Do your clients leave early?
Everything seems to be going fine, but one day they don't show up.
You're sure there's more to do, more value to add, but it's time for their regular appointment and no one's knocking at the door.
Sometimes they call, sometimes they text, but often they disappear.
Another book goes unreturned.
Worse perhaps are the clients who drop in for one session. Satisfactorily unburdened, vague and uncommitted, they promise to give you a call.
Frustrating, isn't it?
Recent research shows that almost 20% of clients fail to complete psychotherapy treatment. And the number is even higher when you extend out to general counselling. Early termination is endemic in our industry.
And that's just sad because it doesn't do anyone any good.
Clients who leave therapy early have poorer outcomes than those who complete treatment.
Is there nothing we can do?
Based on strong empirical support, new research suggests eight practical strategies to at least reduce the chance of early termination.
Simple and effective. These strategies don't get taught in training programs. And they're often overlooked by seasoned practitioners too.
Clients often arrive with misconceptions about therapy. These include roles and responsibilities and the degree of commitment required. I once had a client who complained after 30 minutes that she wasn't better yet, and was feeling worse.
Yet if they remain confused about therapy, they are more likely to drop out.
Educate clients about acceptable therapy behaviour. Make it clear what you expect from them and what they can expect from you.
It's crucial to build collaboration with your clients. Share information about different types of treatment options. Turn them into an informed client and let them have their say; it helps them feel invested in the process.
Have you ever had excellent service at a bank, where you're given clearly explained investment options?
It's not about giving clients what they want. It's about helping them feel they have a voice. You still need to consider the best treatment options.
Clients need information on how long treatment is likely to take. Discuss a possible progress timeline with them. Doing so builds hope for the client. It gives them a goal to work to and promotes the expectation that eventually everything will be alright.
It also sets expectations. Some clients expect an easy fix and leave when that isn't forthcoming.
Managing expectations is key. And it's a natural habit to get. To help, I created a short checklist, which you can download here.
Forewarn clients that they might be tempted to leave. Explain that progress is never linear, and setbacks inevitable. Draw out a map of development, showing a bumpy line upwards. Use timeline examples from other clients.
If suitable, remind clients that sometimes things get worse before they get better. Also, tell clients that often there's a favourable bounce, but that doesn't mean the end.
Alcoholics and compulsive liars are particularly prone to the "I've changed, and everything's fine" rebound.
Clients who have hope are more committed. They are more likely to work through setbacks. They are more likely to stay the course, even if things aren't going well. "Hope is the Thing with Feathers", said Emily Dickinson.
Remind clients of your experience and that therapy is proven to work. Encourage a sense of optimism and present a clinical persona that inspires trust and confidence.
Is there any supervisor or teacher you particularly liked? What is it about them that inspired your faith?
Sometimes you have to be cruel to be kind. Well, just a little. Highlighting the difficulty and pain clients are in can strengthen their desire for change. It can help them talk about their need for change.
Elicit clients' reasons for wanting to move from the status quo and increase confidence in their ability to get there.
Also communicate to clients that they are not alone in their experience or their ambivalence about changing, help them understand that many people experience difficulty adjusting.
The alliance is important. Be kind, accepting and caring. Pay close attention to clients' needs and expectations; these might shift. Look carefully for signs that the client might not be happy with treatment and progress so far.
If ruptures occur, repair them as soon as is possible. Own up to mistakes if you've made them, clients appreciate honesty.
Above all, always be authentic. Clients know when you are lying and your reasons for doing so. They often know you better than you think.
It's essential to have a system of feedback in place. Processes can either be in-session discussion or through objective self-reports. Outcome rating scales and session rating scales can be particularly useful.
The earlier, the better. Studies show that therapists often aren't the best predictors of clients' progress.
When and how often to use are up to you. I deal with each on a case by case basis. If I forget, I usually regret it. Download standard outcome measures here.
The experience of premature termination is standard across the field. It's part of the job. But it can be demoralizing, especially when you've put a lot of effort into making something work.
And there's always a sense of not knowing.
Why did your clients leave? How exactly are they doing?
Yet clients are the ones in charge. We'll always have a sense we could have done more. It's the client's decision. You're just a tiny fraction of their life and week.
But there are still some things that are in our control. By following the eight strategies above, you can mitigate the chance of clients leaving.
Boosting your effectiveness and their well-being.
I'm a qualified mindfulness teacher pursuing my doctorate in counselling and psychotherapy. My goal is to blend mindfulness with therapy to help therapists expand their inner peace as they develop their practices.
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