Sometimes therapy does not work, and this is not avoidable, but for therapy to fail for something as simple (and preventable as drop-out) is an enormous lost opportunity. In large-scale effectiveness studies, it has been shown that around 30% of clients drop out before session 3.
The number of recommended sessions varies by condition and treatment type, however, the majority of psychotherapy clients report feeling better after 3 months; those with depression and anxiety experience significant improvement after short and longer time frames, 1-2 months & 3-4.
In psychotherapy we are also aware of the important fact that the amount of unwanted effects is very similar to fields such as pharmacotherapy, and the number of patients reporting unwanted effects of psychotherapy is between 3 and 15% of cases (Berk and Parker, 2009).
About 75 percent of people who enter psychotherapy show some benefit from it. Psychotherapy has been shown to improve emotions and behaviors and to be linked with positive changes in the brain and body. The benefits also include fewer sick days, less disability, fewer medical problems, and increased work satisfaction.
One study of mental health treatment patient retention found that approximately 35 percent of patients stopped their therapy after just one session, while approximately 50 percent of patients stopped their treatment by their third session.
Therapeutic Breach
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.
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.
The authors note some reasons why patients drop out: They are unwilling to open up about themselves; they cannot agree with the therapist about what the problem is; they just don't get along with or feel confidence in the therapist; they believe they are not improving quickly enough; they have unrealistic expectations.
There are potential risks to psychotherapy. People may initially feel worse as the therapy progresses. In rare cases, psychotherapy may even trigger some people to have thoughts about wanting to hurt themselves or end their lives.
Studies estimate that anywhere between 21 percent and 61 percent of mental health practitioners experience signs of burnout (Morse et al., 2012).
One study, by San Diego psychologist Amy Blume-Marcovici, PsyD, found 72 percent of the 568 U.S. psychologists, postdoctoral psychology fellows and psychology graduate students she surveyed had cried at least once while with a patient. Of these, 30 percent had cried within the past four weeks ( Psychotherapy , 2013).
Therapy can help successful people recognize that their net worth isn't tied to their self-worth. This can help them recognize that even if they fail, they'll still be okay. Treatment can also teach healthy ways to cope with anxiety and offer strategies for calming the constant self-doubt.
Ruth Wyatt, MA, LCSW: With therapy, there usually is no set length of treatment. Therapy can last anywhere from one session to several months or even years. It all depends on what you want and need.
You can always go back to therapy once you've “finished” — and it doesn't have to be with the same person as before. As humans, we grow and change through the years, and so do our needs.
Why therapists don't stay therapists when they wanted to stay therapists. Obstacles and lack of opportunities. The lack of quality of supervision or inadequate training for other elements of the job. The lack of research on therapist workforce issues.
This can occur for many reasons. For instance, the client may not be ready for the necessary changes, the gap between sessions is too long, or the therapist isn't pushing the client enough. Feeling stuck in therapy can happen for multiple reasons, including the structure of therapy.
Clients may initiate termination for a variety of reasons. These may include limitations in finances, feeling dissatisfied with the psychotherapist or with how treatment is proceeding, losing one's job, loss of or changes in their insurance coverage, or moving from the local area.
(a) Psychologists terminate therapy when it becomes reasonably clear that the client/patient no longer needs the service, is not likely to benefit, or is being harmed by continued service.
Habitually starts sessions late or ends early
If your therapist makes a habit of starting sessions late, this may mean they have too large of a caseload, or poor boundaries surrounding how many clients they can see in one day. The same goes for if your therapist is constantly ending sessions early.
Five to six patients a day is a pretty typical number of clients for a therapist in private practice to see. Keep in mind, you want to buffer one or two slots in the event of cancellations to actually see the number of clients you are aiming for.
Biweekly Sessions
Often you're only able to discuss one area or thing that happened to you. Therapy twice a week on the other hand allows you to go much deeper. We recommend this option for people who want to take the skills they've learned in therapy and apply them to their life in a more practical way.
The number of clients a full-time therapist sees in a week depends on the therapist and the number of hours you want to work per week. If you aim for a 40-hour workweek, you could see up to 30 clients per week and then spend 10 hours writing notes and doing other paperwork.