Surreal illustration of a labyrinth symbolizing therapy with a path ending abruptly to represent therapy dropout.

Why Do Some People Quit Therapy Early? New Research Explores What Makes Treatment 'Stick'

Beau Callahan in Mind & Education August 2025 • 5 min read.

"Understanding the factors that lead to therapy dropouts can help improve mental health outcomes for everyone. Learn how initial distress, treatment length, and therapist support all play a role."

Psychotherapy offers a path to healing and growth, but not everyone who starts this journey sees it through to the end. The decision to discontinue therapy early, often referred to as 'dropout,' is a complex phenomenon that has long puzzled both therapists and researchers. Is it a sign of treatment failure? Or are there other factors at play, such as external barriers, symptom improvement, or a mismatch between client and therapeutic approach?

Approximately 20% of clients discontinue therapy prematurely, leading to a significant question in the field: Are psychotherapies with more dropouts less effective? A recent study by Catherine M. Reich and Jeffrey S. Berman delves into this issue, using meta-analytic techniques to explore the relationship between dropout rates and treatment outcomes. Their findings shed light on the characteristics of those who drop out, the impact of dropout on treatment effectiveness, and the factors that may contribute to early termination.

This article breaks down the key insights from Reich and Berman's research, offering a clear and accessible explanation of what drives individuals to discontinue therapy early and what these findings mean for anyone considering or currently undergoing psychotherapy.

Decoding the Dropout Dilemma: Key Findings

Surreal illustration of a labyrinth symbolizing therapy with a path ending abruptly to represent therapy dropout.

Reich and Berman's meta-analysis consisted of three main studies, each designed to answer a specific question about psychotherapy dropout. By synthesizing data from numerous existing studies, they were able to identify patterns and draw conclusions that would not be apparent from individual studies alone. Here's a closer look at their key findings:

Individuals who drop out often begin treatment more distressed: The research indicated that clients who discontinue therapy early tend to start with higher levels of symptom severity or emotional distress compared to those who complete their treatment plans. This suggests that the initial stages of therapy may be particularly challenging for those experiencing significant distress, potentially leading to early discouragement.

Here's a few reasons why some patients drop out of therapy early:

High initial distress levels.
Shorter treatment durations.
Lack of perceived benefit.
External barriers like finances or scheduling.

Treatments with higher dropout rates are often less effective for completers: This finding suggests that dropout isn't just a reflection of individual client characteristics, but also of the treatment itself. If a particular therapeutic approach consistently leads to high dropout rates, it may indicate that the treatment is not well-suited to the needs of the clients it serves. Factors such as the therapist-client relationship, the structure of the treatment, and the client's perception of progress can all play a role. It’s particularly important in shorter treatments, where premature termination can significantly impact overall outcomes.

What This Means for You: Taking Control of Your Therapy Journey

Reich and Berman's research highlights the complex interplay of factors that influence whether someone stays in or drops out of therapy. If you're considering or currently undergoing psychotherapy, here are a few key takeaways: 1) Acknowledge your initial distress. Starting therapy when you're in significant distress can be daunting. Be patient with yourself and communicate openly with your therapist about your challenges. 2) Find the right fit. Not all therapies are created equal. Explore different approaches and therapists to find someone who aligns with your needs and preferences. Don't be afraid to switch if something doesn't feel right. 3) Communicate openly with your therapist. The therapeutic relationship is a partnership. Share your concerns, ask questions, and provide feedback to help your therapist tailor the treatment to your specific needs. 4) Consider the length of treatment. If you're opting for a shorter course of therapy, be mindful of the potential for early termination to impact outcomes. Work with your therapist to set realistic goals and develop strategies for maintaining progress after therapy ends.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1080/10503307.2018.1534018, Alternate LINK

Title: Are Psychotherapies With More Dropouts Less Effective?

Subject: Clinical Psychology

Journal: Psychotherapy Research

Publisher: Informa UK Limited

Authors: Catherine M. Reich, Jeffrey S. Berman

Published: 2018-10-22

Everything You Need To Know

How does a person's initial mental state affect whether they're likely to drop out of therapy, according to Reich and Berman's research?

Research by Catherine M. Reich and Jeffrey S. Berman suggests that a client's initial level of emotional distress can significantly influence therapy dropout rates. Individuals who begin psychotherapy with high levels of symptom severity are more likely to discontinue treatment prematurely. This may be because the initial stages of therapy can be particularly challenging when someone is experiencing significant distress, potentially leading to discouragement. Addressing this requires therapists to be aware of a patient's initial distress levels.

What does Reich and Berman's work suggest about the relationship between therapy dropout rates and the overall effectiveness of a particular treatment?

According to Reich and Berman's research, treatments with higher dropout rates tend to be less effective for those who complete the therapy. This indicates that high dropout rates aren't solely due to individual client characteristics but also reflect the suitability of the therapeutic approach itself. A specific therapeutic approach may not be well-suited to the needs of the clients it serves, highlighting the need for flexibility in therapeutic interventions and treatment selection.

Based on Reich and Berman's research, what are some actionable steps individuals can take to ensure they get the most out of their therapy experience and reduce the likelihood of dropping out?

To take control of your therapy journey, you can acknowledge your initial distress by communicating openly with your therapist. Also, finding the right fit between a therapeutic approach and therapist will help. Ensure you share your concerns, ask questions, and provide feedback to help your therapist tailor the treatment to your specific needs. Consider the length of treatment as well and set realistic goals.

Besides what Reich and Berman found, how do practical issues like money or time affect people dropping out of therapy early?

External barriers, such as finances or scheduling conflicts, can lead to premature therapy termination. While Reich and Berman's research did not focus specifically on these external factors, they are important considerations. Clients may drop out of therapy due to an inability to afford treatment or difficulty in scheduling sessions that fit their lifestyle. Addressing these barriers could involve sliding scale fees, flexible scheduling options, or telehealth services to improve accessibility.

Why might the planned duration of a therapy program be a factor in whether someone completes it, according to the work of Reich and Berman?

Shorter treatment durations are linked to higher dropout rates. Reich and Berman's research highlights the importance of treatment length in psychotherapy outcomes. When therapy is cut short, the potential for positive change is limited. In shorter treatments, premature termination can significantly impact overall outcomes. The interaction between treatment duration and client outcomes suggests that therapists and clients should carefully consider the planned length of treatment.