Beyond the First Session: Therapy Retention
The rates of client dropout, arguably a stigmatizing term in and of itself, have been a topic of interest in the literature for over 50 years. Despite interest, there remains a lack of consensus on its definition and why clients discontinue therapy. Study results also vary in terms of dropout rates, with estimates ranging from 20 to 70 percent. In one qualitative literature review published by the American Psychological Association (APA), authors examined therapist, relationship, and process factors influencing dropout, and concluded a weighted dropout rate of 35% across 44 studies1.
Understanding why clients may stop therapy is crucial in developing strategies to improve retention and access to mental health care. In addition, addressing these barriers can also improve emotional consequences for therapists themselves.
Navigating client retention: Insights from APA 2024
This past August, MHS hosted an APA Exchange session that brought together clinicians and behavioral health professionals from various settings. We asked them to share their experiences with retaining clients and the barriers they had observed in practice.
In many cases, both novice and seasoned clinicians conveyed similar experiences. Clients and patients had a myriad of reasons for ending therapy. Some of those factors were external, including:
- Access to care
- Stigma
- Challenges with regards to personal resources, including money and time
Other factors were considered internal, including:
- Client/therapist fit
- Moving out of crisis
- Feelings of improved mental wellness
Participants concluded that successful therapeutic experiences are a matter of both choice and autonomy for the patient and, in some ways, for the clinician as well.
“Drop out” and “retention” in therapy are difficult to define, which leads to varying rates in studies. Some questions participants pondered included:
- What are the factors that signal a client has moved out of therapy?
- Are there trends in the data that show consistency?
- How do patient and therapist expectations for treatment impact the relationship?
Participants in the discussion expressed that the term “drop out” has negative connotations, suggesting failure on the client’s part, whereas “retention” is seen as more positive and empowering for both clients and clinicians. This shift in perspective encourages considering metrics like patient experience and clinician wellbeing to better understand and improve therapeutic outcomes.
Both independent practitioners and those in larger healthcare settings discussed strategies they have implemented to retain their patients. Emphasis was placed on approaches to the first meeting, such as connecting by phone first, providing a warm and comfortable setting, using remote administration for assessments, following up with additional communication, and implementing automated reminder systems for appointment times. Notably, most talked about setting unambiguous expectations for the clinician/patient relationship and guiding the patient into an active role in that conversation during their first meeting.
The professionals we spoke with expressed innate respect for their clients and the value of their participation. Several noted that workflow challenges, complicated intake processes, wait times, and administrative difficulties create additional barriers to care. Ideas intended to help clinicians establish closure, adjust to feedback, and practice self-care were also mentioned: mentorship, regular exercise, mindfulness, laughter, self-reflection, professional development, personal hobbies and boundary setting. Ultimately, the approach of both giving and receiving grace for yourselves and others rose to the top. As one participant articulated, practicing, after all, is not a final act but a practice, an ever-evolving journey of learning and growing for both the patient and the therapist.
Enhancing healthcare with assessment tools and technology
While the conversation did not focus on assessment, using assessment tools that support more accurate diagnosis can increase treatment success and satisfaction from that very first visit. At MHS, a leading developer of innovative assessments and solutions, we are committed to empowering individuals to reach their full potential and contribute positively to the world around us. We strive for fairness and equity in the development and deployment of the products we make, the solutions we provide, and the people we lead.
There are ways to make healthcare better for both patients and care teams. Using scientifically validated assessments, clinicians can make more accurate diagnoses, leading to better treatment outcomes and happier patients from the first visit. Technology can do more than just send appointment reminders; it can be integrated into the entire healthcare process, including patient intake, evaluation, communication, and quality monitoring. These practices are already common in other industries. MHS solutions can seamlessly incorporate trusted tools into existing digital health infrastructure driving the automation of diagnostic intelligence to reduce wait times, improve access and raise the quality of care quickly.
Learn more about our custom healthcare solutions.
Have questions? Get in touch with a member of our team.
References
1 Roos, J., & Werbart, A. (2013). Therapist and relationship factors influencing dropout from individual psychotherapy: A literature review. Psychotherapy Research, 23(4), 394–418.
