.

    From the therapist’s side, I’m not sure how well I’ve developed a “therapeutic alliance” with any of my clients. And, I suspect, that even if I say and do all the right things, I may not ‘fit’ well with a client, and that should be okay.

    From the client’s side though, I’ve definitely had the therapist that seems ineffective, and worse. I had one that called me a ‘mental rapist,’ and a ‘jack—-.’ Arguably, these comments were purposeful, and designed to shock me into …something. I guess. I dunno. What bothers me is he was a seasoned veteran in psychotherapy…I figure stupid mistakes like that should be more common for students (training therapists) and beginning practitioners.

    I want to believe though that psychotherapy CAN be beneficial to those with mental health needs. Scientific evidence suggests it is! But as the author of this article points out (and the comments seem to suggest), it’s definitely not helpful in most client-therapist dyads.

    One last comment: while we are informed about the less trainable characteristics of a good therapist, I’m not sure how many nascent therapists are similarly informed, and I suspect the message is mitigated by the trend of “manualized treatment.” This is probably why many people have heard the response that they should trust the treatment, etc. It’s the downside of ‘science’; manualized treatments are easier to show scientifically as beneficial, and so they are recommended. It downplays the therapist’s role, and sometimes the client’s role. And interestingly, the trend is particularly american… so I’m curious how many responders are american?

    As to the author’s question about dropping a therapist…
    I suppose I’ve only actively dropped three therapists (of approximately eight). I don’t think I told one of them why, but I felt a responsibility as a psych student to do a termination session with the other two…the aforementioned ‘shocking’ therapist was more than willing to lose me as a client.

    I feel though that it’d be better for all involved if the system made shopping for therapists easier… It would have its own problems of course.

  • August 22, 2018 at 10:03 am

    I was a drop out in a clicnical psychoteraputical centre. I gave it my best, but my symptons only got (way) worse.
    They gave me a warning, but then they told me toch leave. At first they tried to commit me against my Will (i didn’t knew that at the time). Then i had to leave without help or a plan or anyting.

    They really hurt me with their therapy. It took me years to recover (i comitted 6 times). I can get zo angry if i read they don’t know a lot about the side effects of treatments. A girl in my group had a simular story. I met her at mental health care for chronical psychiatric problemen. A lot of people there have a simular experience with therapy (often group).
    Maybe people can search for answers about drop outs there. Often with wrong diagnosis (wrong therapy).
    With me they capt trying to give me therapy. And i thought they knew what was best for me. At one Day a psychiatris from the crisis departement told i was psychotic (not the first time). He told my parants they really had to stop treat me with all kinds of therapy. And than we said no to therapy. And i was getting better. Just looking at prarical stuff. After that i went and got my degree in orchanical chemistry. Something nobody had thought of anymore.
    Now unfortunaly my situatian is getting worse again. But the thing is, im terified as hell for psychiatrical help. The worst thing is that aren’t aware of the damage they can do.


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